Goose

Is there that much fire up there that you need two ladder trucks?

I see your point but how many EMTs go into EMT class with volunteer time under their belt? Lots. Not a bad thing, don't get me wrong. But many these days have already picked up the bad habits and formed the preconceived notions well before they step into the class room. That is beyond difficult to teach away (for lack of a better term). Try to teach them that they should be able to handle A,B and C alone they will tell you "oh well, where i volunteer the medic will be there." You can't force someone to stop thinking that way.

There are far more pressing issues that need to be dealt with.....like the current health care reform debates.

This looks worse then i previously thought.

Whatever you want. But i think it is slightly relevant in that fact that there is obviously a disparity amongst the degree of experience, knowledge and comfort amongst EMTs county wide. How can we add a new tool to the tool box if we (we as in a county) have difficulty preforming our initial job description? That's my over arching point. I should have been more clear in my previous post, sorry for the ramble.

Not always the case. I have always worked in a Paramedic system and i am more than confident in my ability to hold my own. In fact, working in a Paramedic system has made me a better EMT. Just because a medic is riding the job in doesn't mean that you can't learn as a new EMT. I learned the basics from a Paramedic when i first fell into EMS - the EMTs didn't want much to do with me, but he took the time and effort to teach me and much of my success is as a direct result of that. Maybe new EMTs shouldn't be driving the medic truck back? Maybe you should throw them in the back to get their hands dirty? From my limited experience i have always felt that a lot of that medic dependent stuff is a top down phenomenon. Leadership screaming for a medic on a stubbed toe or being unable to make a decision without a paramedic filters down to the rank and file. I know that being paramedic dependent is not part of the NYS curriculum. That said, being an EMT is an entry level position. It's a very basic course, granted we can do some cool stuff and occasionally save a life. It's my belief that EMT is too basic in nature - i've always felt that EMT-I should be the B equivalent. It would raise the bar and weed out those who really don't belong.

Free - as in you're not billed or as in the organization takes no tax dollars and does not bill you? Ultimately, if we took all the money wasted on the overabundance of resources we have county wide, we could have a few million to start looking at a county wide third service.

There are agencies that have it. There is also RSI...but i think only Empress is allowed to preform it because of the high volume of tubes that occur down there. Besides, i recall hearing that RSI is being phased out by a lot of EMS agencies nationwide due to a combination of low success rate and the danger.

It's been a proven therapy for years...never understood why it took some of our local MACs so long to buy into it. A number of Westchester agencies already use it. As far as BLS getting it...i'm not too sure how i feel about that. I doubt the region will buy into it. My reservation is that there are so many BLS providers that have difficulty doing the job as is and are completely incapable of operating without a paramedic...ie: cannot identify a candidate for BLS albuterol. I suppose it would be nice...but given the conservative nature of the MAC and the patchwork of BLS agencies we have countywide i don't see it happening anytime soon.

Or maybe the chief just never calls? Been involved in a few situations where chief's never called for a bus unitl a firefighter was down...

As per the title, why do you think it's so difficult to earn a decent living in EMS? This has been something that has been eating at me lately and i figured it might be an interesting/worthwhile discussion. Take the average medic (I'm not one): - Goes through anywhere from 1 - 2 years of school at the college level to become a paramedic which is far longer than even a 6 month PD or Fire academy (plus, it seems like most pay their way through school and work). - Has to sit for state and local exams to become credentialed - Has to attend a variety of continuing education programs including physician contact hours to maintain both state and local credentials - Is faced with a constantly changing field where things are being subtracted, added, new techniques and equipment introduced. - Thats just to do the job, factor in everything else (long hours, high volume, potential job related injuries/dangers, etc.) I guess from where i sit this is pretty much on par with or exceeds the requirements/expectations of being a cop or firemen yet a rookie paramedic is lucky if he/she makes 20 bucks an hour, has an ambulance that runs, half-way decent equipment and has to work a second job just to survive. So, what gives? Is it the commercials? The vollies? The politicians? Ourselves? A deadly combination of everything? And how, most importantly, do we fix it?

Who cares?

When the going gets tough cut EMS!

I mentioned the commercial agencies (sloper, alamo, empire, transcare) to highlight the lack of stability in the system due in large part to the fact that the system is put out to bid or contracts were assumed during buyouts. It's hard on the employees and their families and not fair, sadly it drove some solid paramedics away from the county. Likewise, i am not debating the quality of service, i left before the current system was put in place but i do know some of the medics personally and know that putnam is well served. As far as positioning units and stuff like that. Bro, you got me. I'm not an analyst, just a provider. The only way to figure out how to do it right is have a survey and research company like Fitch & Associates (leader in EMS studies) come in and do their thing and report back. I like your enthusiasm though!

Putnam is not the best example - Sloper, Alamo, Empire, Transcare. Constantly changing shirts in Putnam, ask any medic and they will tell you it becomes downright unfair. Besides they have been saying they are going to go to a county run municipal ALS system for at least 10 years - biggest problem there is the County has no money (we all remember when they wanted to get rid of ALS altogether, don't we?). Besides, its hard to compare a system where the entire county only does ~4,000 EMS calls. I don't know the duthcess numbers but i am sure they are WELL above that.

Relax. I worked for the same commercial company you do. I never said commercials employed sub-par employees, i worked with some amazing people in Dutchess and i loved about 99% of my time there. But the fact's remain that commercials, generally speaking, are part of the problem for more reasons than i feel like outlining here. This notion that subcontracting EMS is going save dollars and cents is asinine, if you ask me. Would you subcontract a police department? Point is, make it a budget line item and you will not only eliminate the waste county wide (duplication of services - Wake County has 15 ambulances for an entire COUNTY which includes a busy city, how many trucks are in duthcess? Probably more than their are staff to complete crews). You won't have to deal with the Ambulance Wars that occur all the time in dutchess or the inability to properly cover contracts - those are just two of the most frequent issues that arrive from subcontracting out a vital service. You can shut your eyes, stuff your ears and whistle dixie. If other counties around the country can do it, there is no reason why we can't. Eventually, call volume is going to increase so much that you will have no choice but address the issue with a REAL solution. Maybe not right now, given the economic climate but its, in my opinion, the only solution. You simply can't ignore the type of system places like Wake County are - they are what ems should be country wide. I suppose it's difficult if you've never worked commericial EMS and have never looked at places like Wake county. They are about 25 - 30 years ahead of us in every single way. Honestly, you compare the two and you want to throw up.

I can't tell if you're kidding or not. Hopefully you are. Most commercials are for profit - they pay sucks, the bennies suck, the rigs suck, the equipment sucks and the staffing will suck. County EMS will give you a more robust budget to attract the best and brightest and pay them well (on par with FD and PD), county bennies & retirement, cutting edge education, cutting edge equipment, modern vehicles that are well maintained, vast expanses in resources - hazmat, USAR, PD support for SWAT entry teams, etc. It won't even cost a whole lot - granted you eliminate all the useless duplication of resources. No one ever wants to cut FD, but you look at some of these departments in Westchester, Putnam and Dutchess and sometimes (most of the time) you just have to scratch your head. Probably could save a few million in needless apparatus expenditures. Consolidate smaller PDs into a larger regional/county system, do the same for school systems and add a dollar or two surcharge onto parking violations or other county/regional forms to benefit EMS. You can really fund it 1000 ways. Check out Wake County EMS in North Carolina - see how it hails in comparison to the the NY Metro Area. It's a joke, we are living 20 - 30 years behind the times.

You've got me there bronamath!

Cool your jets. I didn't know spaghetti straps were part of the protocol.

Local - i appreciate your concern. When i worked in Dutchess i saw some of this stuff (not just on the east) and my jaw dropped. A medic flycar doesn't fix the central issue. Sure, the medic gets there and he/she can dump the whole drug box into the patient but this is just a stop gap. It's a smoke and mirrors excuse - staff the flycar to stop the clock and give the volunteers more reason to not address the real issue - why their bus isn't getting out. I only was requested a few times into those areas and as such i am not familiar with the politics (i loved playing in Poughkeepsie too much). It will be a hard fight - i'm sure of that. But, regardless of call volume, those ambulances need to be staffed. A regional solution (ie: consolidation) is the best, but they don't have to look far to get some ideas: BVAC - they contract through Alamo for EMTs to staff their BLS bus Pleasant Valley - They have a ALS/BLS truck Mon - Fri during business hours staffed at the FD This may have changed since i left Dutchess, but those are two examples of different organizations addressing their issues. And, during my time in Dutchess, Pleasant Valley Rescue was one of the best at getting a bus out the door! Great topic, hopefully something is addressed.

Dress down PPE day. Cool.

Guido beach is old...sad part is...i know the girl in the last segment...

Nothing is for free, we all know that. But you are correct that many volunteers like to point out that they "do it for free." Sure they don't get a paycheck but like you aptly discussed, some of the operating budgets are insane. I know of area departments that have budgets that are anywhere from 1 to in excess of 1 million dollars. Maybe they do ~700 calls a year? Often hit or miss if they get out. The cost-benefit ratio is rather low. Look at most Westchester towns/villages/hamlets - they have their own fire department and ambulance corps (if it's not part of the FD). Two huge budgets for a miniscule swath of land. 2 ambulances, engines, ladders, rescues, utilities, 24 cheifs cars, etc. It's just bizarre. The millions of dollars in apparatus, equipment and buildings, the large budgets and still it takes 4 departments to put out a fire and hell, forget about EMS - 1 EMS call overwhelms most agencies in Westchester. Forget crews in quarters or uniforms, thats unlikely to happen. Remember, they volunteer. I agree with you, and at times i wonder if they are not holding things (primarily in EMS) back. Why shouldn't they pull in-house duty hours and wear a uniform? There is no real reason they can't or shouldn't have to, but many play both sides of the "im a volunteer" mantra. It's such a complicated politically charged mess it's unlike to change. Only in the wake of a horrendous catastrophe will things start to be shaken up...

Take it a step further.... Most of the ambulances in Westchester at any given time aren't even in service - gotta have providers in an ambulance to make it worth anything. Forget changing policies - someone or something needs to take total control and either regionalize or make the entire county a single agency. The first step, however, is centralizing EMS communications. Have the county provider the dispatchers, establish the policies and procedures and go from there. Putnam County did it - granted Westchester is far larger and does exponentially more EMS runs a year, there is no reason why we can't do it either.

Takes about 3 - 5 minutes to go to 90% of the jobs (very ballpark). Anywhere from less than 10 minutes to 35 - 45 minutes (i think thats the longest for me) during a complicated medical control RMA spent on scene. And then anywhere from probably 10 minutes to 45 or so minutes at the ER - transferring care, giving the report, decon, restock, paperwork, etc. The average EMS call for me probably lasts in the area of an hour. If things start to get busy we do our best to cut the turn around time considerably.