Putnam County ALS and EMS

[helicopper 1,050]

Let me see if I understand this...

If Ambulance X can't get a crew out - Empire's medic unit (ambulance) will transport the patient effectively taking a medic unit out of service for a BLS call.

If a second call comes in that medic unit's district, the adjoining medic unit will be dispatched.

If this is all correct - please correct me if I'm wrong - we lose TWO medic units (or 50% of the ALS service) because Ambulance X can't get their crew out the door. If the first medic unit was in-service after the BLS call, they would respond to the next call in their area.

On the other side of the County do they still take a medic unit out of service on BLS calls when the ambulance can only get out with a driver?

How is this acceptable? Why is the County subsidizing inefficient ambulance service like this? Does Ambulance X have to reimburse the County for this coverage?

[Guest]

Essentially, you are correct Chris. This is how it exactly works:

Monday - Friday 6a - 6p Empire supplies a Full Ambulance (Medic and EMT) to Medics 3 and 4 (East Side). When any job is dispatched Bravo - Echo, the medic unit (along with EMT) rolls to the job, the volly ambulance who's district the call is in is also dispatched. If they cannot muster a crew within 3 dispatches, Empire handles the call - regardless if the call is BLS. Once a Medic unit goes out, the closest medic unit relocates into the middle of both response areas until the medic unit that is out comes back into service.

What has been happening as of late, if a volly crew only has a driver p911 will ask the driver what his/her pleasure is. If they respond they will take the empire Medic or EMT (depending on the call obviously) on board and off they go to the hospital. If the call is BLS, and the Empire EMT is borrowed that medic unit is still considered OOS until the EMT is back to his/her truck.

No one is penalized for not getting out, as far as i know. If empire transports they bill the patient accordingly - for treatment and millage. If the empire medic techs the call ALS they bill for the treatment.

On the west side of the county, you have Putnam valley, garrison and Philipstown. Philipstown employs EMTs 24/7 365 days a year. The village of cold spring, Nelsonville and North Highlands have all been paying for EMT salaries since 2000. We are stationed @ PVAC HQ and roll on their ambulance. If the job is ALS and no driver has signed on - and the medic is comfortable - we respond to the scene and drive, if the job is BLS and no driver has signed on mutual aid goes out. Often, if at all possible, crews are combined. IE: if no driver signs on for Philipstown, garrison gets toned out and i'll ask for their driver to the scene to drive for me. Putnam Valley, Garrison and Philipstown have little trouble getting out - hence why their Medics are in flycars and not full ambulances.

During weekends and weekday nights 6p - 6a, Medics 3 & 4 are staffed with only a paramedic and use the ambulances as fly cars and respond accordingly, just like Medics 1 and 2 do.

As far the efficiency, the system is a** backward if you ask me. The reason it was sets up like this, i'm sure, is so no one in the political hierarchy would step on the toes of the volunteer fire departments and the vacs - namely on the east side, who were not happy (to say the least) of this change. Medics 3 & 4 should be in fly cars with 2 EMTs in buses - but again, this would cause problems for the volunteers - hence why they probably glanced right over this option.

Currently the plan is to reevaluate the situation in 6 months time, to see if the horrid response time issues have been fixed and to see what would be the best method of moving froward. If you ask me, your going to be seeing full trucks on the east side sooner than most people think. Hope that helps

Edited March 9, 2007 by 66Alpha1

[Guest alsfirefighter]

Sooner or later the powers to be in Putnam county are going to run out of fingers to plug the holes in the dike. Problem is many of the holes are still leaking making the holes to big to plug. I mean no disrespect to those whom serve in Putnam, however the problem was well known when I worked in the system 5 years ago and it hasn't been getting any better and I was critical of the current system when it was announced. Whether its a problem of the tail wagging the dog still I don't know, however I still can't see how if I were to live in the eastern part of the county I can be assured to get transported in a fairly decent time frame between 0600 to 1800. Anytime other then that its a roll of the dice and if I live on the western side its always like that. Again I want to say this isn't a dig to the agencies on the west side of putnam...I have many personal friends there and they often do well. How about getting a even common sense system for all county residents and stop the at this time and if this occurs system. I really am growing old of the 10% that stops advancement because they can't see past their noses. Wake up, there are problems and I'm sorry your toes are sore...but some agencies are at the point where stepping on toes shouldn't be an issue, more like jumping on heads. I saw similiar in the town where I live, when the politicans listened to someone from the fire district and said we cannot even come close to providing effective ems care with what we have right now. They brought in a private company on contract. What an outrage!!! (right). Meanwhile, equipment was known to be damaged and tampered with (what maturity) and meanwhile there still is a private ambulance here and its nice to know. It is one of the reasons why I moved here. I can rebuild a house, I have numerous fire protection and notification systems in my home..but I have no doctor, nor no ambulance. Some in this business still need to figure out that its not about you, or what you want to call yourself or that you donate your time. Its about the service you are supposed to be providing. Some just can't get nor see that.

[Guest]

Well put ALS. I, and others, have said this over and over again: someone is going to die (sadly) before a drastic change is ever going to be made. They have been talking for years about turning towards civil service (as i know you know) but always fall back on "we don't have the 5 million to make it happen." For now - speaking for myself - i make due with what i have to work with. Its extremely frustrating being expected to pull miracles out of your a$$ and not knowing if any backup will decide to show up. I love my job and i love working in Putnam, but this game is getting very old, very quickly.

Edited March 9, 2007 by 66Alpha1

[helicopper 1,050]

Essentially, you are correct Chris. This is how it exactly works:

What has been happening as of late, if a volly crew only has a driver p911 will ask the driver what his/her pleasure is. If they respond they will take the empire Medic or EMT (depending on the call obviously) on board and off they go to the hospital. If the call is BLS, and the Empire EMT is borrowed that medic unit is still considered OOS until the EMT is back to his/her truck.

We are stationed @ PVAC HQ and roll on their ambulance. If the job is ALS and no driver has signed on - and the medic is comfortable - we respond to the scene and drive, if the job is BLS and no driver has signed on mutual aid goes out. Often, if at all possible, crews are combined. 

During weekends and weekday nights 6p - 6a, Medics 3 & 4 are staffed with only a paramedic and use the ambulances as fly cars and respond accordingly, just like Medics 1 and 2 do.

Thanks for the hypertensive crisis! Geez, I hope I don't need a medic - they might be the EMT on a BLS call in @#)(*$%)?>.

As pathetic as this is, the thing that I really don't understand is why the MEDIC is out of service in an ALS unit while the EMT is playing volly-sitter???? If the ambulance is used as the fly-car on the overnights, why the heck can't he still respond alone during the day? That makes even less sense than the rest of the system!

Whaddya mean if the medic is comfortable you respond to the scene? You mean the medic can't be by himself in the back while the EMT drives? Don't even get me started on that! What is he going to do - wait half an hour while a crew of three is assembled to accompany him to the hospital?

ALS - you're so right! It has been very well known that the system is Putnam is failing for years. They've tried recruitment videos, sharing EMT's, running special training programs to accommodate the varied schedules of people who ultimately don't have time to respond to calls anyway and now this.

As a Putnam County taxpayer, I'd have more respect for the County administration if they said, hey everyone, we're going to establish a COUNTY EMS SYSTEM and your taxes are going to go up by less than $200.00 per year and we're going to guarantee (within reason, obviously) that you receive an ambulance within X number of minutes and a paramedic on appropriate calls in less than Y minutes. It beats the heck out of paying for golf courses and horse farms. Vollies could continue to exist and if they get out first, fine. But if they're not on the road in a prescribed amount of time, the county ambulance is coming.

As for stepping on toes, tough - if you can't do the job right you shouldn't be able to prevent someone else from doing it!

[Guest]

Haha, I'm just telling you how it is in the field Chris. No sugar coating, no BS. I know you wouldn't want anything else. Like i said - its gotten so bad that, while i love the area, i almost don't want to be associated with the Putnam EMS system.

Edited March 9, 2007 by 66Alpha1

[Guest Truckie93]

I have a question as far as the West side of the county. As stated, Coldspring and North Highlands are covered by a full time EMT 365 days a year. Who flips the bill for that? I assume the Village of Cold Spring and North Highlands or Phillipstown puts the money out for that. If that is the case, then why do the taxpayers in these jurisdictions have to pay for an EMT to transport in there own town and pay there portion of taxes to the county to have an EMT transport someone on the East side of the county. I understand that everyone in the county is paying for the ALS service, but is the west side also paying an even share in unnecessary BLS coverage that is taking place on the East side of the county?

[Guest]

I have a question as far as the West side of the county.  As stated, Coldspring and North Highlands are covered by a full time EMT 365 days a year.  Who flips the bill for that?  I assume the Village of Cold Spring and North Highlands or Phillipstown puts the money out for that.  If that is the case, then why do the taxpayers in these jurisdictions have to pay for an EMT to transport in there own town and pay there portion of taxes to the county to have an EMT transport someone on the East side of the county.  I understand that everyone in the county is paying for the ALS service, but is the west side also paying an even share in unnecessary BLS coverage that is taking place on the East side of the county?

←

As far as i understand, its the tax payers who supply the money to pay our slaries. Over the summer, once the county announced the new addition of EMTs on the east side of the county, i know that the West Side had complained that since 2000 they have, on their own, been paying for an EMT without assistance from the county. With this new plan, county money is set aside for the ALS contract, which includes the EMTs for the east side, but no assistance is provided for the west side. As far as the last i heard, which mind you was over the summer, the county did not allocate any money to pay for the philipstown EMTs.

To answer your question - as far as i know, right now, residents of Cold Spring, North Highlands and Nelsonville are paying for their own EMTs as well as the Putnam ALS contract - which includes EMTs on the east. I know there was an extensive article in the Putnam County news and Recorder.

Edited March 9, 2007 by 66Alpha1

[helicopper 1,050]

As far as i understand, its the tax payers who supply the money to pay our slaries. Over the summer, once the county announced the new addition of EMTs on the east side of the county, i know that the West Side had complained that since 2000 they have, on their own, been paying for an EMT without assistance from the county. With this new plan, county money is set aside for the ALS contract, which includes the EMTs for the east side, but no assistance is provided for the west side. As far as the last i heard, which mind you was over the summer, the county did not allocate any money to pay for the philipstown EMTs.

To answer your question - as far as i know, right now, residents of Cold Spring, North Highlands and Nelsonville are paying for their own EMTs as well as the Putnam ALS contract - which includes EMTs on the east. I know there was an extensive article in the Putnam County news and Recorder.

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That's been the Putnam way for as long as I can remember. They only remember that Putnam goes west of the Taconic (and sometimes not even that far) around election time!

Figures that the west side has been fixing their system with paid EMT's for seven years and the County only just caught up. It is a disgrace that they also have to pay for EMT's on the east side too.

[EJS1810 7]

A few notes/corrections if I may. Bold for Notes/Corrections

Monday - Friday 6a - 6p Empire supplies a Full Ambulance (Medic and EMT) to Medics 3 and 4 (East Side). When any job is dispatched Bravo - Echo, the medic unit (along with EMT) rolls to the job, the volly ambulance who's district the call is in is also dispatched. If they cannot muster a crew within 3 dispatches, Empire handles the call - regardless if the call is BLS. Once a Medic unit goes out, the closest medic unit relocates into the middle of both response areas until the medic unit that is out comes back into service.

What has been happening as of late, if a volly crew only has a driver p911 will ask the driver what his/her pleasure is.

We will tell the Volunteer Agency that they have a driver or driver and attendent only.  it is the Volunteer Agencies choice and decesion to respond and utilize the Empire Medic or EMT

If they respond they will take the empire Medic or EMT (depending on the call obviously) on board and off they go to the hospital. If the call is BLS, and the Empire EMT is borrowed that medic unit is still considered OOS until the EMT is back to his/her truck

Sorry, that is incorrect.  if the Empire EMT is used with a BLS rig, the Medic is sitl in service to cover calls.  They might follow the BLS to Putnam but that is only to pick up thier EMT.  They are still in service as a Paramedic.  They do not go to Danbury or any other out of county hospitals to get thier EMT.  They would have to wait till the EMT is back from the Hospital. 

On the west side of the county, you have Putnam Valley, Garrison and Philipstown. Philipstown employs EMTs 24/7 365 days a year.(with exceptions)  The village of cold spring, Nelsonville and North Highlands have all been paying for EMT salaries since 2000.

The cost of the EMT is paid by Philipstown VAC billing.  Cold spring, Nelsonville and North Highlands Fire District do not pay for the EMT.

We are stationed @ PVAC HQ and roll on their ambulance. If the job is ALS and no driver has signed on - and the medic is comfortable - we respond to the scene and drive, if the job is BLS and no driver has signed on mutual aid goes out.

The Medic can ride if they decide the call is ALS.

←

[Guest]

1) i said that Putnam 911 will ask the driver who signs on what his/her pleasure is AKA do they want to respond and borrow the EMT/use the medic or have empire handle the job - the exact same thing you stated.

2) I have heard countless times medics 3 or 4 go out of service and another medic pick up their jobs because they do not have an EMT...just calling the shots as i see them.

3) As far as i understood, per the Putnam County News and Recorder, the town had been paying for the EMTs since 2000 - maybe they meant via billing, if so thats my mistake. But regardless of where our salary comes from, at least they had the forethought to tackle the problem in 2000 rather than waiting for the county to do something about it 6 years later. As far as exceptions - don't know what your talking about.

Nelsonville Board does Not Support County's Plan to Hire Ambulance Workers

Board approves Butterfield lease option

by Maria Theodore Leiter

At their regular monthly meeting on May 8, 2006, the Village of Nelsonville Board expressed their opposition to the County's plan to hire a weekday ambulance staffed with Emergency Medical Technicians and a Paramedic for the eastern side of the County in a resolution proposed by Trustee Tom Corless.

"The County is leaving us out of the EMT plan," said Corless. "This Town had the foresight to deal with the problem sooner and now we aren't included in the plan." He said that the Town has been paying for a full time EMT for years without any County assistance.

http://www.pcnr.com/news/2006/0517/Front_Page/005.html

3) i never said the Medic couldn't ride the job in ALS, i have been on a number of calls that have gone mutual aid to other districts b/c a full crew could not assemble and a medic preferred help in the back.

Edited March 9, 2007 by 66Alpha1

[helicopper 1,050]

3) i never said the Medic couldn't ride the job in ALS, i have been on a number of calls that have gone mutual aid to other districts b/c a full crew could not assemble and a medic preferred help in the back.

←

Unless it is an arrest or a major trauma (in which case there's almost never a shortage of volunteers), there is no reason to go to mutual aid because he/she "preferred more help in the back".

What a bunch of nonsense - there are systems all over the world where a crew of TWO responds on an ambulance and the medic rides with ALS patients by him/her self. To call for mutual aid for "company" is a gross waste of resources!

[SageVigiles 1,194]

2) I have heard countless times medics 3 or 4 go out of service and another medic pick up their jobs because they do not have an EMT...just calling the shots as i see them.

66Alpha1, you are right. I've seen this several times firsthand as I am at my firehouse up the hill from Putnam Lake. 23-7-1 will go up the hill lights/siren, and the Empire Ambulance will follow without.

[Guest]

Chris, just telling you like it is out in the field buddy.

Also, per Philipstown's salary, it is paid through the Ambulance Corps but a stipend is paid by the towns to the Corps for our salary.

Sage, i appreciate it. However, technically, they are supposed to be in service - i was wrong in saying that they were considered OOS. But, at the same time, i and apparently sage, have heard the backfill unit pick up the job.

[Guest alsfirefighter]

I have to agree with Chris here also. Unless it is a multi-system trauma or arrest a good or decent medic should be able to handle their call/scene. If they cannot then perhaps they should not be on a flycar. What would they do if they get there first and have no assistance for some time? You revert to BLS. This is the same in an ambulance by yourself. I've had numerous occassions on a 1 and 1 ambulance where my emt had to drive and I never got past performing BLS, often this involved bleeding control. Not judging on a case by case basis but the overall thought of it.

[Guest]

Both Chris and ALS are on the money. Fly car medics are paid to be able to handle every situation they encounter alone, at least for a short time. I don't want you to think i was disputing that - i was just conveying what i had seen and encountered in the field.

But, the bigger issue here, i think, is the bulkiness of the system. There are too many "if this then that" clauses. It puts the weekday crews in a rather precarious situation, having to explain to their patient that while they have a full ambulance and COULD transport, they have to wait 5 minutes (or three dispatches) to give the volunteers a chance. It's almost as though its being treated as a game and even the county government is in on it. The public hasn't the fondest idea of the kind of system they are paying for. Crews getting in trouble for transporting or canceling volunteer ambulances b/c you've got a guy with a broken leg in 3 degree weather. I mean, you just cant make this sorta crap up, its pathetic.

[helicopper 1,050]

The public hasn't the fondest idea of the kind of system they are paying for.

Crews getting in trouble for transporting or canceling volunteer ambulances b/c you've got a guy with a broken leg in 3 degree weather. I mean, you just cant make this sorta crap up, its pathetic.

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Alpha, you're so right. The public has no idea. They think that they dial 911 and William Shatner answers, narrates a 15 second response and then paramedics and FFs are banging on the door. Or they think that since their taxes are so high that they must be receiving topnotch services!

As for staying outside with any patient in this weather - put the person on a board, load them into the ambulance to keep them warm and transfer them when and if an volly rig arrives. To keep someone outside (or stay outside yourself) is crazy - but if these are the same medics who need company to "ride in with an ALS call" I guess I shouldn't be surprised!

[JetPhoto 626]

Question -

Volie crew 1 is only driver / emt alone they respond to a call and emt from paid services rides to the out of county hospital leaving the medic as a "fly car". now a 2nd call comes in that requires ALS and a driver / emt from the vollie company shows up on the scene, can that emt / driver, drive the paid service truck?

[Guest]

Chris - No doubt that's the right thing to do, but when you're 2 minutes from the hospital, is it worth it to wait for a mutual aid company coming from 2 or 3 towns away just so they can get their fix for the day?

JetPhoto - Don't know Empire's policy on who can and cannot drive their ambulances. It may be possible for a volunteer driver to drive their ambulance, i know on the West Side, VAC members often drive the fly cars to the hospital/back to the station for the medics. Also that most, if not every, VAC/FD Ambulance in the county has 2 trucks so the chances are the driver will take his/her rig prior to Empire's.

[ckroll 101]

Sometimes it makes sense to have a backfill Medic/EMT pick up a job from a medic alone. If a volunteer agency has been toned out and failed to cover, [using the paid EMT and generating the medic alone] and a second call drops for the same agency, then it is highly unlikely that the volunteer agency will cover the second call.

In this situation, a medic alone cannot transport whereas the Medic/EMT can. If medic alone and Medic/EMT are equidistant to the call for aid, then it is a better use of resources to send the Medic/EMT to a call where it is almost certain that it will be needed as transport, keeping the Medic alone available in hopes the next call to drop will be with an agency that can muster a full crew.

We all know how dynamic EMS can be. Any system depends on those in the field matching resources to conditions and making what hopefully are good decisions.

[paratrooper75 41]

The whole reason this system is so messed up is due to the fact that the county has to please the volunteer agencies. They don't want to step on their toes. If it was a sole 100% county run system I'm sure they would come up with something a lot better than whats going on now. As long as the volunteers refuse to let the county run ems the system isn't going to work right. It really is too bad that some agencies are doing a great job covering calls while others are slacking. In a perfect world the volunteers would get out for every call and all would be fine. I don't know what the answer is but this change has opened some doors and we'll see what happens when they look it over in the coming months. Personally I would like to see four flycars and a couple BLS rigs. I think that would work the best but we'll see what happens. As for response times, they've dropped about 6 min. since the change.

[helicopper 1,050]

The whole reason this system is so messed up is due to the fact that the county has to please the volunteer agencies.  They don't want to step on their toes. If it was a sole 100% county run system I'm sure they would come up with something a lot better than whats going on now. As long as the volunteers refuse to let the county run ems the system isn't going to work right. It really is too bad that some agencies are doing a great job covering calls while others are slacking. In a perfect world the volunteers would get out for every call and all would be fine. I don't know what the answer is but this change has opened some doors and we'll see what happens when they look it over in the coming months. Personally I would like to see four flycars and a couple BLS rigs. I think that would work the best but we'll see what happens.  As for response times, they've dropped about 6 min. since the change.

←

Really good points! The system will never develop since the County is yielding to the interests and in many cases whims of every agency in the County - good, bad and indifferent!

If the County drew a line in the sand and said this is the standard - you meet it or we will - many agencies would rise to the occasion and others would have to be supplemented (or replaced) by the County. Oh well, at least then we'd have a consistent system in the County.

As for the response time reduction of 6 minutes - that's nice but what was the response time before this improvement? If it was 20-25 minutes, that still leaves room for alot of improvement!

[Guest]

Paratrooper you hit the nail on the head pal, couldn't agree with you more. Chris, while your 110% right, the County isn't going to change its position. They simply don't have the balls - like paratrooper said. During the last election cycle a guy by the name of Pat Bonanno was running for a County Legislator seat. He wanted to make a lot of public safety county-run. Needless to say, he didn't get elected (wounder why?).

From Journal News Article - 5/10/06

Pat Bonanno said he would also seek to professionalize the county's emergency services, including firefighters. Putnam's fire departments are currently all-volunteer outfits. Training, he said, needs to be tremendously increased.

"Let's turn them into county employees," he said. "We need to have trained professionals in every corridor of this county."

While response times have gotten better - like chris said - your seeing stuff go from 25 minutes to 18 minutes. Thats pretty piss poor, but the County isn't completely to blame for this. Medic 4 was effectively kicked out of Brewster Fire HQ and moved to Patterson. Seeing as Brewster handles the majority of the county EMS call volume, going from Patterson to Brewster or Patterson to Carmel isn't an easy task. As of recently, i did hear that the county was looking to station 4 on some unused county property (a garage or something) in the Brewster area...no idea if thats going to go anywhere. Medic 3 is in the 10th level of Putnam w/ no radio reception or nextel service (the medic relies on an old minitor pager to hear calls go out). Not to mention hes really in the middle of nowhere.

Sometimes i wounder whats going on over in Carmel.

Whatever the case may be, things are unlikely to change drastically. The next big change i THINK we all will see is full trucks 24/7 on the East by the end of the year.