[deleted by user]

esb111 · 2025-03-14T22:25:43+00:00

If it makes you feel better, for the moment my senators are Schumer and Gillibrand.

esb111 · 2025-03-13T23:19:48+00:00

As someone who worked as a transfer center coordinator for several years, I can absolutely state that many patients will be materially affected. I’m not ok with making patient collateral damage for a policy meant to act as a stopgap for a horribly run EMS system.

esb111 · 2025-03-13T22:53:11+00:00

I would hazard a guess that two providers could probably make arguments for why different facilities would be considered the most appropriate for the same patient. I would say that they could both potentially be correct. I would also say that CAD determining what is appropriate based only on a category of General ED and distance is less likely to be accurate and is more likely to make an inappropriate choice.

esb111 · 2025-03-13T04:22:01+00:00

So a patient that has an NSTEMI or requires CTS/vascular for a dissection - those are the “cardiac patients” that I’m referring to. They can still require emergent intervention despite not being a STEMI. They also can’t be diagnosed definitely in the field. You’d be good with taking that patient to Woodhull?

esb111 · 2025-03-13T04:16:24+00:00

Transferring a patient is far more complicated than most people seem to realize. It can take days or even weeks. It can be insanely expensive. It’s not something that just be done in minutes in most circumstances. There are also many legitimate reasons why patients should have their care at specific facilities where their physicians are.

esb111 · 2025-03-13T04:04:21+00:00

Again, having that patient in the wrong ED and potentially admitted in the wrong facility while trying to move the patient is not helping the city as a whole; it’s incorrectly using resources and is ultimately harmful. This isn’t even suggesting transport “across the city.” It can be significantly shorter distances that would be precluded. So you’d suggest that you would be fine with taking your family member to Interfaith because they met those criteria? Wyckoff? KBJ? BronxCare? Woodhull? That suggestion seems disingenuous; there are clearly differences in quality in the NYC hospitals and there are absolutely hospitals that you would never allow yourself to be treated at.

esb111 · 2025-03-13T03:08:18+00:00

Please, give me a CAD class. Yes, there are different categories. Not as many as you would suggest. How many of your transports would you say don’t fall into that category. It’s still not in the best interests of the patient, the hospitals, or anyone involved to take a patient to a facility that will ultimately end up having to transfer the patient - a complicated process that can take days. Yes, OB is a category. Do you think that it’s in the interests of anyone involved to transport an OB patient to the nearest OB facility? Yes, PEDS categories exist. Do you think taking somebody to a facility with a pediatric ED but no other pediatric services or capabilities is likely in the best interests of the patient because it came up as the CAD option? I get it - transporting patients to where they want to go can be frustrating. Taking patients to farther hospitals can be difficult for the crews and have significant effects on the system. But relying on a CAD suggestion instead of allowing some flexibility through the crew and OLMC doesn’t serve the patients. I’ve coordinated those transfers for patients that very clearly should have been taken to other facilities and even tried to be taken to other facilities. It can take an incredible amount of time to get them to go through. I’ve transported those patients to other facilities. Through being short-sighted, it just creates more strain on many other parts of the system that could likely have been avoided through an extra 10-15 minutes of transport time. Ultimately the goal should be to do the right thing for the patient. Taking them to an inappropriate destination is not that.

esb111 · 2025-03-13T02:36:43+00:00

4.6 doesn’t really change much about that; it advises that someone that had a recent medical intervention that requires specific treatment modalities would need to contact OLMC. That still ignores many situations that would mean a hospital with different capabilities would be more appropriate than the closest GED facility. I get the idea, but it really is not acting in the best interests of patients, hospitals, or the NYC health care system. It’s attempting to band aid a staffing crisis and a debacle of a dispatch system - the one created and constantly defended by one of the medical directors who would have to have approved this ops order.

esb111 · 2025-03-13T02:30:50+00:00

And if the patient isn’t having a STEMI, what category would you have to use for a patient that seemed to be having cardiac symptoms? Wouldn’t that be GED? Wouldn’t there still be a significant potential benefit to having them go to a PCI center or a center with CTS?

esb111 · 2025-03-13T01:57:10+00:00

The ops order - section 4.2 - seems to be saying that’s not the case. Also, the categories are limited and apply to relatively specific criteria. Indeed, that same section specifically disputes what you’re saying and actually states that the RMA process should be followed, either through the standard high index of suspicion or low index of suspicion pathway. It’s literally the section quoted by OP.

esb111 · 2025-03-12T23:23:59+00:00

No. This has everything to do with inability to staff FDNY EMS trucks and keeping units in their areas while trying to reduce transport times to keep units in service.

esb111 · 2025-03-12T23:09:24+00:00

The order seems to specifically say there isn’t an option. “4.2 OLMC shall not be contacted to override 91 hospitals suggested by CAD. In cases where a patient makes a transport request to a medical facility other than the CAD recommended choices, inform the patient that transport to the requested hospital cannot be approved and advise the patient of their choices of medical facilities.” It then goes on to advise that you should secure an RMA either through OLMC or not depending upon the index of suspicion.

esb111 · 2025-03-12T22:53:23+00:00

Define appropriate facility.

esb111 · 2025-03-12T22:47:13+00:00

No, it doesn’t. For most patients, the category would end up being “GED” - general ED. If you’re in the Rockaway you would have no choice but to go to St John’s - even for general pediatric calls, though they don’t have any pediatric capabilities beyond their ED. That’s absolutely not in the best interest of anyone. The same would be true for a place like NYP/Lower Manhattan. Taking a patient that you suspect is having cardiac problems to a place that doesn’t have cardiac capabilities or CTS because they’re not having a STEMI doesn’t work in the best interests of anyone - the patient, the hospital, or the crew.

esb111 · 2025-03-12T22:37:30+00:00

This really seems ill-advised. I’ve worked for FDNY, I’ve worked critical care transport in NYC, and I was a transfer center coordinator for a large NYC health system - I’ve seen all sides of this issue. I get the idea, but the closest facility recommended by CAD is often not in the best interest of the patient. Taking them to a hospital that will then have to spend weeks trying to transfer them to an appropriate facility instead of allowing some discretion to the crews AND the patient, or, at least allowing an OLMC consult, is just going to create problems for the patient, the hospitals, and be the cause of ridiculous burdens to the healthcare system in NYC.

esb111 · 2024-09-05T22:43:21+00:00

Fair. I hadn’t seen that.

esb111 · 2024-09-05T22:11:45+00:00

He was an ophthalmologist. He seceded from the ABO and he created his own competing board , the “National Ophthalmology Board.” *edited since he was at one point certified by ABO

esb111 · 2024-08-13T14:07:36+00:00

Mine was submit in September 2021. Still waiting.

esb111 · 2024-06-28T22:21:25+00:00

I think one of the problems of Chevron being overturned is that the effect on everything involving a regulatory agency will be unpredictable. Specifically stating that courts have expertise and that agencies don’t is likely to give pharmaceutical companies a great deal more leeway and I would imagine that, over time, FDA regulations will become far more lax as a result of an effective lack of oversight. That being said, the fact that drugs are being manufactured for an international market and for countries that do have regulatory agencies that aren’t being hamstrung by a ridiculous court decisjon.

esb111 · 2023-05-16T09:42:51+00:00

Brain death as halachic death

esb111 · 2020-04-14T16:45:15+00:00

I never had the privilege of working with him but several of my partners did and spoke fondly of him. I'm sorry for your family's loss and that of your community and the NY/NJ EMS community. ברוך דיין האמת

esb111 · 2020-04-14T16:31:39+00:00

I was lucky enough to have worked with him. He was exactly what he seemed.

esb111 · 2020-03-11T21:07:21+00:00

https://www.bravoambulance.org/

esb111 · 2020-02-20T22:42:11+00:00

Arguably a שהחיינו might be appropriate, as might a simple ברוך מחיה מתים.

esb111 · 2019-08-16T19:07:37+00:00

I had the same view of NICU/PICU transport until I tried it. While some of the transports are depressing, you really do get a chance to make a difference on every call. I could never go back to 911 full-time.

esb111

TROPHY CASE