sympathomedic

OK, this is NOT directly AMR related, but goes with SageVigiles post: I JUST came home from DC, having ridden a bicycle 320 miles there from Poughkeepsie with the Muddy Angels EMS memorial bike ride. My brother lives there and is a huge scanner buff. Here is what is driving me crazy: DC arrives and updates the job as minor/BLS/no life threat and has AMR sent. AMR then drives full-on lights and sirens to a call where it has been determined that there is nothing major going on. Why are EMT's of any service driving lights/sirens to rush to the scene of a confirmed NON-EMERGENCY? I can guess that DC doesn't want to hang around and wait, or that AMR wants to have good looking response times. But to endanger themselves and the public for that is BS. Of the 50 EMS folks that the Muddy Angels rode for this year, 12, or about 24% died in MVA's. This is NOT against AMR, but against the shot-callers who set this up. Probably NOT an AMR decision, but a dead EMT is a dead EMT. More lights and sirens driving= more dead EMT's.

Does this mean when they do 911 calls in the future that Empress will be out of business? Because what makes you think that AMR isn't going to take Empress out of the big cities in Westchester? What makes YOU think that they ARE? In the past when cities have done business the new big guy in town, (Affiliated, Transcare) they have had issues- like the company disappearing. No Empress ain't perfect but we have never just said AMF YOYO and gone home. As a 29 year Empress guy, I heard similar stories about two decades ago when some other big multi-state company came in. Called Transcare. Anyone remember Careline? Another big company that bought up little ones and then died. Anyhow, these guys are EMT's and medics just like anyone else. I welcome them to the street. Plenty of work for everyone. I hope their bosses are good to them. Almost as a gag, I bought some Envision Stock so I get their corporate shareholder reports and stuff.(so welcome, my new employees!) I also hope that down the road they may join our Union (IAEP) to help make sure their bosses don't unfairly tilt the playing field. Maybe we can do some charity events together. Bill Rothschild

Hey Barry: Is EMS staffing within the scope of the study, or is it fire only? Bill

YES, Please! Bring this to Westchester!! Save the ED for emergencies, save 911 for emergencies, save money, and train and pay us better. Bring IT!. Bill

I have spent 28 years doing EMS in this area. The "chirp" of dieing smoke detector batteries is constant, except where there are NO detectors. I read that every $1.00 spent on smoke detectors save $67.00 in fire damage. If this area has more fires, by history, or some other measure, perhaps the Yonkers FD could concentrate their inspection and prevention efforts here? Makes sense to try to prevent the fires in areas where they are most likely to occur, AND most likely to kill - wooden multi-family dwellings. The lives saved by an aggressive, concentrated effort may those of YFD firemen. Please don't respond with the gibberish that it can't be done. We are problem solvers in this field. This is a problem for us. We can and should solve it. Bill

As one of my partners said, "Any good EMS reality show needs to have an entire episode showing EMS crews in the day room watching and TV criticizing other EMS reality shows."

OMG! THANK YOU, MR. MUNSON!

Truth be told, I work 3 paid EMS jobs and I volly. The all of them put me working with multiple agencies each. The very next time I am on a rig with someone who is driving and they let an incoming call go to voice mail will be the first. That crosses the the entire spectrum of all agencies I work with- about 8 agencies. Transcare I think had the best policy: I believe it was either once and done, or twice and done, but you were done. The phone to me is not as bed as the navigating. Even on a rig with a dash-mounted GPS, folks seem addicted to the hand-held device. You need to stop looking at where you are going and look at the freaking phone!! LET SOMEONE ELSE do that. Anyone who rides with me knows I carry a real paper map. I hate to drive, so I navigate by giving real, live 'Turn here, dummy' by turn instructions. Folks should try that.

Boy is THIS thread targeted at the right audience! We (EMS) are the WORST at this. If I had a dime for everyone I worked with who tried to navigate with a phone while driving light/sirens, I could retire today. I am aware of many emergency vehicle crashes, both regular driving and light/sirens caused by wireless distractions. Even before these devices become common, American ambulances had the highest rate of traffic deaths per mile of ANY VEHICLE ON THE PLANET! That stat includes NASCAR! The safest? American school buses. Think about that next time you take a kid off a school bus and put them in your ambulance. Who was it that said, "We have seen the enemy, and it is US!"

FYI The Atria's do pay taxes. When my parents lived in the Briarcliff one, they had an annual picnic for the VFD and EMS- no idea how well that went. FYI #2 not all these places are equally licensed. Some are independent living with NO help staff, the one in Rye has a bar, with a two drink per resident daily max- so no EMT bravo retirees likely to go there. Some are assisted living with a lower level of care, which I learned meant NO modified food, so when my dad couldn't chew due to a dental issue, he had to leave because they were not allowed to have a resident needing modified food. Others have a higher level, and can deal with less firm folks. When Heritage Hills was built in Somers, they were required to have a 24X7 EMT that the FD could conscript to make a full crew. We did that all the time, but we still failed to cover calls, hence our going to a 24X7 paid first crew. Can't blame Heritage and the old folks for that- they give us an EMT whenever we ask.

Empress handles A LOT of the ME Heart work- that stands for Montefiore-Einstein Heart Center cath lab stuff. If you have a STEMI in many Bronx or lower Westchester hospitals, Empress does the STAT txp from where you are infarcting to the cath lab. EG: St Joes, Mt Vernon, Sound Shore, NCB, Jacobi. Empress also has a crew 24X7 at the old Westchester Square hospital, which was part of the deal with NYS- if that facility was to be a treatment center with no admission beds, there had to be a dedicated EMS presence there to txp folks that needed admission. Empress is also doing some pretty complex work for Einstein involving ECMO- Extra Corporeal Membrane Oxygenation call. These machines are a way of pumping blood and oxygenating blood outside the body while the problem with the heart and lungs is fixed. They are bulky and very heavy. The pt's are usually in an induced come with 5-6 medicated drips, a ventilator, an arterial line monitor and EKG and ETCO monitor. We take two MD's and a perfusionist with us. These are very are intense jobs. Empress also now handles the Live-On NY organ transplant team. We gather a fly-car full of medical staff, run them to where the doner is, then bring the team and the organs to where they need to go. Or we meat a team at an airport with an incoming organ. I hear last night we did SEVEN of these jobs. Not trying to brag(*) but the reaction I have gotten from the facility staff has been, quoting, 'You guys are 10 times better than Transcare', and on another occasion, 'Oh, you're not Transcare? Good!' *= OK maybe a little bit. I Still feel very bad for any still left jobless, or owed pay/vacation etc. FYI: Empress bought some Transcare ambulances at auction. If you want a photo-op before they get re-lettered, let me know. Bill

I don't think 911 dispatches respiratory therapists. I have run 12 leads for free for friends, because going to their PMD = $50 copay. I didn't complain about it. Does that qualify for the example in the last sentence of your post? I was acting as an EKG tech because the PMD office next door to the station would charge $50 insurance co-pay for the identical procedure. If you want me to complain about having to take care of people, you will have to try harder. It is what I signed up for. It is what I do. Volly and paid for 30 years. 64 hours on a quiet week. Maybe I am on the wrong site?

Oh- and one more thing: Please don't make it anyone's fault but our own that these calls tie up the medic. YOU can solve that one with priority dispatch and common sense. Stop sending ALS on calls for falls with no LOC. (Seth covered that in an earlier thread) If that is asking too much, then send medics NO lights, NO siren, in an in-service status until cancelled or the call is triaged to BLS.

I have to say I am saddened by the content of this thread. Both my parents died in 2014, and both spent time in an Atria in Westchester- they did not die there, but both were moved by EMS during their stays. It might seems obvious, but the thread makes me want to point out: These facilities DO NOT MANUFACTURE OLD PEOPLE. These pt's are going to get old and frail no matter where they live. I would rather have a safe, carpeted monitored building with AN ELEVATOR, rather than dozens of folks in dozens of private homes, UNmonitored, UNreliebly medicated, falling and being on the floor for hours before being noticed. I ma pretty sure there is no age range excluded by your EMT class. There is no guarantee of exciting calls. I BET if we issued guns to the facility staff and told them to shoot anyone that falls, so every call came in as a gunshot, there would be no problem covering, and no complaining about it (well, other than pt's and families). As per an article in the NY Times a few years back, nationwide EMS call volume is up 247% in last 30 years. More since then I bet. I have NEVER seen an EKG tech complain that a patient that needed an EKG was not sick enough for them. Never seen a RESPIRATORY therapist complain that the lungs were not wheezy enough for them to give a treatment. Never had a PHLEBOTOMIST say that they were wasting time on drawing blood on a particular pt. It is ONLY the EMERGENCY MEDICAL TECH who feels that they are only there to serve pt's they feel are worthy. I am sorry, but things don't stay the same. The job is changing. The pt population is changing. Safer cars with airbags = fewer sexy trauma calls. Meds = a HUGE decrease in V-fib arrests. Those same meds = a larger elderly population that just want to grow old in safety and comfort. Be nice, be professional: your job is to provide that. Or as one of my favorite movie lines, from Ghostbusters goes, " I am sure a person with your skills and qualifications would have not trouble finding work in either the food service or housekeeping in industries." sorry for the ad-

An authorized rep from TOH would have to answer that. I believe that other municipalities that Empress provides service for have required a "performance bond". I truthfully am not at all sure what that is. Just a guess: some type of insurance that if the provider fails, the bond pays out an agreed upon amount of money to facilitate a replacement. Sort of like a warranty, but for a service product, as opposed to a physical one. Maybe someone on this thread could chip in with accurate info, as opposed to my wild guesses? Here is what wikipedia says: https://en.wikipedia.org/wiki/Performance_bond Failure to check vendors books sort of lead to the situation in Mahopac with the FD losing track of $5million. BTW there is no word yet on a monetary agreement. It could just be for billing revenue. No true reliable info is available. 3000+ calls/year in a town with good demographics pays for a lot. I show about $800-900 thousand/year. NOT including the $1 million/year the TOH was also paying HEMS. $1.8 million for two ALS rigs is a pretty high amount.

There is a NYS DOH item on the DOH BEMS site about stopping service. I think it is more about surrendering your ambulance operating certificate though, so it may not apply in this case. It does not sound like HEMS INC is surrendering the license, they just can't operate without money. Having recently attended a meeting where Transcare was discussed, I have learned that a licensed EMS agency MUST do ONE call per month to keep their license alive. I am not sure what happens if they don't do a call per month, but it is bad. The Transcare bankruptcy folks have contracted with Seniorcare to do at least one call a month as Transcare (they likely have an ambulance with two orange DOH stickers on the windshield, one for Seniorcare, one for Transcare). SO someone are HEMS needs to set something up in the next 32 days or so, or they risk losing their ambulance license, or having to to through some DOH process to re-activate it. Meanwhile, on the Empress on-line schedule system, there are now shifts posted for 2 24X7 ALS ambulances for Harrison. Please do NOT construe that to mean there is any kind of done deal. The shifts have NOT been filled. But since they have been added to the system, then it is likely there is something in process. Once again I find myself offering condolences to a group of fellow EMS professionals whose stable working life has been upended by events they had no control over. It has got to be tough: time off planning, major purchases like homes and cars, life plans like weddings and college are now all askew. All the HEMS staff, please know you are in our thoughts. Bill

That increased visibility worked great: St Agnes is closed and the bld is now an assisted living facility. Our Lady of Mercy was bought out by Monte and it ambulance department was closed.

When we tried to get a line of duty death coverage benefit at Empress (4+years ago) we were told that no one makes such a product. Apparently there is/was no demand from private sector companies for line of duty death benefits for their employees. It makes sense; most of the jobs we consider dangerous are done by government employees. Despite EMS having a LODD rate comparable to the fire service, the demand for this kind of insurance does not exist. I will say that I personally did not research it. In a conversation with management I said that I have no issue with this type of work if we are trained, equipped and insured. I MUST be 100% confident that my widow and kids will not be evicted if I am killed doing it. We settled for $50,000 life insurance on all employees, no matter how they die. Even deaths by boredom from reading EMT Bravo posts are covered.

Very interesting how someone makes an assumption and then it becomes an (incorrect fact). Someone who THOUGHT the knew what they were talking about told me that New Rochelle fueled the NR Transcare rigs for free as part of the contract, as they fueled at the City yard. Looks like the city tracks and bills the EMS fuel costs back to the provider. Oops: I just realized that makes NR a creditor to TC. Barry, how much money is NR out for unreimbursed fuel consumption?

I have heard alternately that we have ordered either 7 or 10 new ambulances. I count us running 6 flycars now: 2 Yonkers 1 Yorktown 1 Pelham 1 White Plains 1 supervisor So a new spare or two might be needed. Note: Pelham owns the Pelham truck, but Empress sends a company spare when it goes out for service.

The RSI requirement sure limits the field of bidders. Barry: I assume this was 80 % you and maybe 20% legal dept? Does anyone have the LAST RFP for a side-by-side comparison of how it has changed?

The night tour at the ED is supposed to have 9 nurses. It is not uncommon for that level to dip to FOUR on some nights. Proper staffing will help more than additional space. Staff what you have. I guess that last statement applies to ALL of our own agencies! An expansion like this does not come without a lot of financial planning. Am-surge must have better reimbursement than the ED.

As your preceptor, I want all my time back!

No one should be out of a job. Simple math is that the number of calls has not gone down, just the number of companies answering those calls has gone down; by ONE. The staff will need to shift to other providers that are expanding into the Transcare void. Sadly though, many will lose vacation pay, salary, seniority, schedule and partners. ALL of which is very sad. A forced job change is always traumatic. Company names no longer in the picture: Abbey-Richmond, A1, AA, Approved, Ambassador, Empire, Care 1, Park, Admiral, Metropolitan, Metro-North. Hudson Valley, Transcare, National... any others? Still lots of open jobs and hiring despite all those companies going away.