Medicone

We ran them upstate NY. Saved a ton of money on gas. Easy to drive, tons of space. Ours were RWD police package from Warnock with the same tires NYSPD ran on their chargers. We fit all of our gear in the trunk without any problems (Defib, 2 oxygen duffels, BLS bag, ALS primary bag, spare ALS bag, vent, suction, KED, everything). We typically put the defib and the primary ALS bag on the top and popped the trunk on arrival. Best setup ever. No complaints; highly recommend. We had to run the SUV's in big snow storms though, otherwise charger was the primary vehicle.
Empress will have a lot of luck with this new AWD I bet. Congrats!

Photo by Daryn Baia, and reposted with permission.
BTW, if you're a Paramedic, Empress has openings...click here for more details

We ran them upstate NY. Saved a ton of money on gas. Easy to drive, tons of space. Ours were RWD police package from Warnock with the same tires NYSPD ran on their chargers. We fit all of our gear in the trunk without any problems (Defib, 2 oxygen duffels, BLS bag, ALS primary bag, spare ALS bag, vent, suction, KED, everything). We typically put the defib and the primary ALS bag on the top and popped the trunk on arrival. Best setup ever. No complaints; highly recommend. We had to run the SUV's in big snow storms though, otherwise charger was the primary vehicle.
Empress will have a lot of luck with this new AWD I bet. Congrats!

We ran them upstate NY. Saved a ton of money on gas. Easy to drive, tons of space. Ours were RWD police package from Warnock with the same tires NYSPD ran on their chargers. We fit all of our gear in the trunk without any problems (Defib, 2 oxygen duffels, BLS bag, ALS primary bag, spare ALS bag, vent, suction, KED, everything). We typically put the defib and the primary ALS bag on the top and popped the trunk on arrival. Best setup ever. No complaints; highly recommend. We had to run the SUV's in big snow storms though, otherwise charger was the primary vehicle.
Empress will have a lot of luck with this new AWD I bet. Congrats!

We ran them upstate NY. Saved a ton of money on gas. Easy to drive, tons of space. Ours were RWD police package from Warnock with the same tires NYSPD ran on their chargers. We fit all of our gear in the trunk without any problems (Defib, 2 oxygen duffels, BLS bag, ALS primary bag, spare ALS bag, vent, suction, KED, everything). We typically put the defib and the primary ALS bag on the top and popped the trunk on arrival. Best setup ever. No complaints; highly recommend. We had to run the SUV's in big snow storms though, otherwise charger was the primary vehicle.
Empress will have a lot of luck with this new AWD I bet. Congrats!

We ran them upstate NY. Saved a ton of money on gas. Easy to drive, tons of space. Ours were RWD police package from Warnock with the same tires NYSPD ran on their chargers. We fit all of our gear in the trunk without any problems (Defib, 2 oxygen duffels, BLS bag, ALS primary bag, spare ALS bag, vent, suction, KED, everything). We typically put the defib and the primary ALS bag on the top and popped the trunk on arrival. Best setup ever. No complaints; highly recommend. We had to run the SUV's in big snow storms though, otherwise charger was the primary vehicle.
Empress will have a lot of luck with this new AWD I bet. Congrats!

We ran them upstate NY. Saved a ton of money on gas. Easy to drive, tons of space. Ours were RWD police package from Warnock with the same tires NYSPD ran on their chargers. We fit all of our gear in the trunk without any problems (Defib, 2 oxygen duffels, BLS bag, ALS primary bag, spare ALS bag, vent, suction, KED, everything). We typically put the defib and the primary ALS bag on the top and popped the trunk on arrival. Best setup ever. No complaints; highly recommend. We had to run the SUV's in big snow storms though, otherwise charger was the primary vehicle.
Empress will have a lot of luck with this new AWD I bet. Congrats!

Not to be a downer, but your chances of getting a CON for an area already covered by adequate EMS is like 1 in 1,000,000; not exactly that ratio, but it would be near impossible.
First you have to show a need, most likely you will have to get the data from one of the commercial agencies who provides coverage who probably would not want to part with it.
Second, assuming you get the data, you put in an application to REMSCO. You will probably not be surprised to see all the commercials/potential competitors of yours sitting on the REMSCO as members; don't expect them to do the right thing, assuming there is a right thing. They will not turn on their interests.
Third, even in the slim chance that you get enough REMSCO members to agree that there is a public need, and that your CON should be approved, all the commercials have a chance to appeal it.
Fourth, assuming they appeal it, it goes to SEMSCO which also is littered with commercial ambulance lobby grounds that control who gets a license. Plan on them not wanted to give you a share.
So, the whole process is supposed to be 60 days, that is up to the REMSCO determination. Plan on it taking anywhere between 1-3 years or until you run out of money on legal fees fighting the man.
It's sad, but it is a very difficult process to get a new license due to the conflict in the REMSCO's and SEMSCO's.
I am speaking from experience. But with that said, there is always that chance, so best of luck!!
-M1

Depends on the region and whether you plan to do it as a career.
In the REMO region (Albany area), the system depends on AEMT-CC's and many agencies employee CC's and Paramedics (they serve the same position). Nassau and Suffolk counties also have a lot of CC friendly agencies.
However, if you go downstate into NYC, you will basically never have a job workings as a CC: most places only hire paramedics.
The growing trend seems to be limiting CC's and pushing the higher level of care Paramedic education. 10 years ago, there were a lot more agencies that were CCT friendly but that is becoming few and far between.
If you are doing it just for fun and don't have the time for a Paramedic education, CC may be the way to go (significantly less hours).
If you get your CC you can also bridge up to paramedic at SUNY Cobleskill/Bassett Healthcare which is a great option if you are serious about a career in EMS.
I guess in the long run, I would envision the employment of CC's to end. There has also been talk at the DOH agencies and REMACs of getting rid of the CC level or care, although never approved. However, many REMACs have eliminated protocols for CC's.
I was a CC and bridged up to paramedic and think it was a fantastic decision. If you are serious about your career you should def strive to obtain the highest certification/education available.
just some thoughts,

Depends on the region and whether you plan to do it as a career.
In the REMO region (Albany area), the system depends on AEMT-CC's and many agencies employee CC's and Paramedics (they serve the same position). Nassau and Suffolk counties also have a lot of CC friendly agencies.
However, if you go downstate into NYC, you will basically never have a job workings as a CC: most places only hire paramedics.
The growing trend seems to be limiting CC's and pushing the higher level of care Paramedic education. 10 years ago, there were a lot more agencies that were CCT friendly but that is becoming few and far between.
If you are doing it just for fun and don't have the time for a Paramedic education, CC may be the way to go (significantly less hours).
If you get your CC you can also bridge up to paramedic at SUNY Cobleskill/Bassett Healthcare which is a great option if you are serious about a career in EMS.
I guess in the long run, I would envision the employment of CC's to end. There has also been talk at the DOH agencies and REMACs of getting rid of the CC level or care, although never approved. However, many REMACs have eliminated protocols for CC's.
I was a CC and bridged up to paramedic and think it was a fantastic decision. If you are serious about your career you should def strive to obtain the highest certification/education available.
just some thoughts,

From what the news is reporting, SEMS BOD decided one meeting that they were losing money and somehow chose Empire Ambulance (Troy) as the agency they would "gift" their ambulance operating certificate to.
SEMS is not asking region to dissolve; Empire Ambulance is asking the region to approve the CON transfer from SEMS to them. Empire doesn't have a license for that area which is one of the reasons their bid to provide EMS service to Saratoga was cancelled last year when the City issued the RFP. Mohawk has a license for the area and offered to take over SEMS previously; however, SEMS seems to want Empire to get their license for some reason.
So basically, SEMS is going to stop service no matter what; the fighting now is Empire trying to get their hands on a CON for the area. If SEMS stops service for 30 days before the transfer, Empire might not be able to get their hands on that $$, I mean license.
Other issue that came up I believe is that SEMS, a 501c3, needs to have a dissolution plan approved by the attorney general; basically, how they will legally divide the assets. Their CON is an asset worth $$, so the AG will probably look into why Empire is getting it for free v. selling it and paying off debt/donating monies to charity.

City of Utica v. DOH is going to make some great case law; however, the ability of a municipality to secure a permanent operating authority still largely depends on the REMSCO. Unfortunately, the REMSCOs and SEMSCO are still dominated by employees, managers and stockholders of commercial ambulances entities. In the event that conflicts of interest are not disclosed and a municipal CON is denied; it is appealed to the SEMSCO which comprises many members of UNYAN (United New York Ambulance Network, lobby group funded by the majority of commercial ambulance services including MLSS) making an impartial appeal very difficult.
Either way, arguments could be made for both sides. It is debatable how fair/practical it is to have a municipality essentially instantaneously declare Public Need and operate, pushing out a commercial provider who depends on those calls to sustain a larger operation. However, it certainly is not fair to have your competitors sitting on the REMSCOs and SEMSCO determine whether or not your municipality or organization should be granted a license.
With that being said there are many Fire Departments in upstate New York who have successfully obtained municipal CONs and have secured permanent operating authority (as well as seen a significant amount of profit to help offset department budgets).
With respect to the profitability of a specific municipal contract, while the specific call volume within the municipality may not yield a profit if the municipality is to run a standalone service; if a large commercial provider provides the service and adds it to their system status, the call volume may actually yield a profit for them by increasing their calls/unit.
However, many smaller municipalities are forming consolidated EMS districts/programs that are extremely successful. The call volume and resources are shared rather than duplicated and there is a level of accountability that is not commonly found when contracting with commercial EMS entities.
Just some thoughts,
M1

Just a few thoughts and a quick disclaimer; I currently operate as a career paramedic but previously was in law enforcement. While being involved in both fields, I have never been a “Tactical Medic” affiliated with an active team, although I have attended tactical medic training through several institutions in the northeast and southeast.
Tactical medicine provides some great advantages; both in a hot zone and perhaps even more so in the staging area/warm zone providing occupational health oversight and team monitoring. There is no need to go into the benefits of such a position as we all are well aware of them.
Some comments on TRAINING:
One of the biggest problems is that providers are under the assumption that completing some form of a TEMS course is sufficient to have them effectively participate on a team. I am constantly running into civilian (and some currently detached LEO) EMS providers (Paramedics, EMT-Bs,I,CCT) that say they are “Tactical Medics” because they took a TEMS course. All the TEMS courses (CONTOMS, HSS International, U.S. Training Center etc) provide a basic introduction to TEMS and some basic firearms instruction. They provide the mindset needed; but do not qualify someone to operate on a team (for the safety of the team, their safety and the safety of the general public).
Simply being able to manipulate, engage a target and render safe a firearm coupled with EMS training is not sufficient to make a TEMS provider ready to operate on a team.
ERT operators (LEO Officers) are highly trained in special operations. In additional to consistent firearms training, operators are educated in coordinated movements, tactics and procedures that make up a majority of the curriculum.
Someone previously mentioned that it is more desirable to have an active paramedic operate on the team because they are currently practicing. I agree with that principle, however, the same principle applies to the skills required of an LEO.
ERT operators train frequently; not monthly, but weekly. Movements need to effortless and second nature. Firearms must be readied, sighted in and used. To be a proficient ERT operator, just as a proficient Paramedic, your skills must be used constantly and maintained.
Some comments on PROFICIENCY/ACTIVITY
Being a proficient Paramedic comes down to having a solid education and being active to keep your skills up. NYC provides an excellent environment for Paramedics and EMS in general (coupled with a significant amount of BS). There are many voluntary hospitals that have per-diem staff members who can select from a plurality of locations to work ranging from the Bronx to Northern and Southern Manhattan. Paramedics who may be in a practical slump can select tours in busy areas to practice skills and procedures.
Unfortunately, as most EMS providers know, it is common to work 50-60 hours a week as a Paramedic to make a living.
LEOs also need to keep their skills up. Range days, team trainings and working the street are all part of a law enforcement career. With respect to LEOs on ERT teams, even more practice is necessary. Transitioning between carbines/pistols, non-lethal weapons, tactical reloads etc etc etc, ERT movements, room clearing…and then the legal aspects of entry and engagement. Distinct from EMS, most urbanized law enforcement agencies are primarily FT career based operators. Almost, if not all, ERT teams are comprised of full time LEOs.
DISCUSSION
While everyone should agree that it is desirable and necessary to have Paramedics and LEOs who are both proficient and active; that very concept presents and inherent conflict. There simply are not enough hours in the day to truly do both.
I know there are a lot of civilian Paramedics who really want to be on an ERT team (including myself), but we need to take a step back and think logically about what the job entails. It is not just attending a TEMS program and purchasing a drop holster and a chest rig. The job requires 100% dedication to the ERT team which includes maintaining proficiency at every skill that the LEO ERT member has as well. Teams by definition function as a group. Each member must be an equal participant and be predictable. This requires constant interaction. All dreams aside, without 100% dedication, an unnecessary risk is placed on the team and the public. Working 50-60 hours a week and an addition 20 hours per week plus deployments just is not possible anymore.
However, it is essential to have medical trained providers on the ERT team.
During deployments, 70-90% of the time, no medical interventions are necessary. However, when they are, they are generally trauma related requiring immediate intervention.
Many LEOs are also per-diem paramedics. It is possible for them to have a primary job on the ERT and have a per-diem job in EMS. To maintain their proficiency as a paramedic, or at least their skillset as it relates to traumatic injuries (GSW, hemodynamic comprise, IV/IO access, ETI, advanced airways, bleeding control; almost a NREMT-I curriculum will suffice), they have the ability to pick up tours in busy areas. I cant remember a time that a 12 Lead ECG or advanced medical case present/was treated in the hot zone. Not saying that it won’t happen, but the victim would be extracted in that case anyway; and complex aided case is not going to be treated with an active cqb scenario.
One of the important aspects of this is that the LEO/Paramedic can pick up shifts INDIVIDUALLY based on his schedule to maintain his skillset as a paramedic. He can select a busy bus in the BX for example or BK. A career paramedic does not have the ability to pick up a shift on the ERT without deploying the entire team. Fulltime LEOs are already on the team regularly and train with them as a group; practicing as a paramedic can be done per-diem to maintain proficiency. Several NYPD ESU members work per-diem for the hospitals and are very capable and proficient.
In summary, while it a civilian Paramedic may find it desirable to operate on a ERT team, while theoretically possible, it is far more efficient to simply train an existing LEO with EMT-I or EMT-P skills and require they maintain proficiency in their secondary capacity as a TEMS provider.
When 70-90% of the job is going to be LEO related proficiency, the remainder can be trusted to a proficient LEO TEMS provider who has the ability to stabilize the patient to allow extraction.
Just some thoughts, I do not mean to offend anyone. Best of luck with everyones endeavors!!
M1

Just a few thoughts and a quick disclaimer; I currently operate as a career paramedic but previously was in law enforcement. While being involved in both fields, I have never been a “Tactical Medic” affiliated with an active team, although I have attended tactical medic training through several institutions in the northeast and southeast.
Tactical medicine provides some great advantages; both in a hot zone and perhaps even more so in the staging area/warm zone providing occupational health oversight and team monitoring. There is no need to go into the benefits of such a position as we all are well aware of them.
Some comments on TRAINING:
One of the biggest problems is that providers are under the assumption that completing some form of a TEMS course is sufficient to have them effectively participate on a team. I am constantly running into civilian (and some currently detached LEO) EMS providers (Paramedics, EMT-Bs,I,CCT) that say they are “Tactical Medics” because they took a TEMS course. All the TEMS courses (CONTOMS, HSS International, U.S. Training Center etc) provide a basic introduction to TEMS and some basic firearms instruction. They provide the mindset needed; but do not qualify someone to operate on a team (for the safety of the team, their safety and the safety of the general public).
Simply being able to manipulate, engage a target and render safe a firearm coupled with EMS training is not sufficient to make a TEMS provider ready to operate on a team.
ERT operators (LEO Officers) are highly trained in special operations. In additional to consistent firearms training, operators are educated in coordinated movements, tactics and procedures that make up a majority of the curriculum.
Someone previously mentioned that it is more desirable to have an active paramedic operate on the team because they are currently practicing. I agree with that principle, however, the same principle applies to the skills required of an LEO.
ERT operators train frequently; not monthly, but weekly. Movements need to effortless and second nature. Firearms must be readied, sighted in and used. To be a proficient ERT operator, just as a proficient Paramedic, your skills must be used constantly and maintained.
Some comments on PROFICIENCY/ACTIVITY
Being a proficient Paramedic comes down to having a solid education and being active to keep your skills up. NYC provides an excellent environment for Paramedics and EMS in general (coupled with a significant amount of BS). There are many voluntary hospitals that have per-diem staff members who can select from a plurality of locations to work ranging from the Bronx to Northern and Southern Manhattan. Paramedics who may be in a practical slump can select tours in busy areas to practice skills and procedures.
Unfortunately, as most EMS providers know, it is common to work 50-60 hours a week as a Paramedic to make a living.
LEOs also need to keep their skills up. Range days, team trainings and working the street are all part of a law enforcement career. With respect to LEOs on ERT teams, even more practice is necessary. Transitioning between carbines/pistols, non-lethal weapons, tactical reloads etc etc etc, ERT movements, room clearing…and then the legal aspects of entry and engagement. Distinct from EMS, most urbanized law enforcement agencies are primarily FT career based operators. Almost, if not all, ERT teams are comprised of full time LEOs.
DISCUSSION
While everyone should agree that it is desirable and necessary to have Paramedics and LEOs who are both proficient and active; that very concept presents and inherent conflict. There simply are not enough hours in the day to truly do both.
I know there are a lot of civilian Paramedics who really want to be on an ERT team (including myself), but we need to take a step back and think logically about what the job entails. It is not just attending a TEMS program and purchasing a drop holster and a chest rig. The job requires 100% dedication to the ERT team which includes maintaining proficiency at every skill that the LEO ERT member has as well. Teams by definition function as a group. Each member must be an equal participant and be predictable. This requires constant interaction. All dreams aside, without 100% dedication, an unnecessary risk is placed on the team and the public. Working 50-60 hours a week and an addition 20 hours per week plus deployments just is not possible anymore.
However, it is essential to have medical trained providers on the ERT team.
During deployments, 70-90% of the time, no medical interventions are necessary. However, when they are, they are generally trauma related requiring immediate intervention.
Many LEOs are also per-diem paramedics. It is possible for them to have a primary job on the ERT and have a per-diem job in EMS. To maintain their proficiency as a paramedic, or at least their skillset as it relates to traumatic injuries (GSW, hemodynamic comprise, IV/IO access, ETI, advanced airways, bleeding control; almost a NREMT-I curriculum will suffice), they have the ability to pick up tours in busy areas. I cant remember a time that a 12 Lead ECG or advanced medical case present/was treated in the hot zone. Not saying that it won’t happen, but the victim would be extracted in that case anyway; and complex aided case is not going to be treated with an active cqb scenario.
One of the important aspects of this is that the LEO/Paramedic can pick up shifts INDIVIDUALLY based on his schedule to maintain his skillset as a paramedic. He can select a busy bus in the BX for example or BK. A career paramedic does not have the ability to pick up a shift on the ERT without deploying the entire team. Fulltime LEOs are already on the team regularly and train with them as a group; practicing as a paramedic can be done per-diem to maintain proficiency. Several NYPD ESU members work per-diem for the hospitals and are very capable and proficient.
In summary, while it a civilian Paramedic may find it desirable to operate on a ERT team, while theoretically possible, it is far more efficient to simply train an existing LEO with EMT-I or EMT-P skills and require they maintain proficiency in their secondary capacity as a TEMS provider.
When 70-90% of the job is going to be LEO related proficiency, the remainder can be trusted to a proficient LEO TEMS provider who has the ability to stabilize the patient to allow extraction.
Just some thoughts, I do not mean to offend anyone. Best of luck with everyones endeavors!!
M1

City of Utica v. DOH is going to make some great case law; however, the ability of a municipality to secure a permanent operating authority still largely depends on the REMSCO. Unfortunately, the REMSCOs and SEMSCO are still dominated by employees, managers and stockholders of commercial ambulances entities. In the event that conflicts of interest are not disclosed and a municipal CON is denied; it is appealed to the SEMSCO which comprises many members of UNYAN (United New York Ambulance Network, lobby group funded by the majority of commercial ambulance services including MLSS) making an impartial appeal very difficult.
Either way, arguments could be made for both sides. It is debatable how fair/practical it is to have a municipality essentially instantaneously declare Public Need and operate, pushing out a commercial provider who depends on those calls to sustain a larger operation. However, it certainly is not fair to have your competitors sitting on the REMSCOs and SEMSCO determine whether or not your municipality or organization should be granted a license.
With that being said there are many Fire Departments in upstate New York who have successfully obtained municipal CONs and have secured permanent operating authority (as well as seen a significant amount of profit to help offset department budgets).
With respect to the profitability of a specific municipal contract, while the specific call volume within the municipality may not yield a profit if the municipality is to run a standalone service; if a large commercial provider provides the service and adds it to their system status, the call volume may actually yield a profit for them by increasing their calls/unit.
However, many smaller municipalities are forming consolidated EMS districts/programs that are extremely successful. The call volume and resources are shared rather than duplicated and there is a level of accountability that is not commonly found when contracting with commercial EMS entities.
Just some thoughts,
M1