Putnam Co. to try paid ambulances ?

[Guest]

Putnam seeks to shorten emergency response times

By SUSAN ELAN

THE JOURNAL NEWS

(Original Publication: April 25, 2006)

• The ambulances would be staffed with a paramedic and an EMT 12 hours per day during weekdays.

• During nights and weekends, the ambulance staffing would be reduced to a paramedic only.

• The "fly" car vehicles would continue to have a paramedic.

• If a volunteer ambulance can't respond to a call, the ALS ambulance would take the patient to the hospital.

• ALS units are staffed at all hours and this will allow patient transport to the hospital to begin sooner.

• If approved by the Legislature, Putnam would sign a contract with an ALS service for the roughly $485,000 a year service.

CARMEL — It's taking ambulances in Putnam longer to reach people experiencing an asthma attack or heart failure than it did several years ago because fewer volunteers can get to emergency scenes during the workday.

To reduce transport time to the hospital for the sick or injured, county officials want to try an arrangement that would allow a paid ambulance service with advanced life support on board to respond when volunteers are not immediately available.

"People don't have the time to volunteer that they had 20 years ago," said Robert Cuomo, the county's emergency medical services director, and a Patterson resident who became a volunteer in 1982.

Communities with volunteer response teams throughout the nation confront the same problem, Cuomo said.

New Castle is currently considering whether it should hire a paramedic service of its own to get better response times than it does now under an arrangement in which eight northern Westchester towns share three paramedics in an area covering hundreds of square miles.

In Putnam, between 2002 and 2005, response times of more than 20 minutes rose from 8 percent of the time to 25 percent, Cuomo points out in a 16-page proposal to modify emergency medical services.

During the same period, response times of longer than 30 minutes increased from 0.6 percent to 6 percent.

Putnam wants to try paying for daytime ambulance service 12 hours a day on weekdays when volunteers find it more difficult to get to the scene of an emergency.

Putnam currently has an interim contract with Alamo Ambulance Service of Poughkeepsie for $445,000, Putnam County Executive Robert Bondi said.

The enhanced service would cost an additional $40,000 a year, he said.

Instead of four paramedic "fly" cars for the county, the new system would provide two ambulances in the eastern half of Putnam and two fly cars in the western half.

The ambulances would be staffed with a paramedic and an emergency medical team 12 hours per day during week days. On nights and weekends, the ambulance staff would be reduced to a paramedic only.

The fly car vehicles would continue to be staffed with a paramedic.

"In a life-threatening emergency, transportation can be as important as the paramedic response," said Bondi, who has volunteered with the Mahopac Fire Department for 15 years. "We are looking to enhance the transportation component of our service."

A decade ago, the Brewster Fire Department received between 50 and 60 ambulance calls a month, said Meg Miller, a 14-year volunteer who kept records for the department. Today, the number has jumped to between 90 and 100 a month, she said.

The population has grown and includes more senior citizens living in group settings, Miller said.

At the same time, volunteers who once had jobs in town and flexible hours now work many miles away in White Plains and Manhattan, she said.

One of those volunteers is Glenn Bisogno, Miller's brother. He started volunteering in 1992 as a firefighter and an emergency medical technician, These days, Bisogno, director of marketing for Time Warner Cable New York, does a weekly Friday overnight stint for the Brewster Fire Department.

"I wish I could do more," said Bisogno, who works in Manhattan and Middletown in Orange County. "I'm not in the area to catch the calls. It's a delicate balance between family, career and volunteering."

Wylie Sypher, chairman of the board of directors of Putnam Valley's Volunteer Ambulance Corps, said his organization understands the need to address the problem of response times but would oppose any plan that would treat eastern and western Putnam differently.

The Legislature would have to approve the proposal before it would go into effect. Putnam then would negotiate a contract with a service provider, Cuomo said.

Edited April 25, 2006 by hoss

[Porsha911gt3 8]

If approved by the Legislature, Putnam would sign a contract with an ALS service for the roughly $485,000 a year service.

Any leaks/news on this, would they be staying with Alamo

[smwells 7]

I cant comment on Alamo, but I believe the existing contact will be up for renewal in the near future..

While the need to get ambulance to a scene promptly is #1, and appreciate the county's attempt at a fix, I am not sure if this proposed plan will fix the issue or create other ones...

[fitzjr11 17]

The County has received bids from 4 different companies, no decision has been made yet

[Guest]

I cant comment on Alamo, but I believe the existing contact will be up for renewal in the near future..

While the need to get ambulance to a scene promptly is #1, and appreciate the county's attempt at a fix,  I am not sure if this proposed plan will fix the issue or create other ones... 

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What they really need is 2 or 3 dedicated BLS units and to maintain the Medics in the flycars. This WILL solve the problem. The volunteer agencies have been given more than enough chances to shape up and get their units on the street in a timely fashion. While I can’t say that every call has a 20 minute wait for an ambulance, I can say that the level of service provided by a significant number of the volunteer agencies is grossly inconsistent. The county has an obligation to ensure that its citizens are provided with the highest level of pre-hospital care available and adjust/augment as needed. In all fairness, this is actually seems to be a great compromise for both the volunteers and the county REMSCO. The paid units will only be in operation Mon – Fri between hours of low manpower (6am – 6pm or 7am – 7pm), this seems like the best way of doing things while still maintaining the local volunteer agencies.

Edited April 25, 2006 by 66Alpha1

[fitzjr11 17]

With this new proposal, 2 als ambulances will have an emt staffed on it, this will provide the volunteers an emt if they only have a driver. The volunteer ambulance will respond driver alone and meet the paid emt- the paid emt will then ride on the volunteer ambulance

[Guest yzfemt108]

Is there really a down side to a paid ambulance or two in the busiest parts of the county during the day? I think not. No matter what happens you have a full crew responding to the scene. This is most beneficial to the patient. So what if it is a paid crew arriving on scene or a volunteer. If you think about it the paid crew isn't there to "steal" calls from the volunteers. They are there to asist the volunters whether it be by initiating treatment, stabalizing the patient, Begining ALS interventions and transporting if necessary. The way it should work is if the paid crew responds begins treatment and hears a volunter agency responding and the patient is in no immediate threat of death or injury then they could wait for the volunteer to show up. When everyone works together it just becomes beneficial to the patient. Say a volunter bus rolls with only a driver knowing there is a paid bus there whos to say the medic might want to ride it in the volly bus since it is bigger and he has more to work. Or even the EMT could jump on to that rig and transport. Ask yourself this which is more important, which bus the patient goes in or that the pateint goes to the hospital. Also a paid bus in some of the busier towns mean this. Say the voluntercrew rolls up on the paid crew and it's a "BS" call hey the volunter unit could pawn it off on the paid and be back in service for a second hit. Most paid people are also volunters so it's not like they are cold heartless people who do it for the money. (let me assure there really is no money in it) All I ever heare from people is EMS is a small community. It is small compared to Fire And Police. Paid, volly were all still EMS and we kinda forget it we are like family and we need to work together not fight each other. Thats how we end up going nowhere.

[Guest]

66a I agree with just about everything you say. The one great thing about this is people will get a ambulance in a reasonable amout of time for 60 hours a week. I can see now, A paid crew standing by waiting to decide to transport on the possibillity that a vac may have a qualified driver. What qualified is also varries by agency. It opens the door for the inevitable. I think for the most part vac's should stand aside and allow paid agencies to come in and provide professional service for the bread and butter calls. Unless the vac calls on the air in service with a full crew stationed in quaters. Vac's should continue to operate and support thier VFD's in support at fire scene, mva's and mci. You only need to look at the words of Bob Cuomo and Bob Bondi to see that the job is not currently getting done by any set standard. I started writing letters two years ago on this same issue. I am very glad that progress is being made.

[Guest]

66a I agree with just about everything you say. The one great thing about this is people will get a ambulance in a reasonable amout of time for 60 hours a week. I can see now, A paid crew standing by waiting to decide to transport on the possibillity that a vac may have a qualified driver. What qualified is also varries by agency. It  opens the door for the inevitable. I think for the most part vac's should stand aside and allow paid agencies to come in and provide professional service for the bread and butter calls. Unless the vac calls on the air in service with a full crew stationed in quaters. Vac's should continue to operate and support thier VFD's in support at fire scene, mva's and mci. You only need to look at the words of Bob Cuomo and Bob Bondi to see that the job is not currently getting done by any set standard. I started writing letters two years ago on this same issue. I am very glad that progress is being made.

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Well articulated, i couldnt agree more.

[smwells 7]

An additional 2 cents..

What is not mentioned in the Putnam County plan is the fact that only 2-3 (out of 14 FD & 4 VAC) departments in the county have a consistant issue with coverage.

Most of the departments are carrying their call volume with minimum issues. In some cases they are covering their calls and some of the neighboring volume.

A better plan (which was proposed) was to go with 4 existing fly cars + 1 ambulance on the east side of the county, then the ALS coverage would not be impacted.

I see the replacement of 2 existing flycars with ambulances on the proposed plan creating delays getting ALS care to a patient that truly needs it.

[BuffMedic236 0]

An additional 2 cents..

What is not mentioned in the Putnam County plan is the fact that only 2-3 (out of 14 FD & 4 VAC) departments in the county have a consistant issue with coverage.

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Well, not for nothing but I think that there is more than two departments on the east side of Putnam tha have trouble. I know that we are one of them, as well as the three other departments that surround us. We are all having issues getting out sometimes.

It's about time that the county steps in and does something about this, hopefully this is just a temporary fix. I hope that more members of other departments would take the EMT or higher course and be more readily available during the day.

As far as the ALS coverage is concerned, I have had these long talks with both Bobs, it should not be affected. The thing about this is that it is for now only a six month trial. After six months, the County will re-evaluate the need for paid EMT's.

[Guest Orpi442]

Here I go! May you all forgive me for adding my two cents. After all that is all I have.

Great the county is doing something to fix the problem hra hra. It needs to be done. We all know that we hear the call go out and we listen & listen and 15 min later they are paging out 3 corps and still no one but the medic is responding. Yes I am listening! As a paid staff at Philipstown I have actually called in to offer to do a job from the other side of the county. I really think that it hit the pile this weekend when a corp that had a prearranged mutual aide aggreement for a other corp couldn't get out really forced the hand. Good for the county.

I will not quote one of you, but this really needs to be said, What is going to happen now & we all know it is the vols will listen to the calls & will only come out for the MCIs the wrecks & other big jobs. Then at the same time they will pass off the medical calls that need the same attention to the paid staff still holding up the medic unit on a simple BLS call when the resp arrest has no one. This is facts and we all know it.

Hey if you are a volly Great, then volly and make every effort to get your bus out for every call not pick and choose. We all need each other voll 7 paid to get the job done.

[Guest alsfirefighter]

When did having only "minimal issues" become acceptable? People deserve consistant, timely service regardless of what emergency service they need. I also have always taken issue with the "reduce personnel (note I didn't say manpower that is unprofessional and not politically correct) times" concept. So if you go to staffed BLS ambulances from 7a-7p....and a family member has a MI at 6:45 you don't get the same response if you have a MI at 7:15.

I've worked in the Putnam system and the riding in of BLS calls was ridiculous when you have 4 cars covering that area and often on most days medic 2 out of Putnam Valley would be sitting in Carmel on Rte 6. In fact I think I've picked up more jobs out of medic 2 in Mahopac then I did in the Valley. Putnam finally do it the right way and stop sticking your toe in the political waters of increasing staffing in a all volunteer area. If you want 2 ambulances so be it...but leave the fly cars alone and staff the ambulances fully with 2 EMT's. If you don't need a medic then he goes in service in his car. And what time is it gonna be considered a volunteer agency isn't getting out. Then what happens when the paid ambulance is responding and a volunteer agency does get out and just wants to cancel them even if they are farther away? Or in some cases which I've had experience in, the agencies step up with the "they are trying to take this over" mentality and you want to back down and the bottom falls out again? Does Philipstown get some support from the county for being the leader in Putnam and hiring staff to ensure their citizens get coverage? Or do I perhaps look at the litigation side of it and ask if I live in Kent or Putnam Valley that because the call volume there is lesser I get lesser service with 2 ambulances on the East side of the county. Enough already...get real about protecting your citizens...this NY home rule crap costs us safety and level of response. Why do they have state requirements on law enforcement staffing and not fire or EMS. I can say why but the thread would probably be shut down even though its the truth not a bash, and sometimes the truth hurts. I don't want volunteerism to end, I want to enhance it with common sense combination departments that can work together when ego's are left behind and proper leadership is put into place to make it work.

What everyone everywhere needs....

1. A standard response that is consistant.

2. Persons with open minds that realize its not about them, the agency or volunteers who can come up with good solid funding ideas. Like getting a system from insurance companies much like the fire service 2 % funding. (Even though that needs to be revamped also). Adding a small fee to all building and road permits that will generate funding for EMS, etc.

[Guest]

When did having only "minimal issues" become acceptable?  People deserve consistant, timely service regardless of what emergency service they need.  I also have always taken issue with the "reduce personnel (note I didn't say manpower that is unprofessional and not politically correct) times" concept.  So if you go to staffed BLS ambulances from 7a-7p....and a family member has a MI at 6:45 you don't get the same response if you have a MI at 7:15. 

I've worked in the Putnam system and the riding in of BLS calls was ridiculous when you have 4 cars covering that area and often on most days medic 2 out of Putnam Valley would be sitting in Carmel on Rte 6.  In fact I think I've picked up more jobs out of medic 2 in Mahopac then I did in the Valley.  Putnam finally do it the right way and stop sticking your toe in the political waters of increasing staffing in a all volunteer area.  If you want 2 ambulances so be it...but leave the fly cars alone and staff the ambulances fully with 2 EMT's.  If you don't need a medic then he goes in service in his car.  And what time is it gonna be considered a volunteer agency isn't getting out.  Then what happens when the paid ambulance is responding and a volunteer agency does get out and just wants to cancel them even if they are farther away?  Or in some cases which I've had experience in, the agencies step up with the "they are trying to take this over" mentality and you want to back down and the bottom falls out again?  Does Philipstown get some support from the county for being the leader in Putnam and hiring staff to ensure their citizens get coverage?  Or do I perhaps look at the litigation side of it and ask if I live in Kent or Putnam Valley that because the call volume there is lesser I get lesser service with 2 ambulances on the East side of the county.  Enough already...get real about protecting your citizens...this NY home rule crap costs us safety and level of response.  Why do they have state requirements on law enforcement staffing and not fire or EMS.  I can say why but the thread would probably be shut down even though its the truth not a bash, and sometimes the truth hurts.  I don't want volunteerism to end, I want to enhance it with common sense combination departments that can work together when ego's are left behind and proper leadership is put into place to make it work.

What everyone everywhere needs....

1.  A standard response that is consistant.

2.  Persons with open minds that realize its not about them, the agency or volunteers who can come up with good solid funding ideas.  Like getting a system from insurance companies much like the fire service 2 % funding.  (Even though that needs to be revamped also).  Adding a small fee to all building and road permits that will generate funding for EMS, etc.

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Way to lay the law down als.

[Guest]

From the begining the ALS fly cars in Putnam have ben paid emts for vac's. Nothing new here. I sure would like to see the entire 16 page report. I think the two ALS ambulance's will serve the county well for now. It will cut down on the amount of mutual aid requested. Leaving towns that can provide the service alone to do so. If only the people that impede progress can be kept at bay.

[JetPhoto 626]

Why did it take so long? Why didn't local services do something sooner? I suppose a county wide system for back up would be decent though. It deffinitly can't hurt.

[Guest]

Any leaks/news on this, would they be staying with Alamo

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DOES ANYONE KNOW IF THE 445,000 PUTNAM PAYS NOW IS PER FLYCAR MEDIC OR FOR ALL FOUR? AND FOR 40,000 DOLLARS MORE THEY STILL GET 4 MEDICS BUT NOW TWO WILL BE IN AN AMBULANCE WITH 2 EMTS AND 2 WILL BE IN FLYCARS? ALSO DOES ANYONE KNOW WHAT AMBULANCE COMPANIES THE RFP WAS SENT OUT TO?

Edited April 27, 2006 by ziggy

[John Meeker Jr 0]

Why is it the county's job to make sure there is an ambulance?

When is 911 going to be able to determine an emergency from a taxi ride.

When are people going to use an ambulance as a last resort. Only after you tried your friends and family first, unless there is a true emegency.

The current ems system is an outreach of carring neighbors to help those in need. It was not ment to be funded at the county level. If a VAC can make calls it should be their call, its their neighbors in need. If there is to be a county wide ems then there should be an county wide vote with an impact statement to the average person and a note about the added cost to the user.

The biggest problem is we the service providers are being told that if someone dials 911 then we become totally responsible regardless of emergency status. 911 should be able to ask is this an emergency or can it be handle by the people on scene and let the individual state that it is truly an emergency not just a paniced call for help that is not needed.

How often do you call an ambulance?

[Guest]

Ziggy I could be wrong but 445 is for all 4 medics they bill for all ALS rides and pro buno the BLS rides when no emt is available. I could be wrong and corrected in minutes. For sure alamo/sloper has provided Putnam with a premium service for years.

[EJS1810 7]

Why is it the county's job to make sure there is an ambulance?

A;  The County is stepping in because the local AHJ's refuse to recoginize and fix a problem.

When is 911 going to be able to determine an emergency from a taxi ride.

A:  It is not the 911 Dispatchers job to determine what is and is not an emergency.  If a Department or Agency wants to send us a directive saying that they will not respond to this or that type of call then we could tell the calling party that XYZ FD or VAC does not provide that service.  Until then if you ask for an Ambulance, it will be dispatched.

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[Guest alsfirefighter]

Now I know why we get along so well Homer....scary...but like you say...we are not part of the kinder gentler fire and ems system. I had fun the other day.

When local governments can't get their crap together...then someone else needs to step up. There are places statewide that need to knock the parties off in fire districts and get real with funding for real issues. If my fire district told me they need to increase funding to staff ambulances...I'd vote yes yesterday. And if you explain that funding is going up to increase staffing and service...the majority would be ok about it and those that aren't will complain for a month or so and forget about it, and most of the complainers would come from the agency itself. Why? To have something to b**** about or they can't get over themselves or their minds the size of a pea if that.

Want to fund better EMS in some fire districts. Buy common sense apparatus, that is functional, not just big with toys on it. Look at the ambulances that you buy in that district. Is a 130,000 box the answer? Is the patient gonna survive because you can stand up or walk 360's around the stretcher without tripping? Again, buy something common sense, not because its similiar to what you have and it looks nice.

[John Meeker Jr 0]

It is the dispatchers job to figure out what the emergency is.

And then direct the correct response to the scene, police, fire or ambulance. They can also assist the caller in determining what is actually going on. and then if an emergency actually exists. Of coarse if they are just screaming then the dispatch will have to fall back on protocal. I know it is never cut and dry but I don't like hering that government wants to through money at the problem with out asking those who will pay and those who are trying to play.

It is like having a county fire coordinator seeing a chief doing something incorrect on a scene and telling the chief that the county coordinator will take over the scene. Well that is not how it is done and that would be unacceptable in the fire service. The county should be there to help, not take over a service. Some one also has to ask for the help. Who is doing the asking here?

Maybe I don't know the whole picture but I don't like the take over attitude that I am seeing.

[RWC130 594]

Anyone who monitors Putnam County 911 knows they have a problem.

We can bash the "Pro's" and "Con's" of this ALL day and night but I have a lot of respect for Putnam County for a few reasons.

1. Recognizing you have a problem!

2. Actions to make improvements!

3. Most important above all ego's is something we seem to forget....

PATIENT CARE!

Maybe some other EMS agencies and Counties can learn from this.

Hat's off to Putnam County! Good luck.

Just my Two Cents.....Enough said.

[Guest alsfirefighter]

I'm still with homer, or is homer with me being I posted before him? lol..oh well either way.

John your comparison of the county looking at fixing its EMS problems with the CFC at a fire scene is apples and oranges. Your talking about being on a scene and we are talking about an entire system here. Taking over? Well perhaps in a way....I look at as ensuring people are getting consistant appropriate care.

As far as your fire scene comparision...if I CFC was on a scene and serious safety issue were occuring I certainly hope he wouldn't stand there. No different if I see a EMS provider providing inproper dangerous care. If there was a fire department that consistently dropped a high number of calls and had to rely on outside M/A agencies to cover and even that didn't ensure a prompt response then the CFC needs to get involved to ensure that coverage is given. Didn't a fire department in Putnam get disbanded due to low personnel and coverage?

Its about time but good to see big brother is watching sometimes when it comes to personal safety of citizens.

[trauma74 111]

A BIG AMEN for all the posts that support this idea. There are many other counties in our area that need to step up and do the same thing!

[John Meeker Jr 0]

I know of a fire department up in columbia county that was taken over by a neighboring department do to lack of ability to cover their own call.

I still feel the county is the wrong level to oversee what has been a town level service. If the local agency is failing to do what is felt to be needed then the town would be obligated to step up and find solutions. If most of the towns in Putnam County have yelled for help then I could see the county proposing a solution. No where have I see any word of Carmel looking to replace any of the three ambulance services in there town. They obviously do not see the problem.

That where I am having a problem with the county stepping in.

[WAS967 97]

Response issues have been a problem at verious departments in Putnam for a while. Have they done anything about it? Have they supplemented thier crews with paid staff during hard to cover hours like other local corps (Peekskill, Phillipstown)? If the county doesn't do anything, who will? The corps themselves? History seems to reflect an answer of "NO".

[Guest]

I am glad Putnam County is doing something about getting ambulances out to the people that need it, face it, its time to think what is best for the patient not the FD or VAC. However, are there any talks about the county hiring the EMT or is that going to be left up to the private ambulance company. I am also interested in what are the other companies that put bids in are. Safe night everyone.

Anthony P.

[Guest]

tanker42 Apr 1 2006, 06:26 PM Post #3

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Group: Members

Posts: 40

Joined: 22-April 05

Member No.: 2,203

Interesting topic for me, I will give an example of a call that went out this morning. I will not give the depts name.

08:21 Dept A dispatched to a delta level call 80 yom standing fall leg injury (broken hip)

then repeated

08:23 Re-dispatch no call ins

then repeated

08:25 Re-dispatch Dept A a full crew needed bla bla bla

then repeated

08:26 Re-dispatch Dept A needs a emt and driver to complete call last call beforre mutual aid

then repeated

08:27 Re-dispatch Dept A B C Delta level call for a 80 yom standing fall leg injury full crews needed from B and C an emt and driver needed from A Dept

then repeated

08:33 Re-dispatch Dept A B C D E (5 Depts called mutual aid for a delta level call)

then repeated

this continues till 08:42 a driver calls in so the ambulance can respond driver an attendant alone.

08:48 Ambulance A responding

08:52 Ambulance A on scene

The answer to the question about response times in this case is about 31 minutes

I would like to say that this is an unusual occurance but its not, thats where I live.

where I work under 5 minutes anytime everytime

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FIRE IN THE HOLE!!!

This is a post i made on 04/01/06 in another thread , I have several other documented calls. The thing about this one is, it was on a Saturday morning when all the vacs should of been able to staff the rigs. I like the idea of staffing the ALS rigs with EMTs on weekdays. What i would like to say to all the BOBS is Dont stop there. Dont let the EMS council come up w/stupid solutions to serious problems. Years have been wasted hanging out shingles, shared emts, The current mutual aid system.

[JetPhoto 626]

tanker42  Apr 1 2006, 06:26 PM Post #3 

response times in this case is about 31 minutes

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And I thought departments had it bad in Dutchess where there can be 20 minute response times. (sometimes from a private ambulance service)

I want a county fire department too!