Are New York City EMT's Prepared for Terror?

NYC is reeling from the shock of Tuesday's terror attack, in which a truck barreled down a crowded street, killing eight. There is no doubt that EMS response prevented further deaths in the twelve victims who were injured, some critically. As Police Commissioner James P. O'Neill said, "[t]he Fire Department and the EMS personnel surely helped save additional lives."

But this incident raises a very important question.
Is the New York City EMS network prepared for terror attacks? A quick look at the facts indicates that they are. In recent years, the FDNY has ramped up equipment and training for such attacks. In November 13, 2015, a few attacks in Paris killed 130 people, including 89 in a nightclub as the shooters engaged in an hours-long standoff with law enforcement. This was followed by the June 12 massacre of 49 people in an Orlando night club. These incidents changed the departments perception of mass casualty incidents, said Fire Commissioner Daniel Nigro, because in both cases, it is highly likely that some of the victims could have been saved with prompt treatment.

What prevented quicker EMT response in those terror attacks?
During the terror attacks in Paris and in Orlando, EMTs could not respond to victims immediately because there was still active shooting. They did not have the protective equipment that would have allowed them to enter the scene while it was still a "warm zone." "It was clear the FDNY must train closely with the NYPD to enhance the city's response to these deadly incidents. Our members stand ready to enter dangerous areas -- under NYPD protection -- to quickly remove and treat critically injured patients," Nigro said.

How has EMT training in NYC changed since then?
The FDNY has created five borough task forces, with 75 members in each, who are equipped to respond immediately to terrorist or other mass casualty incidents. Each task force consists of three fire officers, three EMS officers, 12 firefighters, six EMS members, and one battalion chief.

What makes these task forces unique?
Unlike most first responders, these EMS workers will enter a dangerous scene, also known as a warm zone, directly after the police. Because they will be trained and equipped to remain safe despite still-present danger, they will be able to reach victims significantly faster.

What equipment is given to the EMTs in the task force?
The FDNY purchased military-grade protective equipment including full combat helmets and FBI approved ballistic bullet proof vests, which are effective against both handguns and long guns.

How exactly are the task forces trained to enter the scene?
Each task force is broken into several entry teams, each consisting of a fire officer, one EMS officer, four firefighters and two EMS members. Four strategic response NYPD officers accompany each entry team to provide protection while they work on victims with critical injuries.

Has this program ever been tested before Tuesday's event?
Unfortunately, yes. The task forces were first tested during last year's Sept 17 bombing in Chelsea. Considered a warm zone since there was still a threat of a second bomb in the area, the EMS workers were brought in to evacuate the wounded from the area. In addition, a partial 25-member unit is activated for major city events such as parades and New Year's Eve as a precautionary measure.

Reading & Understanding a Textbook

Reading and writing, are usually the first two things we learn when we start school. Hand in hand with these two are their brothers and sister; spelling and grammar. If they are the first and foremost things we learn every year in approximately 12 years of school, then why are so many people so bad at it. I am no expert; in fact you probably will find some grammar and punctuation mistakes in this blog. But, no matter, I will attempt to offer some helpful hints on how to read EMT technical material for all you students out there.
First know that reading a textbook is very different than reading a novel or story.

Starting a chapter

1. Read the preview or objectives first. They will point you in the direction your attention should take and set the stage for serious learning later.

2. Read the summary next. It will tell you what is most important.

3. Skim the text. This step will help you develop a big picture by looking for headings, bold print and main ideas.

4. Pay attention to the vocabulary. Find definitions of new or difficult words now. Is there a glossary? (A glossary is an alphabetized list of words and their meanings) Write them down so you do not forget.

5. Examine charts, pictures and diagrams. Ask yourself why is this important.

6. If you have done all of the above, you are now ready for in-depth reading. This is reading more slowly and following the reasoning of the text, since now you have a pretty good idea of what is important.

7. Take notes while you read. It keeps your brain from getting tired.

8. After you have read a few paragraphs, stop & think about what you have read. If you do not understand, then go back and reread. If it is still confusing, try to google the concept. Sometimes the internet has an easier or different way of explaining things.

9. To be a successful reader and understand what you are reading you need to be awake & alert. Don't try this when you are sleepy, you will drool on the book.

10. Even the best readers must reread and take notes to remember what they read.

11. It is quite acceptable to write or make notes in the margins of your textbook or use bright colors of sticky notes.

12. Instead of just taking regular notes, also make some Mind Maps (grouping related information in a highly visual manner) as popularized by Tony Buzan (Use Both Sides of Your Brain). Two examples are Arrow Graphics and showing Contrasts and Similarities, shown below.

Mind maps DO make a measurable difference in the scientific studies of learning. Some EMT Instructors will try and simplify things and make them for you, others will give you handouts that seem to be more complicated than the textbook. In either case, you should start making your own. It will help you to study and really learn the information.

Well, I hope there were some or all parts of this article that you found helpful. Like all things, reading takes practice. Keep practicing!

Medical Terminology for the EMT Student

Being an EMT Student

The first time I walked into the classroom, I was nervous.

Why had I come - was I making the right decision? I wanted to help people, some of my family members had become ill from stroke, heart disease and diabetes and I wanted to help them. They were getting older. I wanted to know what to do in emergencies, like those people I saw on TV or in the movies. They seemed to always know.

Once I got into CPR and bleeding & bandaging, I was hooked. I found a friend who wanted to pass as much as I did. We studied together before and after class.

We made index cards with important facts and flashed them to each other like in Jeopardy. It was hard, but we kept studying and practicing and having a good time. We would compete to see who could get the higher grades and before we knew it the course was over and we had passed our state exams.

I couldn't help it - I loved the flashing lights, the uniforms and working with the medical equipment.

I felt good because I was now part of something much bigger than myself. I knew the city in a way other people did not. I had my fingers on its pulse and knew when it was hurt and scared or celebrating and 'under the influence.' I watched more experienced EMT's and hospital personnel and yes, I continued to study. Emergency care is an ever-changing and evolving field, and I wanted to learn all I could. Then, with my EMT certification and my driver's license I got a job!

Helpful Hints on How to Pass your First EMT Class

1. Find a private & quiet space or corner in your home where you can set up a table, chair and lamp and where you can leave your study materials out without anyone disturbing them.

2. Purchase the book at or before the first day of class. Purchase a highlighter.

3. Post a wall calendar at your study space and mark the dates assignments are due. Look at you class schedule daily. Stay ahead of the reading.

4. Buy a pack of index cards so you can write down vocabulary words or names of medical conditions with the meanings + signs and symptoms written on the back. Carry them around and test yourself whenever you have some spare time during the day.

5. Always complete the assigned reading one or two days before the class.

6. List questions about the assigned reading the day before the class.

7. Listen carefully to the lecture & take notes. If the instructor has not answered your questions in the lecture, then ask.

8. Listen carefully when they review quizzes/exams. Many questions are repeated over and over again.

9. Find a friend in the class that lives near you. Plan to meet before or after class to review notes and test each other on your stack of index cards.

10. During skill sessions, make sure you take your turn at doing the skill. Don't be afraid of making mistakes, practice makes perfect. Sitting there watching others does not develop muscle memory.

11. Attend as many free tutoring sessions as you can. Bring questions, take notes.

12. The book is not a novel (story) and cannot be read that way. Some pages need to be read over and over. Go to your study area every day when you are fully awake and study one topic at a time. Small bites are easier to digest.

13. Be your own coach. Someone needs to make you sit down & study and if mom and dad aren't available any more, then that person is you....READ/STUDY/READ!


CPR & First Aid in your Workplace

If you have spent just one time not knowing what to do in an emergency, then it is time to learn.

We previously spoke about spending a few hours at your workplace learning CPR, so now I must reiterate the benefits of also learning basic first aid skills. There can be hours at the office that turn out to be unproductive time, so why not schedule a CPR and Basic First Aid class for just a few hours before, after or during the work day.

It is knowledge that everyone needs to know so why not do it where you spend the majority of your time. It will not take long and, chances are, it will help you, your loved ones and people around you.

Scheduling a CPR and Basic First Aid Class for your workplace is easy. Depending on how many people you have in your group, the instructor(s) will come to you, bringing along manikins, AED trainers and First Aid supplies so you can practice the skills being taught. All they need is some space. I can remember training groups of people in the hallways, lobbies, libraries or conference rooms of schools, court buildings and even museums. There was never a time when we didn't have fun doing it either. Heart Attacks, Stroke, Allergic Reactions, Diabetes, Choking, Bleeding, Burns, Bites are some of the topics that can be covered. You can also ask that specific subjects be covered if your workplace has a need or an interest. In workplaces dealing with machinery, traumatic injuries can be covered whereas in court buildings with a gym, then medical issues such as heart attacks, stroke and diabetic emergencies would be discussed. We can easily taylor your 'need to know' into a CPR and Basic First Aid Class for your organization, teaching it all in the same day or breaking it up into parts.

Treat your employees to something more important than monthly birthday parties. Allow us to teach them skills that could save a life.

CPR in the workplace. Why you want to train your employees.

According to the American Time Use Survey, put out by the Bureau of Labor Statistics, Americans spend approximately 8 hours a day working at their jobs. The next largest chunk of time is spent sleeping at approximately 7.8 hours. Most jobs are conducted in an environment with other players, whether they are your office mates, partners, team or group.

A good way to break out of the mold of everyday work activities is to conduct a CPR Training Class at your work environment. Besides being a welcome change of pace, it stimulates thoughts on healthy living and saving lives. Is there a better way to spend a few hours?

Most CPR classes include a discussion on heart healthy living habits vs. unhealthy ones. This is included to emphasize the fact that individual's who have more than one unhealthy habit, have a much higher risk of developing cardiac and vascular damage than people who follow prudent heart living. This information on unhealthy habits has been slow to reach the public because of many years of advertising lies. They claim tobacco, soft drinks, fast food and breakfast cereals (cigarettes, sugar, salt) are part of the American lifestyle and you MUST have it in your homes and consume large quantities of it. They not only convince you to buy it, but your children as well. It has taken years for the government to put restrictions on the advertising and sale of tobacco products. Unfortunately, much too late for my parents, aunts and uncles who were persuaded that smoking was the thing to do in the roaring 20's. (1920's that is) They died long painful deaths from every kind of cancer. We need to, absolutely, learn what can hurt us, how to prevent it, and what to do if it does. All office or corporate workers can easily learn 'hand's only CPR'. Add in choking (the Heimlich Maneuver) and the use of a public access AED and you have a complete CPR Class.

To be able to recognize the warning signs of heart attacks is knowledge worth having for everyone:

1. Uncomfortable pressure, tightness or squeezing in the chest area.
2. Sweating, nausea or shortness of breath.
3. Back pain or pain moving down the arm or up to the jaw.
4. Skin might be pale, cool and wet.

Encourage your manager or boss to arrange a CPR class for your organization. And when the CPR Instructor arrives at your place of work with the manikins, pay attention and ask questions. Don't worry; they will make it interesting and fun. Just wear clothing that will be comfortable when kneeling over a manikin.

After cardiac problems, the second leading cause of death in Americans is stroke. (A clot or bleed in the brain instead of the heart)

We need to know those warning signs also because FAST transport to a stroke center is the only thing that can reverse permanent disability and death. Here are the Stroke (brain attack) warning signs:

1. F =Facial drooping
2. A =Arm weakness
3. S =Speech difficulties
4. T =Time to call 911

The more people that know CPR, AED and the Heimlich maneuver, then the more people we can keep alive until the ambulance arrives. Knowing CPR is knowledge and knowledge is definitely power.

Stop the Bleed

The world has changed drastically in the last 30 some years. Even our language has evolved. No longer do we use terms like; pay phones, rotary dials, transistor radios, beepers, cassette recorders. We also, no longer use that technology. We are now somewhere between self-driving cars and booking tickets to Mars.
Healthcare has also changed with the times, and some diseases once in circulation have been eradicated. Unfortunately though, new strains of 'not so good stuff' have come into the present.

EMS is trying its best to keep up. One of the things we have to look forward to is a discussion on whether or not to train EMT's in scenes of ASHE (active shooter/hostile event). If you are interested in this topic, EMSWORLD magazine (March 2017 / Vol. 46, NO. 3) has excellent articles on the subject. One is a roundtable discussion with 4 top experts and I strongly encourage you to find the publication and read the article.

One of the first questions they ask of these experts is whether or not EMS should be more proactive in assisting casualties in mass shootings? Some of the experts in this article say scene safety might be an illusion. The questions they bring up must cause us to think. No one can truly say that a scene is absolutely safe until you are far from it, in the safety of your ambulance, driving away. They will not be asking EMT's to go into the line of fire but all of them agree that the emergency system needs a solution.

Another question brought up in this article is weather it is feasible to expect the police to help with the medical stabilization of patients. E. Reed Smith, MD states, " the law enforcement officer who is no longer stopping the killing can very quickly switch over to stopping the dying." He goes on to say that the scope of practice for the police would be very much the same as a current lay-person's knowledge: bleeding control, tourniquet use, compression only CPR, public-access defibrillation, and maintaining body temperature.

What I found enlightening is that some of these experts are advocating for hemorrhage control kits to be displayed right beside AED's in public places. In fact there is a program out there called Stop the Bleed. The goal of the Stop the Bleed program is to make training in bleeding control as common as CPR training and Combat Application Tourniquets (C-A-T's) publicly available, with enough pressure bandages to treat 8 patients, mounted alongside your public-access AED. The article states, "The recommendation to train citizens and all first responders to stop bleeding came out of the Hartford Consensus." "This committee was formed in direct response to the 2012 mass shooting at Sandy Hook Elementary School in Newtown, CT, which left 20 children and 6 staff members dead."

Ed Racht, MD, sums it up and says that an important part of the strategy of responding to ASHE's is preparing law enforcement and other responders for aggressive hemorrhage control. "If law enforcement-which has the training and expertise to go deeper into the uncontrolled hot zone –can rapidly identify and control significant bleeding and bring patients to safety, they can have a significant impact on patient outcome and loss of life." The question is, will they want to?

A similar thing took place when many fire departments strongly encouraged the fire fighters to become CFR's (Certified First Responders), which is the level below EMT. A very large amount of fire fighters I have come across clearly stated to me that all they wanted to do was fight fires. Maybe this narrow tunnel thinking needs to change to a much broader vison and training in the present world of violence and terrorism.


One of the most important considerations in EMS today should be the mental health of our first responders and care providers. With traumatic situations at an all-time high, EMS providers, along with all uniformed first responders, are seeing an increase in horrific situations. The end result of these visual images, in addition to the pain and suffering of fellow human beings becomes the perfect recipe for PTSD.

The most significant contributor to PTSD is not only what you see and hear but also denial of the impact of these memories that become imprinted in our brains. Our EMT Courses teaches us the importance of CISM (Critical Incident Stress Management) but is it really out there and readily available? And if it is, what about the social stigma related to our "strong & brave" going for mental help?

"We suffer what I call cultural brainwashing," says Jeff Dill, a captain at the Palatine Rural Fire Protection District in Illinois. "Once we put this uniform on, we're expected to act a certain way: Be strong. Don't show weakness. Don't be the weak link of the company – we can handle problems on our own.....We forget we're human beings first....

Preventing burnout in the EMS System can also help with keeping PTSD at bay.

One study found that the top causes of emergency services burnout are:

  • Abuse of the 9-1-1 system

  • Extensive time shift length

  • Extended length of service

  • High call volume

  • Sleep deprivation

  • Lack of administrative support

If you find that you are experiencing any of the signs & symptoms below:

  • Flashbacks

  • Nightmares

  • Hopelessness

  • Loss of interest in normal activities

  • Loss of interest in normal activities

  • Irritability and anger

  • Insomnia

  • Difficulty concentrating

  • Difficulty making decisions

  • Overuse of alcohol

  • Misuse of drugs

It might be time to take action. The newest weapon in the fight against PTSD is called First Response Resiliency Curriculum Training. Take some time and do a little research. It just might be time to invest in YOU. Find a program near you that offers CISM or First Response Resiliency Training. One of the best methods of releasing the trauma of PTSD is being able to talk to people who also work in the same field and have similar experiences. You are worth it!

Delayed EMS Responses – Causes and Solutions

Will you survive a life threatening medical emergency in the US?
Depends on where you live.
Collapse in Seattle from cardiac arrest – you're guaranteed defibrillation within minutes. Collapse in Washington? Call a cab.
In the fifty largest US cities, about 9,000 people collapse from cardiac arrest caused by a short circuit in the heart. This is a very treatable issue – all it needs is a shock from an AED machine. Yet only about 10% are saved.
Something is clearly wrong. True; in a large percentage of EMS calls, a longer response time will not cause harm to the patient. But what about all the other times, when every second counts?

Let's take a deeper look at the problem.

1) Insufficient Ambulances

Before we get into all the complicated issues, let's get down to the most obvious problem – lack of ambulance units. As populations in different areas grow and change, the need for ambulances changes as well – but EMS systems are not evolving enough.
Recently, Mayor Martin J. Walsh of Boston announced that Boston Emergency Medical Service had begun training a new class that would increase their EMS count by 24 employees.
It's time for other cities and towns to follow their lead and ramp up the number of ambulances.

2) Dispatch Errors

Last year, two young siblings, Ayina and Jai'Launi Tinglin, were killed in a Far Rockaway fire. EMS did not reach the scene until 20 minutes after the call was received.
The cause? Personnel errors preceding the dispatch.

Why the errors? Not enough training, says Jack Tanski, a telecommunicator for the Colony Police Department in Latham, NY, and a former paramedic.

Much more funds and effort needs to be invested in training and overseeing EMD. At the moment, in many agencies the management uses the communications center as a "dumping ground" for women who are on maternity leave or employees on light duty.

The outcome?
A dispatch center full of improperly trained employees who don't even want to be there. Like every other part of the EMS system, EMD needs a clear protocol and oversight. "EMD is like the kid in the family who gets the hand-me-downs," said Jeff Clawson, MD, owner of Medical Priority Consultants, Inc., in Salt Lake City, UT, "EMS buys all the fire engines, helicopters and equipment, but balks at buying a protocol that may cost $300-about the same as a battery for a defibrillator and half as much as the chair a dispatcher traditionally sits in."
In addition, personality needs to be assessed when hiring dispatchers. A good dispatcher must have good interpersonal skills and a calm, reassuring manner.

3) Lack of Teamwork Between the EMS System and the Fire Department

The fact is that firefighters today are more likely to respond to medical emergency calls than to actual fires. Yet the culture doesn't yet reflect that. Firefighters went into their careers expecting to fight fires, and not to plug in AEDs – so it is unsurprising that it is often difficult for them to respond properly.
In one city, firefighters median response time to a dumpster fire – which requires donning protective boots, pants, coats and breathing apparatus – was faster than their response to a cardiac arrest call. And this is understandable. Medical treatment was not what they signed up for. It is not what they were trained for.
In addition, infighting and turf wars between fire departments and ambulance services cause deadly delays.
Maybe it is time for firefighter recruiting and training to be changed to reflect the new reality. Let's develop a new culture of partnership between EMS and fire departments.

4) Inability to Find Location of Emergency

Paper maps are basically extinct, right?
Many city's ambulances have high priced GPS systems – but their paramedics still use time consumer paper maps. Why?
Because those GPS systems are only there to let the dispatchers keep track of the ambulances, not to provide direction to the drivers. Although this does cut 30-plus seconds off response time, there's no reason the EMS responders themselves shouldn't have GPS to help them navigate the streets.
The FDNY says that it isn't so necessary since most EMTs work in the same areas each day. But even in an area that's basically familiar, a GPS can go a long way in helping to locate a specific address and the best route to get there.

5) Calls Coming During a Shift Change

From his apartment window, Jonathan Agronsky saw Julia Rusinek on the ground. He rushed to the firehouse less than a block from where she fell – the firefighters there said a fire engine from another station farther away was on the way. Why couldn't they come? Their ambulance crew was going off duty.
Last December, a paramedic was dispatched to a report of a cardiac arrest at 6:01 – but his shift had ended at 6. What did he do? He drove back to his firehouse to go off duty, and firefighters performed CPR on the victim for 25 minutes until the new paramedic crew drove to the scene.
It is not certain if such scenarios take place often, but it is definitely an issue that should be address, perhaps by offering a significant financial incentive for post-shift calls.

EMTs continue to be devoted to their jobs and saving lives. Putting some of the above changes into practice can go a long way towards increasing efficiency and making things easier for EMTs everywhere.

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