Putnam ALS- Apparently Official Now

[PC414 0]

http://www.lohud.com/apps/pbcs.dll/article.../607260359/1017

PC414

[Guest]

Dum dum dummmmmmmm

PC-420

[Guest]

Monday through Friday. A volunteer ambulance team would have five minutes to assemble a crew before Empire State responds. On nights and weekends when volunteers are more available, Empire would provide paramedic service but not transport.

Can some one clear this up? Currently a medic is dispatched on all calls in the county. Does this mean that esa will only be dispatched to bls runs after 5 minutes ? Maybe above is typo or mis quote. also good luck esa.

[Guest Orpi442]

I really think that there is a lot more that is not written in the article & what was implied. Not for not has anybody actually see or read the mins from the legs meeting? I really do not think this is over yet. if so somebody could be in a little bit of a problem. We will all have to see. The article did not jive with some actual live events.

[Guest]

Monday through Friday. A volunteer ambulance team would have five minutes to assemble a crew before Empire State responds. On nights and weekends when volunteers are more available, Empire would provide paramedic service but not transport.

Can some one clear this up? Currently a medic is dispatched on all calls in the county. Does this mean that esa will only be dispatched to bls runs after 5 minutes ? Maybe above is typo or mis quote. also good luck esa.

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To clear this up for you:

First of all, medic's are not dispatched on all ems runs in the county. Putnam 911 recently (this is over 6 months back) started to prioritize dispatching to more efficently utilize the 4 ALS units in the county. The dispatch center will tone out the following calls Alpha - BLS unit , Bravo - ALS/BLS unit, Charlie - ALS/BLS unit, Delta - ALS/BLS unit, Echo - ALS/BLS unit.

The ambulances on the eastern side of the county will be a medic/emt unit. EMTs will be on duty probably for 12 hours, maybe 6a - 6p or 7a - 7p (thats really up to empire to determine). So, lets say brewster cant get a crew out for a call Monday morning - Empire will be dispatched as part of the mutual aid ( so youd have Brewster, Patterson, ESA 1 ambulance needed to respond....). This is how it was explained to me, it could have chanced since offical word came down. After the EMTs are off duty the medic will just use the ambulance as a flycar (just...alot bigger and slower lol). Again, this is what i was told - empire and the county could have changed it by now.

And yeah, the article was misleading for sure. It read as though Alamo was the one with response time/patient care issues - which is furthest from the truth.

Edited July 29, 2006 by 66Alpha1

[JohnnyOV 2]

To clear this up for you:

First of all, medic's are not dispatched on all ems runs in the county. Putnam 911 recently (this is over 6 months back) started to prioritize dispatching to more efficently utilize the 4 ALS units in the county. The dispatch center will tone out the following calls Alpha - BLS unit , Bravo - ALS/BLS unit, Charlie  - ALS/BLS unit, Delta - ALS/BLS unit, Echo - ALS/BLS unit.

so whats the difference between bravo-echo level calls?

[Guest]

so whats the difference between bravo-echo level calls?

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Alpha - EMS assists (like - helping grandma from the car to the house), most intox, standing falls, joint/most limb injuries, most types of pain/general illness

Bravo - MVAs, back/abdominal pain, unknown medical, some intoxes, medical alerts, etc.

Charlie - over dose, dehydration, some medical

Delta - any medical problem with a history, diff breather, chest pain, MVAs w/ confirmed mechanisim (ie: rollover, car v. tree/pole, etc.), trauma w/ LOC

Echo - cardiac arrest/respritory arrest

all of this is dependant on what information is given to the call taker so depending on what he/she gets determines the assignment. PC1414 can probably give the actual critera for each designation.

Edited July 29, 2006 by 66Alpha1

[PC414 0]

I don't know much to add, Alpha - seemed like an excellent summary to me! Maybe I'd add that most calls involving some kind of "unknown status" are "Bravo."

An interesting aside is that, as developed, the Bravo protocol does NOT include ALS. It was originally meant to be a "hot" BLS only response. Putnam County, when implementing EMD, decided it would be better to change the Bravo dispatch to include ALS. No idea how common that is.

As practiced in Putnam: Alpha level - BLS only. All others - ALS sent on original dispatch. Practically speaking, response modes are addressed by local agencies and not by the County. No one here monitors lights and sirens for Alpha level (or whatever). The designators give some sense of "seriousness," although, frankly, I don't believe that is/was the intent as developed. It may be a misconception on my part, but Alpha level calls don't seem to generate the quick call-ins an Echo level call usually does. Alpha level isn't BS though - could include broken bone, amputation (non-dangerous body area, of course), etc.

As written/developed ("cold" and "hot" response are terms used in protocol - not really defined but assumed, by me anyway, to indicate use of lights, siren and level of urgency).

Alpha - BLS "cold" response

Bravo - BLS "hot" response

Charlie - BLS "cold"/ALS "cold" response

Delta & Echo - BLS "hot"/ALS "hot" response.

I'm about 99.9% certain (but too lazy right now to either check online or in the textbook), that the protocols were originally developed (Salt Lake City) to determine an "appropriate level of response" to limit liability issues. Like, "Why were you going lights and siren and hit the other car for a dislocated pinky?"

It works but it sure ain't perfect.

Hmmm ... guess I added more than I thought ...

PC414

[Guest]

see this is what is confusing. say its a bravo level call, under current guidlines a esa ambulance with a medic and emt is dispatched ( day tours 6-6). Why would you need to m/a to patterson, A fully staffed bus is enroute at time of dispatch. The article states they will have to wait 5 minutes before dispatching the esa crew Why Why

The Legislature approved the change as a pilot program earlier this month. The two new ambulances would be on call from 6 a.m. to 6 p.m. Monday through Friday. A volunteer ambulance team would have five minutes to assemble a crew before Empire State responds. On nights and weekends when volunteers are more available, Empire would provide paramedic service but not transport.

Was the legislatures mis informed about something?

pc 414 wrote

So, lets say brewster cant get a crew out for a call Monday morning - Empire will be dispatched as part of the mutual aid ( so youd have Brewster, Patterson, ESA 1 ambulance needed to respond....).

on what level calls is this I thought the whole idea was to improve response times. they will wait 5 minutes before dispatching a staffed crew minutes away. The idea of this is to end the need to go m/a to cover medical calls.

pc 414 wrote

First of all, medic's are not dispatched on all ems runs in the county.

I hate to burst your bubble but I have personally rode as emt/driver and taken the medic on alpha level calls. because of under staffing. ergo the reason for change.

emsjunkie wrote

whats the difference between bravo-echo level calls?

no differance in response level ?

from what i understand the reason als is sent on bravo level calls is to guarantee that some sort of care arrives in a timely fashion. For the official reason make up something good.

Lets face it ems in putnam county is broken. Hopefully with the new pilot program change can come about.

In no way are my comments meant to disparage the brave and dedicated men and women of vacs in putnam .

Edited July 30, 2006 by tanker42

[PC414 0]

Good questions

I'd just be guessing as there has been nothing passed on through the office at this (still) early stage. I would suspect that the article may not be 100% accurate (constraints of space/editing, misunderstanding/misinterperetation by the reporter, etc.), at least based on logical questions such as you raise.

Gonna' be lots of speculation for a while. Sorry I know of nothing concrete to help.

PC414

[tglass59 27]

AS A TAXPAYER A HOMEOWNER A HUSBAND AND A FATHER, I DO'T CARE WHO SHOWS UP PAID OR VOLUNTEER EMS AS LONG AS THEY GET THERE FAST. THAT FIVE MINUTE WINDOW THEY TALK ABOUT, HOPEFULLY THERE ON THERE WAY TO MY HOUSE IN FIVE MINUTES. FIRE, POLICE, AND EMS SHOULD BE A TOP PRIORITY REGARD OF CAREER OR VOLLIE, ITS ABOUT GETTING THERE IN A TIMELY MANNER AND PROVIDING A SERVICE.

[Guest]

Tanker, like 1414 said, alot is still unknown as to how the county wants to handel the new system. Maybe the county has decided to staff 2 BLS only units in addition to the medic flycars, i really dont know. As per the article in the JN, i would take that with a grain of salt, it was poorly written and the facts are shoddy.

[Skooter92 7]

Daytime: 2 ALS flycars, 2 ALS ambulances.

Nighttime: 2 ALS flycars, 2 ALS "flybuses".

Weekends, I believe are covered by flycars only.

PM ImpMedic. He can clear it up.

[PC414 0]

Well, a couple of things, this hot afternoon ...

Tanker, not sure if I'm misreading or something but no "bubble to burst" for me. Not disputing that you've ridden with a medic on an Alpha level call in the past (or even the reason Putnam is sending them on Bravos now). Just information in my original post and not commentary or editorial at all. The fact is, though, that since instituting the EMD program not quite a year ago, we do not send medics on Alpha level calls - even when they can't be staffed. We just keep going mutual aid until they are covered by a BLS crew. Possible exceptions to that based on a unique experience? Sure, or I'd so imagine but there is a STRONG emphasis on protecting the tiered-response in dispatch that comes from the top down.

I also got quoted for an awful lot that I didn't actually say or write but that may just be a function of the "Reply" button, I don't know.

If I came across in my post as disparaging or something, I apologize. Just recounting the things I have to practice four days out of every six for at least eight hours a day. I have no personal vested interest in the way agencies are dispatched, respond or anything else. I do what the bosses tell me to the best of my ability and adapt as new directives come down.

Generally speaking, the "line-up" that Skooter92 detailed is accurate, I think. My comments about the "unknown" refer specifically to the questions raised earlier about mutual aid dispatches after 5 minutes, not to the specific number of medics and so forth on duty in the County.

Again, if anything I've added to the conversation has rubbed anyone the wrong way, feel free to PM (or continue to discuss same here). That was certainly not my intention.

PC414

[Guest]

Tanker, you could have been riding at a time in which the medics were allowed to tech BLS calls (IE: if they were dispatched on a bravo that met the criteria for handing off to BLS) that could not be staffed (b/c the vollies couldnt get out). That stopped some time ago, however.

[Guest]

Thank you all for the replies !

PC this is just a hot topic for me. Thank you for your info.

I to went out for a ride this hot afternoon to cool off. I think I figured it out. Politics.

In order to give the vacs a chance and assemblance of some sort of crew the five minute wait. Change the response levels to bls only on bravo level call. no crew after 5 go m/a. Then use the driver alone w/ ma EMT or other variances. just a theroy.

As the article states they will wait 5 before going m/a . So that means vacs are back up to at least 8 to 10 minutes mark just to get out the door.

I see this plan as a way of hog tieing the new vendor. Instead of just letting them cover the call and be able to charge for thier service. A vac ambulance staffed driver alone using the esa emt would not be able to charge anything. That would allow the als unit to stay in service, but would still have to pick up crew at hosp.Let esa cover all the bread and butter ems jobs on the eastside of county and dispatch them on the originial call. use tha vacs in support of thier fd activities piaa's,mci's,fire scenes. If the breakfast club is in quaters at vac dept A and calls p-911 and says we are fully staffed and want to cover all calls in our district from 8-12 well hometown rules rule.

I really like the choice of esa, I wish them well, I hope they offer up thier transport ambulance in times of need . You often see them sitting around for hours in between transports.

I dont see a 9 yom w/a broken arm as a alpha or bravo level call. I see a child in pain in need of care in a reasonable amount of time.

[PC414 0]

"I don't see a 9 yom w/a broken arm as a alpha or bravo level call. I see a child in pain in need of care in a reasonable amount of time."

Well said, Tanker, throughout.

Thanks.

PC414

[paratrooper75 41]

This is just the first step in an inevitable direction. The day is going to come where the county will initiate an all paid municiple service to handle all EMS in the county. I'm not saying its close but its going to happen. EMS is growing faster than ever with the population increasing and the advances in pre-hospital care. I myself am a volunteer as well as career and I have to say although the VACs are very proud and dedicated you can't be sacrificing patient care for the sake of keeping a volunteer organization happy. When it comes down to it, there is no guarentee when you call 911 that you'll have an ambulance at your door at a reasonable time. Try to tell a mother that her son wouldn't have died if he had just gotten to the hospital ten minutes sooner.

The mentality of an everday vollie knows two words "ego" and "excitement".

Professional over volunteer anytime!

[EJS1810 7]

The mentality of an everday vollie knows two words "ego" and "excitement".

Professional over volunteer anytime!

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Comments like this add nothing to the dicussion

[Remember585 815]

I don't do what I do for those two words, it's more of a "service to my community."

Nice input though, this thread was DYING for some stupidity.

[BuffMedic236 0]

The mentality of an everday vollie knows two words "ego" and "excitement".

Professional over volunteer anytime!

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You know, this is what gives paid providers a bad rap. I am paid and volunteer, and I am professional in both jobs.

You should be ashamed of making such a comment!

[Guest]

Well, its no question that the county's decision to staff an ALS/BLS ambulance during weekday hours does present some complicating questions IE: Will volunteer members disreguard pages knowing that a full crew is already enroute reguardless of nature? Also, will residents grow weary of the volunteer organizations when a fully paid crew arrives on the scene of an ALS job and cant transport before they give the vollies 5 minutes? Only time will answer these questions, but your not going to see the local VACs fail any time soon and the county is deffinately not going to revert to an all-paid municiple EMS system (Hell the PCSO has been operating w/o a contract for years!) the money isnt there.

Edited August 3, 2006 by 66Alpha1

[PVFD113 6]

Remember this phrase--

UNPAID PROFESSIONALS

We all must act professional, the communities we serve count on it!!!

[Skooter92 7]

Who cares who shows up-as long as they are timely, equipped, knowledgeable and act in a manner so as to convince all that they are there FOR THE PATIENT.

If you don't fulfill the above, I don't care whether you are paid, volunteer, Martian or from Uranus.....

You are NOT a professional.

No further, no further on the thread, K, per the officer on scene.

[Guest]

as a Brewster vollie (the busiest in Putnam) and ESA professional all I think about is God forbid my Grandma is c/o c/p and my agency can't even pick up the phone and call Putnam 911 before 5 mins. I'd rather she walk to PHC before waiting for Pawling (paid EMS) to be dispatched 30 mins+ later into the ordeal, as much as I love BFD where I first got my FF/EMT experience... anyone who could give service to my family when most EMT's are at work, or busy, are much appreciated and needed... who cares if they charge or their past reputation... as long as my grandma can get to the hospital ASAP and in somewhat goodhealth IM HAPPY!