Re: Rescue and Hazmat in EMS

[Guest guest]

1) Austin/ County EMS, of course.

2) No comment.

-Wes Ogilvie

In a message dated 12/29/2008 5:13:00 P.M. Central Standard Time,

wegandy1938@... writes:

Query: What EMS services have their own rescue and hazmat units?

Query #2: Why?

Gene G.

In a message dated 12/29/08 3:50:21 PM, _xxxx911emtbxxxx@xxxx911em_

(mailto:xxxx911emtbxxxx@...) writes:

>

> You are correct sir. We still have 24 hour shifts at our " slow stations "

and

> most of our medics work a hybrid of a 24 and two 12s. The exceptions being

> our rescue and hazmat units.

> Sent from my Verizon Wireless BlackBerry

>

> Houston

>

> I didn't mean to sound like a smart-ass. You are right in that I am not

> sure of the actual cause. Sorry.

>

> BEB

>

> E. Bledsoe, DO, FACEP

>

> Clinical Professor of Emergency Medicine

>

> University of Nevada School of Medicine

>

> Department of Emergency Medicine

>

> University Medical Center of Southern Nevada

>

>

[Guest guest]

Worldwide.

GG

>

> Texas or other locals as well?

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/ FF/

> Typed by my fingers on my iPhone. Please excuse any typo's

> (Cell)

> LNMolino@...

>

>

>

> > Query: What EMS services have their own rescue and hazmat units?

> >

> > Query #2: Why?

> >

> > Gene G.

> > In a message dated 12/29/08 3:50:21 PM, xxxx911emtbxxxx@xxxx911em

> > writes:

> >

> >

> >>

> >> You are correct sir. We still have 24 hour shifts at our " slow

> >> stations " and

> >> most of our medics work a hybrid of a 24 and two 12s. The

> >> exceptions being

> >> our rescue and hazmat units.

> >> Sent from my Verizon Wireless BlackBerry

> >>

> >> Houston

> >>

> >> I didn't mean to sound like a smart-ass. You are right in that I am

> >> not

> >> sure of the actual cause. Sorry.

> >>

> >> BEB

> >>

> >> E. Bledsoe, DO, FACEP

> >>

> >> Clinical Professor of Emergency Medicine

> >>

> >> University of Nevada School of Medicine

> >>

> >> Department of Emergency Medicine

> >>

> >> University Medical Center of Southern Nevada

> >>

> >>

[Guest guest]

xxxx,

What about rescue and hazmat requires ALS capability by the folks operating

the tools and taking care of the spills?

G

>

> A/TCEMS has rescue and hazmat. The rescue is because the fire dept does not

> have ALS capable providers to respond to a rescue. Same thing with hazmat.

> Sent from my Verizon Wireless BlackBerry

>

> Houston

> >

> > I didn't mean to sound like a smart-ass. You are right in that I am not

> > sure of the actual cause. Sorry.

> >

> > BEB

> >

> > E. Bledsoe, DO, FACEP

> >

> > Clinical Professor of Emergency Medicine

> >

> > University of Nevada School of Medicine

> >

> > Department of Emergency Medicine

> >

> > University Medical Center of Southern Nevada

> >

> >

[Guest guest]

A/TCEMS has rescue and hazmat. The rescue is because the fire dept does not have

ALS capable providers to respond to a rescue. Same thing with hazmat.

Sent from my Verizon Wireless BlackBerry

Houston

>

> I didn't mean to sound like a smart-ass. You are right in that I am not

> sure of the actual cause. Sorry.

>

> BEB

>

> E. Bledsoe, DO, FACEP

>

> Clinical Professor of Emergency Medicine

>

> University of Nevada School of Medicine

>

> Department of Emergency Medicine

>

> University Medical Center of Southern Nevada

>

>

[Guest guest]

Texas or other locals as well?

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone. Please excuse any typo's

(Cell)

LNMolino@...

> Query: What EMS services have their own rescue and hazmat units?

>

> Query #2: Why?

>

> Gene G.

> In a message dated 12/29/08 3:50:21 PM, xxxx911emtbxxxx@...

> writes:

>

>

>>

>> You are correct sir. We still have 24 hour shifts at our " slow

>> stations " and

>> most of our medics work a hybrid of a 24 and two 12s. The

>> exceptions being

>> our rescue and hazmat units.

>> Sent from my Verizon Wireless BlackBerry

>>

>> Houston

>>

>> I didn't mean to sound like a smart-ass. You are right in that I am

>> not

>> sure of the actual cause. Sorry.

>>

>> BEB

>>

>> E. Bledsoe, DO, FACEP

>>

>> Clinical Professor of Emergency Medicine

>>

>> University of Nevada School of Medicine

>>

>> Department of Emergency Medicine

>>

>> University Medical Center of Southern Nevada

>>

>>

[Guest guest]

I can see Basic EMT as a requirement for rescue/hazmat folks, but ALS?

Sorry. Does not compute.

I can see rescue/hazmat when EMS is done by the fire service, because they're

the same service; I cannot see any advantage nor reason for a 3rd service

like Austin running rescue or hazmat trucks. It would seem to be economically

unwise from an equipment and staffing standpoint, plus it's not within the

mission of EMS as I see it. However, I see things differently from many

others.

GG

>

> Pittsbugh EMS plays a lead role in the County HAZMAT team. I think

> they also do rescue at some level. Several services in the east do

> both EMS and rescue and many are actually titled as Rescue Squad in

> thier names.

>

> As for why, that's often a mater of the historical evolution ofva

> given areas EMS system. In at least one east coast area there was a FD

> a third service EMS service and a seperate Rescue Squad that did

> nothing but rescue. We refered to them as a " fouth service " . They

> required EMT-Basic as a minimum level if EMS training.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/ FF/

> Typed by my fingers on my iPhone. Please excuse any typo's

> (Cell)

> LNMolino@...

>

>

>

> > Query: What EMS services have their own rescue and hazmat units?

> >

> > Query #2: Why?

> >

> > Gene G.

> > In a message dated 12/29/08 3:50:21 PM, xxxx911emtbxxxx@xxxx911em

> > writes:

> >

> >

> >>

> >> You are correct sir. We still have 24 hour shifts at our " slow

> >> stations " and

> >> most of our medics work a hybrid of a 24 and two 12s. The

> >> exceptions being

> >> our rescue and hazmat units.

> >> Sent from my Verizon Wireless BlackBerry

> >>

> >> Houston

> >>

> >> I didn't mean to sound like a smart-ass. You are right in that I am

> >> not

> >> sure of the actual cause. Sorry.

> >>

> >> BEB

> >>

> >> E. Bledsoe, DO, FACEP

> >>

> >> Clinical Professor of Emergency Medicine

> >>

> >> University of Nevada School of Medicine

> >>

> >> Department of Emergency Medicine

> >>

> >> University Medical Center of Southern Nevada

> >>

> >>

[Guest guest]

Sounds reasonable.

Now all we need to know is what kind of rescue operations routinely

require ALS skills.

I'm racking my brain here...

xxxx911emtbxxxx@... wrote:

>

> A/TCEMS has rescue and hazmat. The rescue is because the fire dept

> does not have ALS capable providers to respond to a rescue. Same thing

> with hazmat.

> Sent from my Verizon Wireless BlackBerry

>

> Houston

> >

> > I didn't mean to sound like a smart-ass. You are right in that I am not

> > sure of the actual cause. Sorry.

> >

> > BEB

> >

> > E. Bledsoe, DO, FACEP

> >

> > Clinical Professor of Emergency Medicine

> >

> > University of Nevada School of Medicine

> >

> > Department of Emergency Medicine

> >

> > University Medical Center of Southern Nevada

> >

> >

[Guest guest]

It's been a pleasure, Chuck. While we've disagreed at times, I'm proud to

know you and wish you all of the best success in your new responsibilities.

As EMS is often neglected in the emergency management arena, I do hope that

you'll remember us....

All the best,

-Wes Ogilvie, MPA, JD, LP

-Attorney/Licensed Paramedic

-Austin, Texas

In a message dated 12/30/2008 12:10:44 A.M. Central Standard Time,

ems@... writes:

--- In _texasems-l@yahoogrotexasem_ (mailto:texasems-l ) ,

wegandy1938@, wega

>

> I can see Basic EMT as a requirement for rescue/hazmat folks, but

ALS?

> Sorry. Does not compute.

If I may, It does compute. If a HAZMAT team is going to be a HAZMAT

Team, it must be prepared for all possibilites of treatment because

of exposure, not only to the public, but the team members as well.

For example, a team member goes down during decon, would a street

medic truly understand the possible secondary exposure of off gassing

while intubating or using a BVM in an enclosed unit or the needed

PPE? No, but a fellow team member would. Does everyone in an EMS

service understand the administration of the old and the newer

cyanide antidote kits? How about the expected ETCO2 and/or O2 sat

readings of patients exposed to CO, H2S or Cyanide? Unless there is

an initiative that is system wide to keep all ALS personnel up-to-

date, then it would be great to have those team members that train

constantly to be ALS so that the training has a two-fold effect. I

am currently assigned to HM 22 with HFD and we have current certified

paramedics assigned to the team, but we are not allowed to use our

skills or apply them in an emergency, even for our team members

should the situation arise. This is because we are not

credentialed. Granted, there is usually a unit available within the

response area, but not always an ALS medic. We have already had a

team member go down after an entry with an MI. Fortunately, he did

not need an AED. And that is good because they had pulled them off

the units because " we are not first responders. " We have since had

them returned, but it took an incident such as this to see the light.

I really think and believe that each and every HAZMAT team with techs

that make entry into the HOT zone, either have techs trained as

Paramedics or dedicated medics that train along side and are

dispatched as standard SOP.

>

> I can see rescue/hazmat when EMS is done by the fire service,

because they're

> the same service; I cannot see any advantage nor reason for a 3rd

service

> like Austin running rescue or hazmat trucks. It would seem to be

economically

> unwise from an equipment and staffing standpoint, plus it's not

within the

> mission of EMS as I see it. However, I see things differently

from many others.

If no one else is going to do it and the fire service refuses to,

then why not EMS. I live in a county where all the fire departments

refuse to address or train to respond to HAZMAT incidents. Do you

just ignore it?

On another note, beginning Jan 1, 2009, I will be handing over

command of Colorado County EMS to Patty . Patty will start her

director duties and continuing her EMS career from the field to

management. Patty helped start EMS in Colorado County when each of

the cities had emergency corps. She has been with other 9-1-1

services and I know she will be an asset and will continue to grow

the service. CCEMS has expanded over the last 4 years from part-time

shift pay personnel, to a growing full-time staff. With the county's

Emergency Management expanding and my HFD responsibilities, it was

time to have someone come in just to focus on EMS. I hope that you

will welcome her as you did me and assist her in any way possible.

I want to thank all of you that made my brief re-emergence back into

EMS easy and enjoyable. Wes, Gene and Jane, Thanks especially to you

for your legal and training assistance. I will still be around in

Emergency Management and will be doing the HAZMAT, WMD, CBRNE and

Communications planning training thing, if you need me. Oh, to Jack

Pitcock, I sure wished you had told me more while I was your partner

at Baytown. Thanks for answering your phone and emails. Your

guidance will very helpful. (Yes, I still bite my pens, but not in

the ER anymore)

My Best to all and Have a Great New Year.

Chuck

CCEMS

HFD HAZMAT 22

[Guest guest]

And why doesn't the fire department have ALS capable responders?? I seem to

recall something about EMS developing and controlling a " clearance process " in

this county....

-Wes Ogilvie, MPA, JD, LP

-Attorney/Licensed Paramedic

-Austin, Texas

Houston

> >

> > I didn't mean to sound like a smart-ass. You are right in that I am not

> > sure of the actual cause. Sorry.

> >

> > BEB

> >

> > E. Bledsoe, DO, FACEP

> >

> > Clinical Professor of Emergency Medicine

> >

> > University of Nevada School of Medicine

> >

> > Department of Emergency Medicine

> >

> > University Medical Center of Southern Nevada

> >

> >

[Guest guest]

Chuck,

I can understand what you're saying, but you go on to say that your unit is

not allowed to use its medical skills. Apparently your management does not

think that's necessary. So what's your point? Not trying to be difficult, I

just don't get it.

Everything you mentioned as involving medical skills can be done by basic

EMTs. In a hazmat situation, intubation should be limited to putting in a

supraglottic airway and getting the heck out of there. In all the cases you

mention except cyanide, ventilation is the needed intervention, and it doesn't

matter what the ventilator knows about H2S. (I'm referring to ventilators who

are

a part of the team and properly protected.).

You mention a team member that went down with an MI and you say that

fortunately he did not need an AED (and I'm very thankful for that), but let's

face

it: AED is not even a Basic EMT skill. It's a layperson skill.

So, sorry, I don't see the need for paramedics in hazmat/rescue.

I know, I'm terribly hard headed. That's what happens when you get old!

LOL.

Now, the place for hazmat/rescue is in the Fire Service, I believe, not in a

3rd service EMS. If, as you say, fire refuses to do it, then something's

wrong with fire. Something's wrong with the city/county or administrative

organization.. Fire the Fire Chief and get a hazmat team.

My best wishes to Patty in her new job, and best wishes to you as well.

What are your plans? You're not leaving us are you?

Gene

>

> --- In texasems-l@yahoogrotexasem, wegandy1938@, wegandy1

> >

> > I can see Basic EMT as a requirement for rescue/hazmat folks, but

> ALS?

> > Sorry. Does not compute.

>

> If I may, It does compute. If a HAZMAT team is going to be a HAZMAT

> Team, it must be prepared for all possibilites of treatment because

> of exposure, not only to the public, but the team members as well.

> For example, a team member goes down during decon, would a street

> medic truly understand the possible secondary exposure of off gassing

> while intubating or using a BVM in an enclosed unit or the needed

> PPE? No, but a fellow team member would. Does everyone in an EMS

> service understand the administration of the old and the newer

> cyanide antidote kits? How about the expected ETCO2 and/or O2 sat

> readings of patients exposed to CO, H2S or Cyanide? Unless there is

> an initiative that is system wide to keep all ALS personnel up-to-

> date, then it would be great to have those team members that train

> constantly to be ALS so that the training has a two-fold effect. I

> am currently assigned to HM 22 with HFD and we have current certified

> paramedics assigned to the team, but we are not allowed to use our

> skills or apply them in an emergency, even for our team members

> should the situation arise. This is because we are not

> credentialed. Granted, there is usually a unit available within the

> response area, but not always an ALS medic. We have already had a

> team member go down after an entry with an MI. Fortunately, he did

> not need an AED. And that is good because they had pulled them off

> the units because " we are not first responders. " We have since had

> them returned, but it took an incident such as this to see the light.

>

> I really think and believe that each and every HAZMAT team with techs

> that make entry into the HOT zone, either have techs trained as

> Paramedics or dedicated medics that train along side and are

> dispatched as standard SOP.

> >

> > I can see rescue/hazmat when EMS is done by the fire service,

> because they're

> > the same service; I cannot see any advantage nor reason for a 3rd

> service

> > like Austin running rescue or hazmat trucks. It would seem to be

> economically

> > unwise from an equipment and staffing standpoint, plus it's not

> within the

> > mission of EMS as I see it. However, I see things differently

> from many others.

>

> If no one else is going to do it and the fire service refuses to,

> then why not EMS. I live in a county where all the fire departments

> refuse to address or train to respond to HAZMAT incidents. Do you

> just ignore it?

>

> On another note, beginning Jan 1, 2009, I will be handing over

> command of Colorado County EMS to Patty . Patty will start her

> director duties and continuing her EMS career from the field to

> management. Patty helped start EMS in Colorado County when each of

> the cities had emergency corps. She has been with other 9-1-1

> services and I know she will be an asset and will continue to grow

> the service. CCEMS has expanded over the last 4 years from part-time

> shift pay personnel, to a growing full-time staff. With the county's

> Emergency Management expanding and my HFD responsibilities, it was

> time to have someone come in just to focus on EMS. I hope that you

> will welcome her as you did me and assist her in any way possible.

>

> I want to thank all of you that made my brief re-emergence back into

> EMS easy and enjoyable. Wes, Gene and Jane, Thanks especially to you

> for your legal and training assistance. I will still be around in

> Emergency Management and will be doing the HAZMAT, WMD, CBRNE and

> Communications planning training thing, if you need me. Oh, to Jack

> Pitcock, I sure wished you had told me more while I was your partner

> at Baytown. Thanks for answering your phone and emails. Your

> guidance will very helpful. (Yes, I still bite my pens, but not in

> the ER anymore)

>

> My Best to all and Have a Great New Year.

>

> Chuck

> CCEMS

> HFD HAZMAT 22

>

>

**************

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[Guest guest]

Followup question:

In the Hazmat environment especially and in almost any rescue environment,

how does one avoid contamination and infection in performing invasive

procedures such as advanced airway management and IV access?

With the recent rise in nosocomial infections, I'm finding it hard pressed

to justify invasive procedures in environments so prone to infection and/or

contamination. Most of us have a hard enough time maintaining an aseptic (not

even sterile) environment in our rigs...

-Wes Ogilvie, MPA, JD, LP

-Attorney/Licensed Paramedic

-Austin, Texas

In a message dated 12/30/2008 1:15:45 A.M. Central Standard Time,

wegandy1938@... writes:

Chuck,

I can understand what you're saying, but you go on to say that your unit is

not allowed to use its medical skills. Apparently your management does not

think that's necessary. So what's your point? Not trying to be difficult, I

just don't get it.

Everything you mentioned as involving medical skills can be done by basic

EMTs. In a hazmat situation, intubation should be limited to putting in a

supraglottic airway and getting the heck out of there. In all the cases you

mention except cyanide, ventilation is the needed intervention, and it

doesn't

matter what the ventilator knows about H2S. (I'm referring to ventilators

who are

a part of the team and properly protected.).

You mention a team member that went down with an MI and you say that

fortunately he did not need an AED (and I'm very thankful for that), but

let's face

it: AED is not even a Basic EMT skill. It's a layperson skill.

So, sorry, I don't see the need for paramedics in hazmat/rescue.

I know, I'm terribly hard headed. That's what happens when you get old!

LOL.

Now, the place for hazmat/rescue is in the Fire Service, I believe, not in a

3rd service EMS. If, as you say, fire refuses to do it, then something's

wrong with fire. Something's wrong with the city/county or administrative

organization.organization.<WBR>. Fire the Fire Chief and

My best wishes to Patty in her new job, and best wishes to you as well.

What are your plans? You're not leaving us are you?

Gene

In a message dated 12/29/08 11:10:41 PM, _ems@...@c_

(mailto:ems@...) writes:

>

> --- In texasems-l@yahoogro --- In texasems-l@yahoog --- In te

> >

> > I can see Basic EMT as a requirement for rescue/hazmat folks, but

> ALS?

> > Sorry. Does not compute.

>

> If I may, It does compute. If a HAZMAT team is going to be a HAZMAT

> Team, it must be prepared for all possibilites of treatment because

> of exposure, not only to the public, but the team members as well.

> For example, a team member goes down during decon, would a street

> medic truly understand the possible secondary exposure of off gassing

> while intubating or using a BVM in an enclosed unit or the needed

> PPE? No, but a fellow team member would. Does everyone in an EMS

> service understand the administration of the old and the newer

> cyanide antidote kits? How about the expected ETCO2 and/or O2 sat

> readings of patients exposed to CO, H2S or Cyanide? Unless there is

> an initiative that is system wide to keep all ALS personnel up-to-

> date, then it would be great to have those team members that train

> constantly to be ALS so that the training has a two-fold effect. I

> am currently assigned to HM 22 with HFD and we have current certified

> paramedics assigned to the team, but we are not allowed to use our

> skills or apply them in an emergency, even for our team members

> should the situation arise. This is because we are not

> credentialed. Granted, there is usually a unit available within the

> response area, but not always an ALS medic. We have already had a

> team member go down after an entry with an MI. Fortunately, he did

> not need an AED. And that is good because they had pulled them off

> the units because " we are not first responders. " We have since had

> them returned, but it took an incident such as this to see the light.

>

> I really think and believe that each and every HAZMAT team with techs

> that make entry into the HOT zone, either have techs trained as

> Paramedics or dedicated medics that train along side and are

> dispatched as standard SOP.

> >

> > I can see rescue/hazmat when EMS is done by the fire service,

> because they're

> > the same service; I cannot see any advantage nor reason for a 3rd

> service

> > like Austin running rescue or hazmat trucks. It would seem to be

> economically

> > unwise from an equipment and staffing standpoint, plus it's not

> within the

> > mission of EMS as I see it. However, I see things differently

> from many others.

>

> If no one else is going to do it and the fire service refuses to,

> then why not EMS. I live in a county where all the fire departments

> refuse to address or train to respond to HAZMAT incidents. Do you

> just ignore it?

>

> On another note, beginning Jan 1, 2009, I will be handing over

> command of Colorado County EMS to Patty . Patty will start her

> director duties and continuing her EMS career from the field to

> management. Patty helped start EMS in Colorado County when each of

> the cities had emergency corps. She has been with other 9-1-1

> services and I know she will be an asset and will continue to grow

> the service. CCEMS has expanded over the last 4 years from part-time

> shift pay personnel, to a growing full-time staff. With the county's

> Emergency Management expanding and my HFD responsibilities, it was

> time to have someone come in just to focus on EMS. I hope that you

> will welcome her as you did me and assist her in any way possible.

>

> I want to thank all of you that made my brief re-emergence back into

> EMS easy and enjoyable. Wes, Gene and Jane, Thanks especially to you

> for your legal and training assistance. I will still be around in

> Emergency Management and will be doing the HAZMAT, WMD, CBRNE and

> Communications planning training thing, if you need me. Oh, to Jack

> Pitcock, I sure wished you had told me more while I was your partner

> at Baytown. Thanks for answering your phone and emails. Your

> guidance will very helpful. (Yes, I still bite my pens, but not in

> the ER anymore)

>

> My Best to all and Have a Great New Year.

>

> Chuck

> CCEMS

> HFD HAZMAT 22

>

>

**************

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[Guest guest]

Pittsbugh EMS plays a lead role in the County HAZMAT team. I think

they also do rescue at some level. Several services in the east do

both EMS and rescue and many are actually titled as Rescue Squad in

thier names.

As for why, that's often a mater of the historical evolution ofva

given areas EMS system. In at least one east coast area there was a FD

a third service EMS service and a seperate Rescue Squad that did

nothing but rescue. We refered to them as a " fouth service " . They

required EMT-Basic as a minimum level if EMS training.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone. Please excuse any typo's

(Cell)

LNMolino@...

> Query: What EMS services have their own rescue and hazmat units?

>

> Query #2: Why?

>

> Gene G.

> In a message dated 12/29/08 3:50:21 PM, xxxx911emtbxxxx@...

> writes:

>

>

>>

>> You are correct sir. We still have 24 hour shifts at our " slow

>> stations " and

>> most of our medics work a hybrid of a 24 and two 12s. The

>> exceptions being

>> our rescue and hazmat units.

>> Sent from my Verizon Wireless BlackBerry

>>

>> Houston

>>

>> I didn't mean to sound like a smart-ass. You are right in that I am

>> not

>> sure of the actual cause. Sorry.

>>

>> BEB

>>

>> E. Bledsoe, DO, FACEP

>>

>> Clinical Professor of Emergency Medicine

>>

>> University of Nevada School of Medicine

>>

>> Department of Emergency Medicine

>>

>> University Medical Center of Southern Nevada

>>

>>

[Guest guest]

>

> I can see Basic EMT as a requirement for rescue/hazmat folks, but

ALS?

> Sorry. Does not compute.

If I may, It does compute. If a HAZMAT team is going to be a HAZMAT

Team, it must be prepared for all possibilites of treatment because

of exposure, not only to the public, but the team members as well.

For example, a team member goes down during decon, would a street

medic truly understand the possible secondary exposure of off gassing

while intubating or using a BVM in an enclosed unit or the needed

PPE? No, but a fellow team member would. Does everyone in an EMS

service understand the administration of the old and the newer

cyanide antidote kits? How about the expected ETCO2 and/or O2 sat

readings of patients exposed to CO, H2S or Cyanide? Unless there is

an initiative that is system wide to keep all ALS personnel up-to-

date, then it would be great to have those team members that train

constantly to be ALS so that the training has a two-fold effect. I

am currently assigned to HM 22 with HFD and we have current certified

paramedics assigned to the team, but we are not allowed to use our

skills or apply them in an emergency, even for our team members

should the situation arise. This is because we are not

credentialed. Granted, there is usually a unit available within the

response area, but not always an ALS medic. We have already had a

team member go down after an entry with an MI. Fortunately, he did

not need an AED. And that is good because they had pulled them off

the units because " we are not first responders. " We have since had

them returned, but it took an incident such as this to see the light.

I really think and believe that each and every HAZMAT team with techs

that make entry into the HOT zone, either have techs trained as

Paramedics or dedicated medics that train along side and are

dispatched as standard SOP.

>

> I can see rescue/hazmat when EMS is done by the fire service,

because they're

> the same service; I cannot see any advantage nor reason for a 3rd

service

> like Austin running rescue or hazmat trucks. It would seem to be

economically

> unwise from an equipment and staffing standpoint, plus it's not

within the

> mission of EMS as I see it. However, I see things differently

from many others.

If no one else is going to do it and the fire service refuses to,

then why not EMS. I live in a county where all the fire departments

refuse to address or train to respond to HAZMAT incidents. Do you

just ignore it?

On another note, beginning Jan 1, 2009, I will be handing over

command of Colorado County EMS to Patty . Patty will start her

director duties and continuing her EMS career from the field to

management. Patty helped start EMS in Colorado County when each of

the cities had emergency corps. She has been with other 9-1-1

services and I know she will be an asset and will continue to grow

the service. CCEMS has expanded over the last 4 years from part-time

shift pay personnel, to a growing full-time staff. With the county's

Emergency Management expanding and my HFD responsibilities, it was

time to have someone come in just to focus on EMS. I hope that you

will welcome her as you did me and assist her in any way possible.

I want to thank all of you that made my brief re-emergence back into

EMS easy and enjoyable. Wes, Gene and Jane, Thanks especially to you

for your legal and training assistance. I will still be around in

Emergency Management and will be doing the HAZMAT, WMD, CBRNE and

Communications planning training thing, if you need me. Oh, to Jack

Pitcock, I sure wished you had told me more while I was your partner

at Baytown. Thanks for answering your phone and emails. Your

guidance will very helpful. (Yes, I still bite my pens, but not in

the ER anymore)

My Best to all and Have a Great New Year.

Chuck

CCEMS

HFD HAZMAT 22

[Guest guest]

>

> Followup question:

>

> In the Hazmat environment especially and in almost any rescue

environment,

> how does one avoid contamination and infection in performing

invasive

> procedures such as advanced airway management and IV access?

>

> With the recent rise in nosocomial infections, I'm finding it hard

pressed

> to justify invasive procedures in environments so prone to

infection and/or

> contamination. Most of us have a hard enough time maintaining an

aseptic (not

> even sterile) environment in our rigs...

>

> -Wes Ogilvie, MPA, JD, LP

> -Attorney/Licensed Paramedic

> -Austin, Texas

>

Wes,

When it comes to treatment from a HAZMAT/WMD exposure, the emphasis

is to sustain life and counteract or neutralize the agent, while at

the same time, not to cause further secondary spread or contamination

from the chemical/agent. When I refer to contamination, I am

refering to the chemical and/or agent and not the standard reference

used for specifically EMS related topics.

In this application as related to the contamination question for the

patient, one could say that there is no greater harm than the harm

caused by death. Which is the greater harm? More discussion and

debate.

Chuck

[Guest guest]

Life over limb. If they survive another day to recuperate from an infection,

then at least they have another day. Just my thought.

Re: Rescue and Hazmat in EMS

>

> Followup question:

>

> In the Hazmat environment especially and in almost any rescue

environment,

> how does one avoid contamination and infection in performing

invasive

> procedures such as advanced airway management and IV access?

>

> With the recent rise in nosocomial infections, I'm finding it hard

pressed

> to justify invasive procedures in environments so prone to

infection and/or

> contamination. Most of us have a hard enough time maintaining an

aseptic (not

> even sterile) environment in our rigs...

>

> -Wes Ogilvie, MPA, JD, LP

> -Attorney/Licensed Paramedic

> -Austin, Texas

>

Wes,

When it comes to treatment from a HAZMAT/WMD exposure, the emphasis

is to sustain life and counteract or neutralize the agent, while at

the same time, not to cause further secondary spread or contamination

from the chemical/agent. When I refer to contamination, I am

refering to the chemical and/or agent and not the standard reference

used for specifically EMS related topics.

In this application as related to the contamination question for the

patient, one could say that there is no greater harm than the harm

caused by death. Which is the greater harm? More discussion and

debate.

Chuck

[Guest guest]

The question then becomes how many times will an invasive ALS procedure in a

high-risk environment (rescue or hazmat) be the difference between life and

death?

-Wes

Re: Rescue and Hazmat in EMS

>

> Followup question:

>

> In the Hazmat environment especially and in almost any rescue

environment,

> how does one avoid contamination and infection in performing

invasive

> procedures such as advanced airway management and IV access?

>

> With the recent rise in nosocomial infections, I'm finding it hard

pressed

> to justify invasive procedures in environments so prone to

infection and/or

> contamination. Most of us have a hard enough time maintaining an

aseptic (not

> even sterile) environment in our rigs...

>

> -Wes Ogilvie, MPA, JD, LP

> -Attorney/Licensed Paramedic

> -Austin, Texas

>

Wes,

When it comes to treatment from a HAZMAT/WMD exposure, the emphasis

is to sustain life and counteract or neutralize the agent, while at

the same time, not to cause further secondary spread or contamination

from the chemical/agent. When I refer to contamination, I am

refering to the chemical and/or agent and not the standard reference

used for specifically EMS related topics.

In this application as related to the contamination question for the

patient, one could say that there is no greater harm than the harm

caused by death. Which is the greater harm? More discussion and

debate.

Chuck

[Guest guest]

>

> Chuck,

>

> I can understand what you're saying, but you go on to say that your

unit is

> not allowed to use its medical skills. Apparently your management

does not

> think that's necessary. So what's your point? Not trying to be

difficult, I

> just don't get it.

In relation to management, it is the opinion of the Medical Diretor

that he cannot monitor or confirm our skills. Basically, since we

are not assigned to EMS, we cannot be paramedics under his license.

Everyone else see us as seasoned paramedics, except him. I have

spoken with Captians, District Chiefs and others that know we are

paramedics and they ask why we cannot perform patient care. When we

respond, they shake thier heads and walk off. So, it is not a

management issue as it is a Doc issue. In total, we have over 100

years of paramedic experience on the team spread over 4 shifts. It

will bite us one day.

>

> Everything you mentioned as involving medical skills can be done by

basic

> EMTs. In a hazmat situation, intubation should be limited to

putting in a

> supraglottic airway and getting the heck out of there. In all the

cases you

> mention except cyanide, ventilation is the needed intervention, and

it doesn't

> matter what the ventilator knows about H2S. (I'm referring to

ventilators who are

> a part of the team and properly protected.).

While I agree on the simple airway part, getting the heck out of

there is not always the best measure. Has the pt. been decon'ed,

does the medic understand the difference between the expected affects

of the chemical and underlying medical conditions precipitated by the

event, does the medic understand how to protect his/her self from

seconday contamination, does the medic understand routes of

transmission/exposure, does the medic understand and apply the

correct PPE when dealing with the exposed patient, and what about the

clothes, sheets and other items that have come in contact with the

patient that hare now possibly hazardous waste?

While most successful treatment is based on initial BLS, the

understanding of the chemical, communication with ER staff that may

have a basic understanding of HAZMAT and the issues of decon as to

not place addtional personnel, equipment and ERs out of service can

play an important part. Paramedics have that base chemistry/biology

understanding. Should a paramedics be a requirement? No, but they

would add to the overall effectives of the team's mission.

>

> You mention a team member that went down with an MI and you say

that

> fortunately he did not need an AED (and I'm very thankful for

that), but let's face

> it: AED is not even a Basic EMT skill. It's a layperson skill.

I gave this example as a need for medics, not to specify the need for

different levels.

>

> So, sorry, I don't see the need for paramedics in hazmat/rescue.

>

> I know, I'm terribly hard headed. That's what happens when you

get old!

> LOL.

LOL

> Now, the place for hazmat/rescue is in the Fire Service, I believe,

not in a

> 3rd service EMS. If, as you say, fire refuses to do it, then

something's

> wrong with fire. Something's wrong with the city/county or

administrative

> organization.. Fire the Fire Chief and get a hazmat team.

Sorry, I wished it was that easy, but when all the departments are

volunteer, there is no recourse other than a sales job. I started as

a volunteer in High School and I do not understand thier position. I

do wish the SFFMA and the Texas Fire Commission would set a common

standard and commit to it.

>

> My best wishes to Patty in her new job, and best wishes to you as

well.

> What are your plans? You're not leaving us are you?

>

> Gene

>

[Guest guest]

When you say " Rescue Unit " and " Hazmat Unit " , do you mean units that do

absolutely nothing but those disciplines? I don't know of any, and if there

are, I would recommend that somebody put some effort toward prevention.

As has been mentioned, Austin/ Co EMS has rescue medics and hazmat medics.

These units perform the full range of EMS duties, in addition to the Special

Operations duties. Here's my take, from the perspective of a former Austin EMS

employee who is now an Austin Fire Department HazMat Technician Instructor:

At least in Austin, the HazMat Medics don't function as part of the medical

treatment function, they support the hazmat entrants. Their specific functions

include performing Federally mandated pre-entry physical assessments, which can

admittedly be done by any semi-competent EMT.

In Austin, however, the HM medics go through the same hazardous materials

technician course that every other member of the hazmat team in the region (it's

a regional curriculum here) goes through, including getting dressed up in all

the fancy shmancy plastic suits that proably didn't get thoroughly cleaned from

the last student who sweated off 10 pounds in it. This brief taste of Level A

entry, at least in theory, gives the medic the understanding of what the entrant

(by definition, a non-EMS employed Firefighter in all four teams in the Austin

region) is going to be subjected to in the hot zone.

Additionally, ATCEMS HM Medics are available to translate medical information

for AFD - which is admittedly not as high-speed in the medical arena as ATCEMS

is. My understanding is that these medics complete a specialized Hazardous

Materials Medic course, focusing on toxicology and hazardous materials

treatments, in addition to the HM Technician course.

When a HazMat Operations officer hears " I don't recommend this guy for entry " ,

it helps that the person withholding the recommendation has been there and done

that, even if it's only in a class. Additionally, since we see the same medics

every time, the familiarity with how our incidents run is priceless. They know

when to stay out of the way, when to get in the way, and what to do when they're

there.

As far as Rescue medics, the idea is to take the care to the patient to the

extent possible. It's a lot easier and cheaper to train and equip a practicing

Paramedic to function in the rescue arena than it is to train a rescue-trained

Firefighter to be a proficient Paramedic. Generally speaking, while ATCEMS

Rescue medics are pretty good at the rescue thing, they're even better at the

ALS thing. In Austin (I can't speak for Co), the Fire Department doesn't

provide ALS services because the cost of training and maintaining proficiency is

too high, considering the very low incidence of use for those skills and the

fact that ATCEMS has done an exemplary job of putting ambulances where they need

to be for a rapid response almost everywhere in the City. I honestly don't

remember the last time I was on scene longer than 5 minutes before the Medic

unit arrived.

Can ALS care be provided at the end of a rope on a cliff? Certainly - it's been

proven. Whether it can be provided in a swift water scenario is, admittedly,

highly unlikely.

The history of rescue medics in A/TCEMS (Austin EMS back then) includes an era

when there were no fully staffed fire departments in Co. The politics at

the time (both in the County and the City) prevented Austin FD's Technical

Rescue Team or Water Rescue Team from responding into the county except on very

infrequent occasions, and then only after following specific procedures.

Consequently, if an incident occurred that required technical rescue or swift

water rescue expertise, there was nobody else to do it except Austin EMS.

I do not know the capabilities of the Co. fire departments, except that

they are certainly substantially more capable in all disciplines than they were

even 10 years ago. Some of the County departments have ALS-credentialed

Firefighters with all the supplies and equipment to provide the full range of

ALS care, and highly trained and equipped for rope and water rescues. Other

County departments are strictly BLS First Responders with no technical rescue or

water rescue capabilities. Regardless, everybody rides to the hospital in an

ATCEMS ambulance.

Phil Reynolds Jr.

115 Harold Dr.

Burnet, TX., 78611

HP

CP

[Guest guest]

Idiot me fogot the a former employer of mine UMDNJ runs a dedicated

rescue with HAZMAT capability in Newark. So does the Newark FD and the

run HAZMAT as well.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone. Please excuse any typo's

(Cell)

LNMolino@...

> When you say " Rescue Unit " and " Hazmat Unit " , do you mean units that

> do absolutely nothing but those disciplines? I don't know of any,

> and if there are, I would recommend that somebody put some effort

> toward prevention.

>

> As has been mentioned, Austin/ Co EMS has rescue medics and

> hazmat medics. These units perform the full range of EMS duties, in

> addition to the Special Operations duties. Here's my take, from the

> perspective of a former Austin EMS employee who is now an Austin

> Fire Department HazMat Technician Instructor:

>

> At least in Austin, the HazMat Medics don't function as part of the

> medical treatment function, they support the hazmat entrants. Their

> specific functions include performing Federally mandated pre-entry

> physical assessments, which can admittedly be done by any semi-

> competent EMT.

>

> In Austin, however, the HM medics go through the same hazardous

> materials technician course that every other member of the hazmat

> team in the region (it's a regional curriculum here) goes through,

> including getting dressed up in all the fancy shmancy plastic suits

> that proably didn't get thoroughly cleaned from the last student who

> sweated off 10 pounds in it. This brief taste of Level A entry, at

> least in theory, gives the medic the understanding of what the

> entrant (by definition, a non-EMS employed Firefighter in all four

> teams in the Austin region) is going to be subjected to in the hot

> zone.

>

> Additionally, ATCEMS HM Medics are available to translate medical

> information for AFD - which is admittedly not as high-speed in the

> medical arena as ATCEMS is. My understanding is that these medics

> complete a specialized Hazardous Materials Medic course, focusing on

> toxicology and hazardous materials treatments, in addition to the HM

> Technician course.

>

> When a HazMat Operations officer hears " I don't recommend this guy

> for entry " , it helps that the person withholding the recommendation

> has been there and done that, even if it's only in a class.

> Additionally, since we see the same medics every time, the

> familiarity with how our incidents run is priceless. They know when

> to stay out of the way, when to get in the way, and what to do when

> they're there.

>

> As far as Rescue medics, the idea is to take the care to the patient

> to the extent possible. It's a lot easier and cheaper to train and

> equip a practicing Paramedic to function in the rescue arena than it

> is to train a rescue-trained Firefighter to be a proficient

> Paramedic. Generally speaking, while ATCEMS Rescue medics are

> pretty good at the rescue thing, they're even better at the ALS

> thing. In Austin (I can't speak for Co), the Fire Department

> doesn't provide ALS services because the cost of training and

> maintaining proficiency is too high, considering the very low

> incidence of use for those skills and the fact that ATCEMS has done

> an exemplary job of putting ambulances where they need to be for a

> rapid response almost everywhere in the City. I honestly don't

> remember the last time I was on scene longer than 5 minutes before

> the Medic unit arrived.

>

> Can ALS care be provided at the end of a rope on a cliff? Certainly

> - it's been proven. Whether it can be provided in a swift water

> scenario is, admittedly, highly unlikely.

>

> The history of rescue medics in A/TCEMS (Austin EMS back then)

> includes an era when there were no fully staffed fire departments in

> Co. The politics at the time (both in the County and the

> City) prevented Austin FD's Technical Rescue Team or Water Rescue

> Team from responding into the county except on very infrequent

> occasions, and then only after following specific procedures.

> Consequently, if an incident occurred that required technical rescue

> or swift water rescue expertise, there was nobody else to do it

> except Austin EMS.

>

> I do not know the capabilities of the Co. fire departments,

> except that they are certainly substantially more capable in all

> disciplines than they were even 10 years ago. Some of the County

> departments have ALS-credentialed Firefighters with all the supplies

> and equipment to provide the full range of ALS care, and highly

> trained and equipped for rope and water rescues. Other County

> departments are strictly BLS First Responders with no technical

> rescue or water rescue capabilities. Regardless, everybody rides to

> the hospital in an ATCEMS ambulance.

>

> Phil Reynolds Jr.

> 115 Harold Dr.

> Burnet, TX., 78611

> HP

> CP

>

>

>

>

> ------------------------------------

>

>