Putnam Co. to try paid ambulances ?

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Prolonged ambulance response time prompts call for paid EMT service

By: Eric Gross 04/28/2006

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CARMEL - Putnam County's emergency services providers are a dedicated group of men and women yet during the past few months on at least 90 occasions, it has taken 20 minutes or more to get a rescue rig to the scene of an emergency.

The Putnam Bureau of Emergency Services realizes a crisis exists across the county and on Monday officials met with members of the Putnam Legislature's Protective Services Committee to outline a plan that will hopefully remedy the situation.

Commissioner of Emergency Services Robert McMahon, Deputy Commissioner Adam Stiebeling and the county's Emergency Medical Services Director Robert Cuomo outlined the proposal during a 45 minute presentation to the lawmakers.

McMahon explained that the single most important problem facing volunteer EMS systems was a lack of available volunteers particularly during the day. "Despite efforts to increase recruitment and retention, the problem continues to worsen," he told Legislators Terry Intrary, Mike Semo and Sam Oliverio who comprise the committee. Legislators Mary Ellen Odell and Tony Hay were also in attendance.

With the cost of advanced life support rising, McMahon said the most efficient and cost effective approach to addressing the ambulance response problem was to develop a single solution that combined advanced life support (ALS) with ambulance transport capability.

Currently, four paramedic fly-cars patrol the county, 24-hours a day, seven days a week. This service is provided by the Alamo Ambulance Company, located in Dutchess County, at a contract of $445,000 for Putnam. McMahon explained for an additional $40,000 a year, the county would be provided the enhanced service.

The proposed system would provide two ambulances on the eastern side of the county with the two flycars remaining on the western side. The ambulances would be staffed with a paramedic and EMT 12 hours per weekday. During nights and weekends, the ambulance staffing would be reduced to only a paramedic.

Cuomo told the lawmakers in the event a volunteer ambulance was unable to respond to a call, the ALS ambulance would transport the patient to the hospital. "Since ALS rigs are staffed around the clock, this will result in a better response time and will also allow patient transport to the hospital to begin sooner," he said.

Cuomo forecast the new plan could be implemented as early as this summer with a second phase involving the county implementing its own ALS system by obtaining a New York State Health Department ambulance operating license in the years to come.

Legislator Intrary who chairs the Protective Services Committee called the proposal "right on the mark," while Legislator Semo said he "completely agreed" with the plan.

However, in an attempt to quell rumors and any misunderstandings among the county's EMS force, Intrary asked McMahon to set up a round table discussion next month so that "any and all questions and concerns can be addressed. We are not calling for the elimination or abolition of the volunteer EMS corps in Putnam County. Local volunteer ambulances will still be dispatched first and will be the primary ambulance for local calls. The ALS ambulance would only transport a patient if the volunteer ambulance could not assemble a crew."

Legislator Hay inquired about ALS ambulances billing patients for BLS transports.

Cuomo said insurance covers the calls. "In fact, Medicare billing works better for both the patient and the service when the billing agency is the agency that transports the patient. Patients would either pay nothing out of pocket or a small co-pay, depending on their insurance policy," he said.

Seven fire departments currently operate ambulances in Putnam County along with four independent ambulance corps. The fire departments include: Brewster, Kent, Lake Carmel, Mahopac, Mahopac Falls, Patterson and Putnam Lake while the ambulance corps consist of Carmel Volunteer Ambulance Corps, Garrison Volunteer Ambulance Corps, Philipstown Volunteer Ambulance Corps and the Putnam Valley Volunteer Ambulance Corps.

©Putnam County Courier 2006

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[RU 911 0]

Another component to this problem that no one has addressed is the location of some of these calls that are going unanswered for 20 minutes. They are facilities such as nursing homes and assisted living senior housing, that are calling 911 for BLS transports. ex Elevated temps, G-tube reinserts, we all know them. They don't want to wait the 30 minutes for the contracted Ambulance to get there so they call 911 and it takes 20 minutes of paging and another 10min for the crew to assemble and respond and they still waited 30 minutes. But they called 911 and feel better about it. So now these 2 ALS ambulances will be tied up taking these BLS pt's to the hospital and the person having the MI on the east side of putnam will have to wait for medic 1 or 2 from the west to cross over to the east side. We all know what an easy task that is in Putnam County. We will have to watch this one and see.

There is my 2 cents.

[92DLt 0]

Nursing home or not if you call 911 you deserve a quick response. It is unacceptable to only provide fast response to the "glory" calls because thats where the war stories and newspaper articles come from. Remember, every person in that nursing home is someones mother, father, brother, sister, etc. People call 911 for a lot of reasons and yes, a lot of things people call 911 for are things we wouldn't classify as emergencies--regardless of our personal opinions we all have a responsibility when we decide to become an EMS professional to provide the fastest and best service we can when someone picks up the phone and the tones drop. We don't choose the job the job chooses us, and if you're not willing to go to a nursing home at 3am for an injuries from a fall but you're willing to leave Christmas dinner for the 5 car PIAA with entrapment you're in it for the wrong reasons---my two cents.

[PC414 0]

"Another component to this problem that no one has addressed is the location of some of these calls that are going unanswered for 20 minutes. They are facilities such as nursing homes and assisted living senior housing, that are calling 911 for BLS transports. "

While you are right in noting that "some of these calls that are going unanswered for 20 minutes" are at "facilities such as nursing homes and assisted living senior housing," the emphasis should be on "SOME."

I may have misread your emphasis or the point you were trying to make and, if so, I apologize.

Statistically speaking, though, the facilities you identify represent a relatively small percentage of the total call volume within the County, as well as a relatively small percentage of the number of calls which go unanswered for 20 or more minutes. Additionally, the significant difference in terms of response times seems to be time of day and not the location or nature of a specific call.

We can have as much difficulty covering a call for chest pain with difficulty breathing as we do for an (apparent) BS run to a nursing facility, depending upon the time of day. Conversely (and speaking in a general sense), the ambulance corps which cover these facilities respond in a timely and professional fashion even for (apparent) non-emergencies when they have adequate staffing available.

When my department had trouble getting our ambulances out during the daytime, we entered into a contract with Northern Dutchess to provide the people of our community with better EMS care. Volunteers who are able still respond as before. Limited manpower doesn't prevent timely care as it once did, though.

While I'm not sure how the new system in Putnam County will ultimately work out, it seems to be a step in the right direction.

I guess time will tell.

PC414

[Guest]

THE ANSWER IS SIMPLE THE PEOPLE NEED TO RECOGNIZE THAT THEY NEED TO HAVE THEIR OWN EMS AGENCY NOT BORROW OR RENT SOME ONE ELSES,EVERY TOWN ,VILLAGE CITY NEEDS TO HAVE ONE ITS TIME THAT PEOPLE WOKE UP,IT'S WHAT IS BEST FOR THE PATIENT ..........................................

[Guest]

Nursing home or not if you call 911 you deserve a quick response.  It is unacceptable to only provide fast response to the "glory" calls because thats where the war stories and newspaper articles come from. Remember, every person in that nursing home is someones mother, father, brother, sister, etc.  People call 911 for a lot of reasons and yes, a lot of things people call 911 for are things we wouldn't classify as emergencies--regardless of our personal opinions we all have a responsibility when we decide to become an EMS professional  to provide the fastest and best service we can when someone picks up the phone and the tones drop. We don't choose the job the job chooses us, and if you're not willing to go to a nursing home at 3am for an injuries from a fall but you're willing to leave Christmas dinner for the 5 car PIAA with entrapment you're in it for the wrong reasons---my two cents.

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I completely agree with this comment. It doesn't matter who calls 911 or what the call is for. Someone determined that it was an emergency and need help right away and it should not be an unreasonable request.