sympathomedic

Empress staff. IAEP Local 20.

All of the 35 medic trucks are wired up with heaters in the back.

Hey Mark: I didn't know before now how Empress got the contract- no idea it was by a default. I had assumed it was a lost bid. before my time. If I recall correctly, when Empress lost it the last time, it was becasue of a $50,000 difference in bid price. Not sure if that was $50,000 per year, or spread over the 3 year length of the contract. Your post begs the question WHY did Affiliated do that- rotate guys out, put medics in ambulletts and other seemingly silly things? I mean, why annoy your staff to the point that they leave and you lose the contract??!! When they left Affiliated, where did they find jobs? Also, did Abbey actually lay off, or did guys just leave on their own? In the order of a history lesson, I believe it was under Transcare that the contract fundementaly changed. Originally it was set up that NR paid the provider a set amount; I think I once heard $1.3 million, in exchange for 1 ALS unit 24X7 and a second one for 16 or 18 hours a day. Again, not sure if that was per year, or over 3 years. The providor gave the City PCR copies ( no HIPPA bac then) and the City billed. Some years they broke even, most years they lost a few thousand, once ot twice there was a small profit for the city. NR basicly bought wholesale ambulance service, and sold it to their callers for retail. Then Transcare went to a zero-bid deal. They billed directly. That was when Pelham jumped off of being a NR add-on and contracted with Empress for service. As I recall, NR had been getting paid by Pelham $90,000 for use of the NR contracted ambulance when NR was paying for it. When it went to zero bid, NR still wanted to charge Pelham for a service that was costing NR nothing. Pelham didn't like that and so they made their own deal with Empress. Mark, I defer to yourself and Barry who may have better information and memory than I. ( I am sure Barry THINKS he does anyhow!).

Stat, I asked the same question. We all bill the same folks: Medicare, medicaid, automobile, workers comp and private insurance. They all pay the same rates per call, no matter who is doing the call or how much they charge. You can bill $2000, but insurance will pay what they pay, "Usual and customary" I believe is the phrase. So if Emp and TC are both doing a lot of calls (I think they are) and they are both getting paid the same amount per call (again I think they are), then why is one flourishing and the other not? A guy I spoke to who seemed to have banking industry info told me that TC has an bad billing operation. True? Who knows? It would explain things. But if that is the case, why not hire a billing consultant and say "FIX THIS!" Ego? bad management? Good companies fail every day. My heart goes out to all the folks working for Transcare. They are good people I am sure. Having this kind of instability affects a lot of things- vacations, car purchases, new home purchases and other long term planning. Like EMS folks really need another stressor in their lives!? Good luck to all of them. I hope for the best for you. Bill

Hey Willis: Can you make a video (with sound) and get it linked to the Empressems.com site?

I am going to add my semi UN-qualified 2 cents. I have been an Empress medic for 28 years, and I am the VP of our Union, IAEP Local 20. As for stability mentioned by LTNRFD (Mark, shouldn't you add "ret" after that name?): When Empress lost the NR contract about 20 years or so ago, only ONE medic and ONE EMT changed over to the new vendor. Everyone else stayed, no one got laid off. When Empress lost the WMC contract about 10 years or so ago, NO ONE left, and no one was laid off. It was a MUCH smaller contract then, only 3 providers 24X7. We got it back 3 years ago. Now it is 6 spots, 24X7 plus a lot of Txp's. When Empress lost the MV contract a while back, NO ONE went to the new vendor, no one got laid off. When Empress was displaced from the Harrison EMS flycar when Harrison started to be their own ALS rather than contracting, NO ONE switched over, no one got laid off. There was a lay off about 20 years ago, which involved about 12 EMT's. ALL of which were re-called in less than 8 weeks, and in line with our contract. This was in relation to a company strategy to avoid serving clients that were far away and time consuming. I guess it worked. I was speaking with a friend who began as a medic, like me, in 1988. He has been with TC from the beginning. I don't think Transcare existed in Westchester that early, so he may have come over from Abby. He makes about $7/hr less than I do. I also get a $4000 annual longevity bonus. So about $18,000 annual difference. What I did NOT ask is: what is his medical plan cost and coverage, how many paid days off does he get, and is there a retirement or 401K. My 401 K is well up in the 6 digits, 99% of which is Empress money from unused sick and vacation time. So it cost me almost nothing to accumulate that. I guess my point is that there some stability. Never a medic laid off in company Hx. 1 episode of EMT layoffs and all quickly recalled with seniority as contract stipulates. Decent pay and benefits, but ya gotta work hard and put in your time. One more thing, after age 50 (that's me this year!) and 25 years on the job (that's me already!) you can work 20 hrs a week and keep your benefits.

If I may add in another scenario: Someone has an MVA and DOES NOT ask for EMS and is NOT unconsciuous. Someone does call 911 and report it and and ambulance arrives. An involved person says, to the effect, "I have an abrasion on my arm from the airbag, but I am OK", or "My knee hurts from hitting the dash board but I think I am OK." I would say this common type of event makes these folks patients. On the other hand, same collision scenario- no one asked for EMS but an ambulance gets sent due to caller info and the then all involved deny any complaint. I don't think those folks are patients. If you are not sick or hurt I don't feel you area patient. I bet the DOH has some info on this commonly discussed issue, but I am far too lazy to research it and post a link. And it may vary state by state. And State policy may allow for agency protocol.

Interesting development. I would be very surprised if this was an oversight by Monte. It must have been done on purpose, but I wonder why. Monte in the Bronx is not a trauma center, so it would not be to funnel lower Westchester trauma to that ER. Anyone have any REAL factual insight as to what is behind this decision?

When I posted stuff guys on my job didn't like, they c/o to the boss, who very politly showed my the social media policy. I didn't know we had one. If I am careful, I can still post. I just don't want to hurt risk hurting the sensitive feelings of these brave men, and force them to approach the boss instead of me. Again.

In my FD, a number of years ago we had a voter referendum that raised it to $30/year. That same vote also allowed folks to continue to accrue after age 65. Prior to that it was $20/year and no accrual after 65. So for folks who were members before, the have some $20 dollar/month years and now are accruing $30/month years.

Barry I WISH THE LAWYERS WOULD HEAR IT! I feel that every time I am forced by agency policy to use RLS to a (VERY likely of not CONFIRMED non-life threatening) call I am betraying my responsibility to keep the public safe. As Thom Dick (writer for JEMS and EMERGENCY MAGAZINE) says, "If you do something you know is stupid, well, then you are stupid." I saw a stat that about 700 people per year die in collisions with emergency vehicles in North America (Canada too I guess?). If that is true, then we need to save 700 people per year by using RLS over regualar driving JUST TO BREAK EVEN! When we had medics from London Ambulance Service ride with us, they said they spend two months of class time on driving training. 3. The website "statter911.com" used to have a search feature, and he once did an article about the dozens of quotes from fire service people stating that fires doubles in size every (fill in the blank). Like 30 quotes, each with a different time. I used to be able to find it using that search feature. Then he updated his site and I cannot find that search feature, so I can't send you the link. 4. My thinking was there being no calls/ no demand for service meant that a NON RLS response would be more appropriate. Sure you need EMS to standby. You just don't need them to hurry up RLS and wait.

Not just the hinterlands. Many apartment buildings have a door buzzer system to get in that requires a last name to get the apartment on the intercom and get the door opened.

The 3% stat comes from the Emergency Care Information Center in Escondido CA. I think it actually was 2.7%. As to the 8 minute thing, we both know about the flawed logic that comes from: Brain damage occurs in cardiac arrest in 8 minutes. Therefore EACH AND EVERY CALL MUST be considered an arrest. I once found a like to about 50 quotes from fire serice leaders each giving a different time for the "A fire doubles in size every (fill in the blank)". So were does the FD get the 4 minute standard from? We should probably not send EMS with RLS to fires or barricades where there is no report of any need for them. To paraphrase, we send fire units RLS to where there is no emergency for them to handle because there is a law requiring municipalities to provide fire protection. We don't do that with medical resources because we can't afford it.

OK, so bringing it back full circle: Using NR as an example, EMS resources are NOT moved into the city RLS or otherwise even when all city EMS is unavailable UNLESS it is predicted to be hours before a city unit will be free. This is despite a constant and predictable steady drumbeat of 911 demands for EMS calls, about 3% of which are truly life and death. In the Greenville scenario that started the thread (remember back then?) a fire unit had to travel all of 10.2 miles (21 mins per Mr. Google) to cover two (Pelham and the Manor) agencies that COMBINED respond to 2 fire calls per day and maybe 2-3 actual fires per year. The crew used lights and sirens and become involved in a crash that caused $4000 in damage to their truck. (pure guestimate that RLS cut 25% off the response time= 5 minute 15 second time savings) May I assume that the response was terminated by the crash? And that no alarm came was received by PFD/PMFD while ANOTHER mutual aid company was found to replace disabled the GFD rig? And, really kidding here, did anyone respond RLS INTO Greenvile to cover until they got their rig fixed?

Barry: I assume and you can correct me, that this is because many fire alarm calls are of short duration. If 3 and 2 are on a nursing home automatic alarm and 2 and 1 are on another alarm, the feeling is that one company will be able to free up very soon. ( I assume you still use 5/3 in the Queen city). Good, idea as one of your companies would likely be free before mutual aid would even leave their own city. I think ambulance calls take much longer- esp if they have to transport to a burn/OB/Trauma center. Could you find out from DES how often all NR EMS units are tied up and for the total amount of time they are tied up (# of hrs per month?) and how often anyone orders coverage. I go mutual aid into NR from my other job pretty often and it is always to the scene, never to cover, and several have been life and death. PS: I am so sorry I kinda hijacked the thread Mr M'av: I apologize for getting these older details wrong. I thought I had heard that the Union was opposed. I am not sure what you mean by "Pushback from units in the field". Could you say what calls are low enough to be NON RLS here? Now I am curious...

Barry: 1: We agree, 90% should be no RLS. I believe the FDNY union raised a fuss a year or so back becasue they the City wanted things like outside water leaks made into NO RLS, but the Union insisted that such things are RLS. Not sure who won. I believe somewhere on the NYS DOH BEMS site is a 'suggested' policy that states to the effect, 'no RLS unless there is info indicating a true emergency'. So, no RLS for hip Fx, EDP, trip and falls, sick, fever, gen malaise, vomting, abd pain, weak and dizzy, flu, head pain, minor bleeding, dehydration,. Yup, that's pretty close to 90%. And I agree- NO RLS for ANY of those. I offer this to all those "But what if" folks... In 30 years on the bus, I have NEVER had a situation where pt outcome would have been better if the ambulance had been faster. ( not including a few where folks died waiting for an ambulance for like, an hour due to availability.) Found it: Emergency Operations - shall be limited to any response to the scene or the hospital where the driver of the emergency vehicle actually perceives, based on instructions received or information available to him or her, the call to be a true emergency. EMD dispatch classifications6, indicating a true or potentially true emergency should be used to determine the initial response type. Patient assessments made by a certified care provider, should determine the response type (usually C or U as an emergency) to the hospital. In order for a response to be a true or potentially true emergency, the operator or certified care provider must have an articulable7 reason to believe that emergency operations may make a difference in patient outcome. During an emergency operation headlights and all emergency lights shall be illuminated and the siren used as necessary. 2. Not even talking about volunteers- could you imagine if New Rochelle asked for a cover ambulance each time every NR ambulance was busy on a call? Or Mt Vernon? But if the last fire truck in those cities was then sent on a call, it would be Holy Hell- there are no fire engines in NR!!! We need to alert DES, the State, the next 3 agencies need to shift resources in there RIGHT NOW! With lights and sirens apparently.

Websters defines an emergency as immediate threat to life and limb. A big chunk of real estate that happens not to have any available fire engines in it, but also has no call pending, in my tiny brain is not an emergency. Pretty much everyday (if not all day) in this (Westcheste) County a town or large city may have ALL of its EMS resources out on calls or otherwise unavailable. The likelyhood of another call coming in is high, and the chance of it being serious is also high, yet the thought of moving another ambulance in from out of town to cover would NEVER happen, and when it does it is NEVER RLS. Yet when a Town's fire resources are all commited, it is like, Holy Crap, we gotta get crews and trucks over there ASAP, even though there is amost no chance of another call coming in, and the chance of it being serious is tiny. In the above situation, Pelham gets less than a call a day and less then a fire per year, I believe. Can anyone tell me why we fear burning to death so much more than dieing of dieing by or sudden illness, even though the latter is like 1000X more likely?

That is a very interesting observation. There would bet there are more water fatalities than fire fatalities. In my town that is the case. It would take more time than I have to research it. But I don't think more dive teams would mean fewer water deaths. Many are in swimming pools, and some are jumpers that are dead from the fall height, so dive teams wouldn't help save those people. Maybe some one can or will correct me, but I believe the biggest wate rescue operation we have, The Coast Guard, does not have divers. They save by surface rescue only. That is per the book, "Dead Men Tapping", which is a few years old. (real life story of 3 men dieing in an overturned boat while USCG rounded up private divers).

I believe the NYSP has divers. Last drill we had with DEC ESU (yes DEC has their own ESU) they were pushing for dive status but were not there yet. Much dive work is in the resevoirs.

Boxes on their 5th or 5th chassis? Holy Cow, what the heck are you guys doing to your chassis in the Lone Star State? Figuering a 3 year chassis life, are you really re-mounting a 12 year old box on it 5th new chassis new chassis? Wow!

I find PL Custom and Braun to be very good. Any builder can aquire a lemon chasis and build a nice truck on it. Electrical systems have come a long way, especially with LED lighting taking less power. With the federal KKK requriements having expires, there are a LOT of cool efficient ans safer designs coming. DO NOT get mired in tradition; it only impedes progress. Stuff I would focus on: Real seatbelts that are easy to use. That means the harness type that buckle in front and have room to let the crew move. Seatbelts will save you more than anything and face it, most of us just don't use them. EMS folks who die either get hit at the scene, or die in the ambulance, unrestrained. Get the best available hardware for the exterior compartment doors. Cheap hardware breaks and takes trucks out of service. Same for interior compartments, and MAKE SURE you get harware that snaps shut hands-free when you shut the compartment door. It SUCKS to have doors banging back and forth open while driving and you are grabbing stuff. If the hardware latches self-lock, then you just push the door shut and it stays shut, like a refrigerator. Get the thicker plexiglas interior doors, and full length handles. PL custom makes a nice cage for the on-board O2. It allows for a very secure tank but one single easy-open latch to change the tank. Those three strap deals that self-loosen totally suck, as do the three split-metal rings that never match up and you lose the nuts when you open them. Get LED interior lighting, a timer for doing rig checks and another timer that shuts it all off after 10 minutes of the engine being shut. No coming out after a bad job and finding your truck dead in the bay. Why oh why do so many squads put the portable suction deep deep inside the rig? If you need it, you are OUTSIDE the rig. Mount it where you can get it while standing OUTSIDE the rig. See if the dealer will give you a spare rig for long OOS periods. If they won't, ya gotta wonder why they won't back up what they are selling you. Ask for references you can call. Install external speakers for your radios and put them on the bulkhead behind the driver facing forward. The folks in the cab need to hear radio traffic; for they guys in back it is just a noisy distraction. Good luck. Bill

LOOOONNG ago I read that NYC had bizzare specs, like an under-the-hood fire suppresion system and roof hatch that made the cost of production way high. But that was back in the HHC days. Over time, and the switch to FDNY, maybe a NEW batch of odd demands has boosted the cost. Any FDNY EMS guys know the deal?

Based solely on media (we know how that goes) sounds like SCHOOL buses would be fine for this case. Since we are not talking about elderly or othewise compromised folks. Even better, a TAXI to bring a doc and two nurses and a registrar with a laptop to the school, out of the hot/warm zone. Treat and release in place.

Somers lets you be EMS only. Mohegan EMS was part of Fire DEPT (Not District) and seperated quite well.

That's too bad. I have found them to be the worst software providor ever. I quit one job that uses them, mostly over the softwhere, and I tried to quit another. I was really really looking forward to their painful torturous demise. Oh well, my agency that uses them has already committed elsewhere and I couldn't possibly be happier.