Suffolk County Ambulance Times Worse Then Westchester

[x635 4,066]

Interesting article published today in the NY Times about the problems going on in Suffolk County,Long Island with their EMS system. Some of their issues sound similar to ours. Also, they say Westchester has an average response time of nine minutes :roll:

Yeah, maybe for clockstoppers, but I don't think ambulances?

I think it is a good idea to mandate response times as far as dispatch protocol....how many times should an agency have to retone to get a crew....or looking at the other side....how long should we make a sick or injured person wait before care is delivered and transportation to definitive care is initiatied? It seems in this county people care more about their park or library then how fast their ambulance gets there. Why is ambulance staffing and response times still such a low priority, and why do the officers and boards of agencies put politics over people? I just dont understand, and I never will. It just seems to me that the majority feels the same way as I do, and it's only a couple of people in that "wall" thats preventing EMS from being where it needs to be.....maybe when those people leave EMS can be brought to where it needs to be.

In the old days, some of the career fire departments were created to give their members jobs.....why can't we do the same with EMS, lol? It also has a "side" benefit.............faster and more consistent care.

June 5, 2004

'The Ambulance Is on Its Way' Can Be Empty Pledge in Suffolk

By PATRICK HEALY, The NY Times

 

Summer was waning, and Bob and Phran Ginsberg were driving to their Suffolk County home after enjoying a dinner with their two teenagers, savoring their company before school resumed and everyone shot off in disparate directions.

Then, in a split-second crash of metal and glass, everything changed. The black Mazda driven by 19-year-old Jonathan Ginsberg skidded on a dark, slick curve in Lloyd Harbor and plowed into a sport utility vehicle. When Mr. and Mrs. Ginsberg came upon the scene in their own car seconds later, they found Jonathan and his sister Bailey, 15, unconscious. Mr. Ginsberg said someone nearby had heard the crash and called 911, but 20 minutes later there was still no sign of an ambulance.  

That night in 2002, the Ginsbergs discovered what is often the stark reality of ambulance service in Suffolk County: a patchwork of autonomous and sometimes feuding ambulance companies whose ranks of volunteers are declining, routine failures to record crucial emergency data and waiting times of 30 minutes or more for an ambulance.

State data shows that the average response time of emergency services in Suffolk is slower than in Nassau and Westchester Counties.  

"The system is failing," said Mitchell Savino, a former chairman of the county's Regional Emergency Medical Services Council, a state-chartered oversight group, which monitors ambulance service"Are people dying? Sure. People are dying because of this. Just listen to your scanner."

Again and again in interviews, paramedics, police officers, rescue officials and patients' families voiced feelings similar to Mr. Savino's, many sharing accounts of a system that imperils people when they are at their most vulnerable.

As New York City prepares to spend millions of dollars to overhaul its 911 system, critics say it is time to re-examine Suffolk's emergency response network, which relies solely on dozens of independent volunteer companies. The council that monitors the county's companies is pushing for major improvements and greater oversight to raise Suffolk's performance to the level of neighboring Nassau and Westchester Counties.  

The county's Department of Fire, Rescue and Emergency Services says it is trying to recruit more volunteers and to improve its response times, but the department chairman, David H. Fischler, said responders did an "excellent job most of the time" and referred to county data showing that a majority of ambulance calls are answered within nine minutes, the ceiling for an acceptable response time set by the county's oversight council for ambulance service..

But a report prepared in March 2003 by the council and based on state data found that Suffolk's average response time was about 12 minutes per call, compared with 8 minutes in Nassau County and 9 in Westchester. County officials say those figures have changed little in the past year. The quality of emergency response data in Suffolk is one of the main impediments to determining accurate response times. In a digital age, county dispatchers still record 911 callers' information with pencil and paper and walk the forms to other dispatchers who radio local ambulance companies. If an emergency call requires both fire and ambulance services, dispatchers must fill out the same form twice.

Suffolk County was recently awarded a long sought state grant to overhaul and automate its computer dispatch system.

An examination of hundreds of thousands of records for the last two years found that tens of thousands of entries were missing the location of a call, the time an ambulance left the station, or the time it arrived at the scene of an emergency.

Without good data, paramedics and officials with the county's ambulance council say, Suffolk's ambulance companies cannot properly analyze their performance and detect weak points in the system.

An examination of the county's data showed that the county received 110,000 emergency medical calls last year, and in more than 7,000 cases, callers waited 15 minutes or more for an ambulance. In at least 202 cases, that wait stretched on for 40 minutes or longer.

In emergencies like heart attacks or strokes, seconds can mean the difference between living and dying, experts in emergency medicine say. The brain begins to die four to six minutes after the heart stops, and the chances of surviving a heart attack drop to 10 percent if emergency care does not arrive within 10 minutes.

Some response delays are caused by Long Island's notoriously clogged roads and highways, and the sheer physical size of Suffolk County, which covers 912 square miles, but critics say the majority can be traced to dispatch problems and the structure of the ambulance network.

Suffolk's system is rooted in volunteerism and local control, two principles that long defined early suburban life in New York State. Today, 98 local agencies — some fire departments, some individual ambulance corps — operate the 236 ambulances that respond to 911 calls, said David Brenner, the chairman of Suffolk's oversight council for ambulance service.  

The county and the council monitor all the agencies, but the ambulance companies are not part of any broader government agency.

Many are nonprofit corporations financed by local taxes. They set their own rules for how many hours a station is occupied, and how soon a dispatcher can radio another ambulance agency for backup if a company fails to respond to a first call. Some companies wait four minutes before putting out a broader call while others wait 10, said Dr. Jeanne Alicandro, the director of the county's Division of Emergency Medical Services.  

Some ambulance corps respond to calls in other districts every day, thanks largely to a mutual-aid dispatch system, but Dr. Alicandro said many companies were still quite territorial. Some go out of their way to avoid crossing into a neighboring district when on a call, emergency officials said. Some companies hire paid responders but do not allow them to take calls from adjoining districts, Mr. Savino said. Some ambulance services have merged in recent years or hired paramedics to handle calls when few volunteers are available. But most of the services are still part-time, all-volunteer companies that handle a few hundred calls every year.

Next door, in Nassau County, service is more reliable because paid police ambulances answer about three out of every five calls for help, Suffolk county officials said.

Even the harshest critics of the Suffolk system have few complaints about the people racing to calls. In one night spent with volunteers at the Huntington ambulance corps, eight volunteers sat poised to answer calls, and a dispatcher monitored the phones and radio. When emergency tones blared, the crews ran to their trucks and reached homes in a few minutes.

But often, at many stations, no one is around to handle calls. More people are calling 911, but emergency medical technicians said the blue-collar and middle-class residents who have long made up the bulk of volunteers now work two or three jobs to afford the cost of living on Long Island.

"People don't have as much time to put into it," said Rich Becker, a volunteer emergency medical technician in Holbrook. Last year, there were 17,845 calls in Suffolk where departments described the result of the call. In those cases, 4,681 calls were passed on to a different agency after the first failed to respond.

Last month , the regional Emergency Medical Service council imposed new, stricter dispatch standards over the objections of some fire and rescue associations. They call for dispatchers to seek help from a second ambulance company if the first crew fails to respond to an alarm within two minutes.

But some emergency medical technicians questioned whether top-down directives like this can work in a system in which agencies have long been islands unto themselves.

"They can make protocols, but who's going to enforce the changes?" said Mr. Becker, the Holbrook emergency medical technician. "There's very little control with the volunteer departments. They do their own things."

For the people left waiting in living rooms and by the sides of roads, the minutes tick by as emotions go from worry to rage to disbelief. Some call 911 again and again to ask about the delays. Still others grow so frantic that they drive a loved one to the hospital themselves. When Bob Ginsberg found himself in that position in September 2002, he said, he sprinted down a dark stretch of road in Lloyd Harbor in a futile search for a doctor for his two teenage children. Mr. Ginsberg said an ambulance did not arrive for 25 minutes, and county records do not provide a clear picture of what happened that night, including the exact time between the crash and the arrival of the ambulance.

Jonathan Ginsberg survived the crash, but Bailey died at the hospital. Mr. Ginsberg said he did not know whether anything could have saved Bailey that night, but the lost minutes plague him.

"It makes me sick to my stomach," he said.  

[Guest x901]

we really aren't as bad as we think we are.........

[WAS967 97]

Yeah. Instead of not keeping times at all, some agencies just doctor them.

[Guest x901]

???????????????

[x635 4,066]

Well, maybe not such in Yonkers,where SSM and staffed buses allow for a target <8 minute response time 98% of the time, but in other areas of the county, there are very poor response times (AKA "Third Tone For A Driver" or the city will only pay for one ambulance...not only a Westchester exclusive problem though)but considering where the acceptable level should be for a county as populous and wealthy as Westchester.

As far as the doctoring times go, some agencies (and people) still do it NATIONWIDE. Whether its to hide the problem (Which, IMO, by doing that harms the public....as politicians are reactive, poor response times may equal better funding or improved EMS legislation and leadership. Well, I can hope, cant I?) Or some agencies just use clockstoppers, whether it be a flycar or medic on scene. IMO, response time should be determined by when the AMBULANCE arrives.

[WAS967 97]

I know SSM works a heck of a lot better than the old way of things, but come now. Do you really believe that Yonkers can field an ambulance for 98% of thier calls in under 9 minutes? I'm rather skeptical.

Another problem I see occurs to the north. A certain company likes to dispatch thermselves as much as possible, instead of having fire control do it. This allows only them to keep a true track of how long it takes thier vehicles to respond to calls. I'm sure if the county knew the times it took for some of the emergencies they ran, there would be some drastic changes. Now I hear that they are converting to a trunked radio system so that the local people keeping track of them can't track times and complain about it to thier local people of power. ](*,)

As for the clock stopper, I don't agree completely with you there seth. I think that if you get care rendered, then the clock should stop. But they should also track seperately what time the patient left the scene enroute to the hospital. I like the idea of first responders since it gets care to the patient and puts bystanders/familys minds at ease that thier loved ones are being cared for by someone with the training to help. But if the FR gets there in 5 minutes, but the patient does not leave the scene until 1 hour later, then we have a problem.

[x635 4,066]

To further my point:

I think both first response, ambulance, and medic on scene times should be monitored, evaluated, and tracked seperately.

What good is care rendered if your are waiting 20-30 minutes (hypothetically) for an ambulance, especially if it is a trauma or stroke, especially considering some transport times from more remote areas?

IMHO,a capable first response unit, promptly arriving,properly staffed and well trained BLS transport unit, a well trained,staffed and equipped Medic Unit arriving in a reasonable time should be the definitive on scene times that we look at when determing a systems efficiency.

Joe schmo arriving on scene with no training or equipment should not stop the clock.

[Guest x901]

well i wouldn't say that we are there 98% of the time (more like 80%) in 8 minutes then again if Yonkers actually paid for the ambulances then maybe it would be alot higher......

[Guest alsfirefighter]

"We really aren't as bad as we think we are...."

I wouldn't quite say that yet. We have massive problems that are extremely similiar to that article and a enormous amount of ego and ignorance ready to block any attempt by a higher governmental or agency attempt to fix the problems.

In my opinion suffolk has one up on us, the first step and a problem is.....admitting there is a problem!

[WAS967 97]

And even in cases where ego does not get in the way, the locals are unwilling to pay for the much needed service. Go figure. ](*,) :roll:

[x635 4,066]

Unfortunetly, EMS is one of the lowest priorities to politicians in this county, wheter it be on the local or county level of goverment.

As has been said before on this forum, politicians are reactive. Just like it took that big "scandal" at fire control to SLOWLY and eventually start to change the County DES into what it is now, it's probaly going to take another big one to even make a small dent into the EMS issues.

Trained, proffessionally-appearing, well equipped EMS personel arriving within a reasonable time......WHY IS THAT SO HARD?

And while I'm at it, why cant we dispatch via GPS/closest available unit instead of "district"?

Interesting article on FOOPS.org to supplement the above article:

Cable Service Appointments vs. Response Times: Are we missing the point?

From the above article:

So rest easy that when you call a cable company your call will be answered within 30 seconds, and that you will have someone arrive at your home in a 4 hour window, however, if you have chest pain, or an asthma attack, or a sudden cardiac arrest, there is no standard for when help will arrive.

[WAS967 97]

I like the pizza delivery analogy better than the cable one. After all, who wants to call 911 with a heart attack and be told, we'll be there within the next 4 hours? ;->

[Remember585 815]

hmmmmm

[Guest]

Today - 6/17 around 7am....

Croton has an EMS Call - can't cover it, OVAC does.

Braircliff has an EMS Call - can't cover it, PVAC does.

Ossining has an EMS Call - Ossining can't, Croton can't, Briarcliff can't, Pleasantville can't, Sleepy Hollow finally did.

EMS is good, except first thing in the morning?!

Maybe the nursing homes could check on their patients more often then shift change?!

[WAS967 97]

Please don't get me started about nursing homes..... :roll:

[calhobs 110]

ossining was able to they where on a call up in croton and as we pulled into the nursing home OVAC was pulling in right behind us. SHAC gave the call over to OVAC since it is there area and they thanked us kindly for our help and we where on our way. lets face it all we are all on the same team. we have gotten grief from other Corps. when 60 control or Mount Pleasant calls us for mutal aid. we have caught grief from those corps for being in there area after we are on scene there for 10 mins and are packing the pt. into the rig then there ambulance shows up. But OVAC showed class and grace, and thanked us for our help and we moved along . remeber this all when the crap hits the fan we are all on the same team. some corps are up right now some are down its one big wheel. here at SHAC we are riding high but sooner or later that wheel may turn. and it could be OVAC coming to SLeepy.

[Guest 39-1]

Calhobs,

Yes we are all on the same team to a point. But there comes a time when a "team" has to take responsibility for their own operability problems. The fact is that calling it a team in my opinion does an injustice to those we serve. This isn't a sport, sport is a recreation. Mutual Aid is a patch job, it may cover the call but in my opinion we lack a serious realistic standard of care when it comes to response. What is acceptable mutual aid percentages?

[x635 4,066]

I posted this in another thread, but it applies here as well.

Let's not forget that the patients in nursing homes are human beings and deserve the same quality of care as anybody else.

It's disgusting to see some crews take out the frustration of a nursing home call out on the patient and subsequently treat the patient like a fed ex package. As had been said here, the abuse of EMS by long term care facilities needs to be dealt with on a agency administrative and regional MAC level.......no matter what the call, as minor or BS as it may be, or as repetitive as it may be, your job is to CARE for human beings first and foremost.