jps385

$10,000 bail for this!! Thats BS this little princess should be spending the rest of summer sweating in suffolk county jail until her trial.

Level One Facility Requirements: In house qualified trauma surgeon In house qualified radiologist In house qualified emergency physician In house qualified anesthesiologist Trauma medical director (trauma surgeon) Emergency medicine medical director (MD/DO) Trauma program manager (RN) 24 hour CT availability 24 hour equipped and staffed operating suite Backup and equipped surgical suite Trauma intensive care facilities for adult and pediatric patients Trained trauma team -At least 1 trauma surgeon (as team leader) -At least 1 attending EM physician -At least 2 trained trauma nurses Dedicated resuscitation suites (to manage two simultaneously multi-system injured patients) 24 hour laboratory facilities Protocol for in house burn care Rehabilitation facilities Helicopter landing pad Pediatric resuscitation facilities, personnel, and intensive care units Administrative requirements Research requirements EMS requirements *The term, "qualified" pertains to state guidelines. In some instances, senior emergency medicine residents/fellows or senior surgical resisdents can substitute for their attending counterparts. Level Two Facility Requirements: Same as above, except requirements for in house and on call physicians vary. Level Two facilities generally meet all Level One criteria but are not required to have neurosurgeons/trauma surgeons in house. Furthermore, Level Two facilities are not mandated to handle pediatric trauma. Emergency rooms must necessarily be capable of managing critically ill and injured pediatric patients, but Level II facilities are generally not designated as pediaric trauma referral centers (PTRCs). The state requires that on call trauma specialists must sign a letter of commitment and arrive promptly once summoned by house staff. This is from American College of Surgeons who acredit trauma centers. Not all facilites in NYC have the helipad. All Level 1 are not created equally St. barnabas for example has very limtied pediatric surgery and Neurosurgery.

ST Barnabas is a level 1, North Central isn't a trauma center, but lincoln is level 1 (bit of a ride though).

Pawling loses ambulance service Lack of money cited as cause; budget to get relook By Leigh Gomez Poughkeepsie Journal PAWLING - The town has been without an ambulance service provider as of 6 a.m. Sunday, when services provided by Northern Dutchess Paramedics ended. The first responders temporarily provided the town aid at a cost of about $1,200 per day, Supervisor Beth Coursen said. This was after Empire Ambulance Service canceled its services last week. Empire pulled out, Coursen said, because the four-town consortium trying to arrange the service decided not to award a contract for 2007. "Last week, we had a public health crisis in the town of Pawling ... now its a fiscal crisis as well," Coursen said. An estimated $300,000 in service fees is required for the remainder of 2007. The town only has $150,000 budgeted. Depending on neighbors Until the town board finds a solution, residents must depend on aid from nearby communities, which Coursen finds "unacceptable." "We are relying on our neighbors to pick up the slack," Coursen said. "You're asking them to pull out of their town to take care of our emergency calls and leave their community open and vulnerable for several hours." The town board is looking at a way to cut back the budget, or make changes to the existing budget that would shift money to pay for the service fees, Coursen said. The town might also consider a short-term loan that it would pay back in 2008, she said. Town officials will look closely at non-essential services, which may see some cuts. Coursen said non-essential services include library and recreation programs. Gordon Rossland, a 64-year-old town resident, agrees some services should be cut if it means ensuring the safety of local residents. "Some people that go in the ambulance use walkers. A lot of them are elderly and don't drive anymore," Rossland said, adding, "They rely on others for transportation." He doesn't think a cut in library services is the solution. "It's for the public," Rossland said of the library. "The children use libraries all the time." If extra hours for the library can be cut to let residents have their own first responder, so be it, resident Katherine Posilippo, 84, said. "What is more important? Somebody's health? I think so," Posilippo said. Coursen said Pawling's ambulance provider received more than 700 calls in 2006. "No town is legally responsible to provide ambulance services but there is a moral responsibility," Coursen said. It sounds as though Pawling has come to grips with the cost of an ambulance. My guess is you will see other towns facing this reality as contracts come up for renewal.

Empire, Alamo, Mobile, NDP and Transcare

Pawling does 450-600 calls though that has dropped now private units are covering more of the NH calls. Techinically FD does first response but in 2 years there I saw them pretty infrequently and with a staffed bus we were ussually there first.

Not defending anyones actions but EMS isn't cheap. 24x7 ALS ambulance 4.5 Paramedics @ $50,000 with benefits =$225,000 4.5 EMTS @ $25,000 with benefits= $112,500 Equipment, Supplies, administrative support $50,000 Total $387,500 Billing 500 calls @$300 (thats a genrous assupmtion on collections) $150,000 Balance (requiring subsidy) $237,000 Dutchess county has benfited (or suffered) from ambulance wars for 10 years now which results in town receiving contracts whic were too good to be true. This has resulted in Sloper folding, Alamo was circling the drain unitil they started dropping these contracts, and NDP in bankruptcy. In Slopers heyday they covers wappingers, fishkill (town and village) as well as New Hamburg as well as a few nursing facilites and some interecept work with 4 ALS trucks. Respnse times were very rarely an issue. Now this same area is covered by 9+ vehicles (with lower tax payer support). Response times haven't much improved, but you have 3 companies losing money hoping to force the other out and be leftw itht he whole pie. The pull out in Pawling is the first but probabbly won't be the last incident of this nature. If you go to other parts of the country these ambulance battles have left whole counties without coverage as comapnies go out of business. Bottom line: EMS is an essential service which should be provided by municipalities. If billing can offset the cost great but that shouldn't dicate the service level. I won't cry for the Pawling town board (am concerned for the citizens) who have been playing games witht he subsidy for years.

I don't think this topic is as black and white as its being made out to be. The real question is is there an immediate threat to life at the incident you happen upon. If there is you must stop (won't site law or policy although I'm sure a lawyer would have afield day with it, its just common sense and morality). If there is no threat call it in and proceed. Change the scenario abit for those who advocating passing the incident. Your dispatched to a structure fire but en route you pass another working fire with victims at the windows above the fire. By the logic of not self dispatching you should pass this incident because your already dispatched to something else. What if your en route to an auto alarm first due. Would you still not stop?

3rd Party billing is when the insurance company (3rd party) is billed. It is not illegal unto itself, provided no money is received from medicare. However once medicare is billed at a rate which is greater than the rate anyone else receives (and if the patients without insurance receive no bill the effective rate is 0) then crime has been commited. (you can look this up on the CMS website). Soft billing is perfectly legal and actually hard billing for any healthcare (ambulance or otherwise) is currently the focus of congressional oversite as it relates to not-for profit status anf eligibility for fed aid for for profits.

The issue of billing MOS comes down to medicare regulations. By law medicare must receive the best rate for services provided, so if you don't bill someone (an MOS) the rate is 0. If your agency is in a situation where the perception is that someone is receiving a better rate than medicare this is fraud. While places do get away with this if there is ever an audit it will result in serious possible criminal issues for those in charge on an agency. With the regulatory environemnt in NY changing the likelyhood of an audit is increasing. The best way around this is simple soft billing. You mail the bill and forget about it. If you get something great, if not better luck next time.

As a former Brewster resident I would have to say the location is kind of remote. Its about 2-3 miles from 22. How many members does brewster have in that area anyway? 7-10? (how many are available at any given time 2-3?) How could you possibly staff an 8 bay station with that few personel? Would Brewster ever need 8 more truck anyway? Growth is one thing but unless Donald Trump comes to town I don't think you'll that kind of devlopment in the area. While I think coverage on the East side of town is needed this is probably not the way to go. The main house has been falling down since I was there 10 years ago. If your going to ask the taxpayers for a milti-million dollar project replace the main house in an area where you have members, and build a 2 bay substation on Milltown. The medic 4 thing is a whole different issue that needs to be adressed well before this staionis built anyway.

Good Luck to all. For the Putnam 911 dispatchers, now that the trucks all have GPS will you be dispatching closet medic based on GPS, or continue with the dispatch by district?

Why did you guys re-number 23-2-2 and make it 23-2-5?

"regional" trauma center refers to the fact that it is level 1 as opposed to a area or level 2 center. Not the fact that it is located in your region. This is a DOH designation. This has nothing to do with the "EMS region". Many regions such as NYC and Nassau have multiple regional trauma centers.

Mt Kisco's old ladder was bought by Dover Plains (and recently sold). Pattersons was bought for the department by the Jehovah's Witness College when it opened up in 90's.

Give Bob a call he has confirmed for anyone who asks, also Alamo is calling the putnam medics to let them know,

That is the official word from both Bob Cuomo, and Alamo.

It was anounced yesterday that Empire will be the new provider effective in 90 days.

This is a huge problem in our area. How many times do we flya patient when we could drive them to the medical center in the same if not less time? If you look around Westchester county it is a rare location where ground transport time to WMC is greater than 25 minutes. If there is no delayed extrication there is rarely justification for the flight. How long does it take to take a patient to the LZ and transfer care? We often delay definative aptient care so we can play chopper. I have seen many incidents where we are on a highway facing the hospital with transport times of 10 minutes yet we still wait and delay. This is not ideal patient care by any stretch.

You need to check your facts about NYC EMS. Very few call types receive both a BLS and ALS ambulance. The BLS rsponse times are actually for a CFR-D Engine company (which does arrive in 2-5 minutes), however the ambulance times for both BLS and ALS are about 9-10 minutes on the average, and quite often are much higher(particularly during periods of peek demand when no units are available in an area for 10-15 minutes at a time). With the possible exception of the leadership of FDNY, and possibly polticians up for reelection no one involved in EMS in NYC would give the rosy perception of it as you. NYC has a system which fails to meet the standards of most national medical organization for ambulance response times, early defibrilation, as well as cardiac arrest suvival rates.

I've actually heard them refered to as NY's Best. Not sure how official that is, and I wouldn't comment on it with a 10ft pole, but ocasionally the media will use this title.

I find it doubtful that they ran out of O2 and waited on the scene for more. With 3 portables and an onboard it takes a lot of effort for a bus to have no 02. Beside why would you wait for oxygen when your in the bus. Ambulances have four wheels for a reason. It sounds more like the family is making a misinformed allegation ( go figure), and that she coded in the bus on scene and the crew worked her while waiting for another crew to assist during transport. If they walked her down (something that happens all to often in NYC) they will have some questions to answer, but I wouldn't take an article written from only the families point of view as fact.

They'll put out single medic trucks with hand pick people and then (shockingly) there will be know problems and it will be implemnted citywide within the next 18 months or so. From what I have heard the Remac was against it but FDNY managed to force the issue with the state. I'm not really against this whole idea, but you can be sure it won't be evaluated fairly, and just approved.

I believe Bob is provisional (ie never took the test). It's more or less a formality he probally just needs to pass and he keeps his job and title.

Stamford Ct. just had a similar incident with a male EDP. Unfortunately short of using restraints (I mean poseys, four points ect. not seat belts) on every patient there not much we can do. If a patient takes off their seat belts or stretcher straps and heads for the door theres a good chance their going to make it. With only one person in the back wrestling the patient gives you a good chance of following them out the door. Obviously on known EDPs we'll be a little more careful but at the end of the day anything can happen on this job. Just remember to be safe.