Pawling (Dutchess) Ambulance Provider

[Guest]

When i say criminal, I'm not referring to actual legalities. I'm talking more about a government's obligation, given the contract it has with its people, to afford them proper protection. In this instance, the Town of Pawling government has failed its people.

As a side note - The Poughkeepsie Journal's title is a bit misleading, Alamo is currently providing EMS services as of 4/1/07 to the best of my knowledge.

A few observations:

Pawling needs to allocate far more money towards an EMS contract, seems they have been expecting the world while looking to pay as little as possible.

The populations housed at jails and prisons are considered part of a towns population. So, if you get a chest pain at the jail the closest unit has to go, doesn't it?

Backfill is important, no question. But isn't it going to take time for the Unit to arrive if its coming from Poughkeepsie or Fishkill?

Maybe Pawling needs to look to have two units stationed in the town? One 24/7 one during "peak" hours?

If they are still not happy, look into creating an Ambulance District.

Edited April 2, 2007 by 66Alpha1

[Guest alsfirefighter]

As far as a prisons population counting towards a town's population, I'm not sure but leading on the side of I don't think so. As far as the closest unit going, no they do not. Any state prison I believe is state owned land, the state doesn't pay town property taxes so I don't see how that would apply. The closest unit doesn't have to respond to nursing homes so why are prisons any different. Most prisons I know of have contracts with private companies to transport inmates. I know in most areas I have worked or am a member of the agency will only respond for employees and inmates get whomever the state contracted for for that facility. They made their choices to be where they are. I'm sure most, as I would fly off the handle if the ambulance funded by citizens tax dollars would have to go the state prison in the town I live in.

[Guest]

As far as political redistricting is concerned, prison populations DO count towards a town's local population, at least as far as New York state is concerned. Hence the reason i asked. I also know that i've heard Carmel (i think) respond with medic 4 to the County Jail in Putnam for prisoner related emergencies. Which, again got me thinking.

I couldnt find anything relating to if i town is legally responsible for providing EMS services, but i did look at what the DOH had to say about Municipal Certificates of Need.

f a municipality, as defined by Article 1 of the General Municipal Law, wishes to obtain operating authority in order to establish and operate either an Advanced Life Support First Response Service (ALSFR) or an Ambulance Service under the provisions of Public Health Law Section 3008(7).a, the municipality must complete the following steps:

  1. The municipality must file a written request with the State Emergency Medical Services Council (SEMSCO). The request must be sent to the SEMSCO in care of the Bureau of Emergency Medical Services (BEMS) and must include the following items:

  2. A certified copy of the local law, ordinance or resolution from the municipal legislative body empowering the municipality to establish and operate an EMS service. The local law, ordinance or resolution should include, but not be limited to, the following:

    * A statement of need;

    * A statement establishing the type of service (ie. ALS-FR or Ambulance);

    * A statement declaring the area to be served; and

    * The date the resolution is to take effect.

  1. A letter from the chief executive officer of the municipality requesting Public Health Law Operating Authority as a certified ALS-FR or ambulance service.

  2. A complete Application for EMS Operating Certificate, a map identifying the area of operation (geography to be served may not exceed the boundaries of the applying municipality). and evidence that the service meets or exceeds all New York State Department of Health applicable standards.

  3. If the municipality intends on providing Advanced Life Support, it must apply to the appropriate Regional Emergency Medical Services Advisory Council (REMAC) and be approved. The approval letter from the REMAC must be included in the submission.

  4. If the municipality intends to contract with another EMS provider for service, the filing should include copies of signed contracts or agreements.

  5. If the municipality intends to operate an ALS-FR, the filing must include a transport agreement with an appropriately authorized ambulance service.

  6. The filing for a municipal service must be sent to the following address by certified mail or other return receipt delivery:

New York State EMS Council

c/o Bureau of Emergency Medical Services

Operations Unit

New York State Department of Health

Hedley Park Place - 433 River Street

Troy, N.Y. 12180

  1. The ALSFR or Ambulance Service will be issued a Certificate of Operating Authority upon completion of a full service inspection to be conducted by the Department's appropriate regional office. The full service inspection may not take place before the filing is complete, received and reviewed by the Bureau of EMS.

  2. Upon successful completion of the inspection and receipt of the NYS DOH Operating Certificate, the service may begin operation. The municipality shall be granted operating authority for a period of two years from the date the request is received by the Bureau of EMS.

  3. Prior to the expiration of the municipal ALSFR or Ambulance Service (two years from the date of the original filing with SEMSCO) a complete application for New Ambulance or ALSFR Service must be received by the appropriate REMSCO for determination of need pursuant to PHL 3008. It is strongly recommended that the municipality file the application for a new service at least 90 days prior to the expiration of the original certificate.

NOTE: The municipality is responsible for this service even if they enter into contracts with another agency to provide EMS.

If I'm reading this correctly if the town holds the CON and can contract out EMS. So because they hold the CON they are ultimately responsible. Does pawling hold a CON for its area or do the agencies themselves?

Edited April 2, 2007 by 66Alpha1

[irishfire2491 24]

What happened to "OUR PASSION IS CARING" ?

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that quote went out the window a Long time ago i am Assuming Late August early Setember That is why i had to bail out IT got to the point were it became a JOB SECURITY CONSERN EVERY DAY U WENT TO WORK.

[JetPhoto 626]

The games will become evident now that Alamo is back in Pawling. Ready to see Beekman's mutual aid EMS given calls to Pawling spike again? Listen! It was nice not having Alamo in Pawling.

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This situation with Alamo seems to be very similar to the promises it had give the Town of Wappinger a couple of years ago, we all see where that went. Pawling will have to be very careful with the decisions it makes in the next couple of days, as they have already used several providers with limited success and much expense to the taxpayers of Pawling.

EMS in several parts of the state are seeing similar problems. There is no easy and correct way to solve this problem. Having a paid ambulance service in each town is possible but at what expense? Creating a county EMS service, remove all volunteers and limit the paid services to contracts like nursing homes and prisons etc. will not sit very well with them either.

The bottom line is the general public will end up paying for EMS. Whether it's by direct billing to the customer, local or state taxes. Everyone will either pay or suffer!

[Guest]

Turning things into a dollar and cents game is dangerous. Who cares what it costs? Tax me what its going to take to create a system to get me an ambulance when i need one. I'm all for municipal EMS 110% - its alot simpler that way. You call they come. The only thing i would caution is the commercial bashing. Being critical is important, but there is two sides to every story. Lets not forget local governments appear to have or currently are trying to drive the cost of having EMS down so far that it may become difficult for a commercial agency to live up to the contract. On the same token, if an agency is turfing calls to MA agencies or violating terms of a contract willingly then thats just as much of an issue.

Edited April 2, 2007 by 66Alpha1

[Medibart 55]

Turning things into a dollar and cents game is dangerous. Who cares what it costs? Tax me what its going to take to create a system to get me an ambulance when i need one. I'm all for municipal EMS 110% - its alot simpler that way. You call they come. The only thing i would caution is the commercial bashing. Being critical is important, but there is two sides to every story. Lets not forget local governments appear to have or currently are trying to drive the cost of having EMS down so far that it may become difficult for a commercial agency to live up to the contract. On the same token, if an agency is turfing calls to MA agencies or violating terms of a contract willingly then thats just as much of an issue.

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If an EMS agency (of any type) tells a community they can provide EMS for free or very inexpensively, then I don't think it's wrong for a community to expect that service for free or very inexpensively. We, as EMS providers, have a responsibility to the communities we serve to properly educate them as to the need and the actual cost of providing EMS. Without us providing that education, how can you blame a community for being uneducated?

The costs of running an ALS ambulance 24 hours a day can easily be in the $5 - 600,000 range. To offset that entirely given a generous average collection of $300 per transport (not per call - RMAs, cancelled calls, standbys etc don't count). To offset the full cost that would mean you would need 1667 - 2000 transports per year. If you were running that kind of volume, more than likely you would have a lot of difficulty covering all the calls with one bus, especially if you have any length of transport time.

How an agency can run a 24/7 ALS bus that costs that much money and charge a community 0, 15, 25 or even 125 thousand, without the necessary transport volume to offset the cost, and not lose a lot of money on the deal is really a mystery to me.

But I don't necessarily blame a community for saying yes when an ambulance company promises to provide the service for free or at a loss. Hopefully, other communities will look at the experience in Pawling and be wary and see the dangers in the deal that sounds too good to be true.

[Medic137 6]

Poughkeepsie Journal

Tuesday, April 3, 2007

Pawling turns to Alamo

PAWLING - The town board voted in favor of hiring Alamo Ambulance at an emergency meeting Friday - now it must determine how to pay for it.

Services temporarily provided by Northern Dutchess paramedics ended 6 a.m. Sunday. This was after Empire Ambulance Service canceled its services last week.

The contract with Alamo would end Dec. 31, Supervisor Beth Coursen said.

An estimated $300,000 in service fees is required for the remainder of 2007. The town only has $150,000 budgeted.

At the 5 p.m. meeting, the town board determined any amount that isn't budgeted for the service will come out of the fund balance, Coursen said. She would like to avoid resorting to that because she feels the fund balance is too low.

"So on Wednesday, we are going to discuss cutbacks," Coursen said.

Possible cutbacks to recreation programs and town hall services will be considered. In addition, cutbacks to the library will be examined.

Coursen said this is provided, "they won't have a serious detrimental effect on our ability to deliver service to residents."

In 2008, the town will either have to raise taxes to pay for the ambulance service or cut back in services.

"I favor cutbacks ... the property owners in the community sent clear messages to the government they can't afford more property tax increases," Coursen said.

-Leigh Gomez

It seems that a full time ALS ambulance costs about $1200 per day. The other towns better start saving up!

[Guest]

If an EMS agency (of any type) tells a community they can provide EMS for free or very inexpensively, then I don't think it's wrong for a community to expect that service for free or very inexpensively.  We, as EMS providers, have a responsibility to the communities we serve to properly educate them as to the need and the actual cost of providing EMS.  Without us providing that education, how can you blame a community for being uneducated?

The costs of running an ALS ambulance 24 hours a day can easily be in the $5 - 600,000 range.  To offset that entirely given a generous average collection of $300 per transport (not per call - RMAs, cancelled calls, standbys etc don't count).  To offset the full cost that would mean you would need 1667 - 2000 transports per year.  If you were running that kind of volume, more than likely you would have a lot of difficulty covering all the calls with one bus, especially if you have any length of transport time.

How an agency can run a 24/7 ALS bus that costs that much money and charge a community 0, 15, 25 or even 125 thousand, without the necessary transport volume to offset the cost, and not lose a lot of money on the deal is really a mystery to me.   

But I don't necessarily blame a community for saying yes when an ambulance company promises to provide the service for free or at a loss.  Hopefully, other communities will look at the experience in Pawling and be wary and see the dangers in the deal that sounds too good to be true.

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I agree whole heartedly - if an agency said they were going to give them free service for x amount of months, i would too expect free service (however, i think there should have been a bit more research conducted in this instance). However, thats not to say a town shouldn't have some sort of slush fund for emergencies. Education is part of this equation, no doubt about it. But, the town also has an obligation to research the issue on behalf of its residents and, at the same time, the EMS administrators negotiating the contract need to be honest about actual costs. And, from my understanding, the town still owes money on past contracts - which does not make for good business practices. Putting this all together, i think the Government failed 1) to do its homework properly 2) is guilty of trying to scrimp on EMS services 3) is guilty of not having some sort of slush fund for fiscal situations like this. On the EMS side, agencies seem to be guilty of 1) offering deals too good to be true 2) negotiating contracts which don't begin to account for the costs associated with them and 3) not properly educating the town officials on the true expense of EMS.

[ckroll 101]

To quote one of the great thinkers of our age, " You can't always get what you want, but if you try, sometimes, you just might find, you get what you need." While I don't think Mr. Jagger was referring to EMS, he could have been.

If emergent health care is addressed on a town by town basis, the result risks becoming both uneven and expensive. Towns within counties or consortia of geographically aligned towns need to sit down, sooner rather than later, to discuss what level of care towns want for their citizens and how it should be financed. It is a complicated issue with no good answers. If towns abdicate their responsibilities, they put themselves, AND THEIR RESIDENTS at the mercy of county officials whose interests may be more centered on empire building than on delivery of emergent health care....

As free labor becomes proud history, the full cost of services needs to be allocated just as health insurance providers are cutting back benefits. A system where the user is solely responsible for funding EMS, while attractive to the taxpayer (and therefore, the politician), means that those who use the system most, often the elderly, must make the choice between crushing charges or not calling for service when it is needed. The thought of neighbors suffering, or dying, at home for fear of incurring unmanageable bills should give pause to the even most fiscally responsible person.

"I don't care what it costs.." won't give us affordable EMS and offers no assurance that we will get good EMS.

"What is the absolute least we have to pay..." won't get us good EMS and offers no assurance we are even getting our limited monies' worth.

Local government officials have scant understanding of what services are provided or how they are billed. Everybody lives somewhere. As residents and as EMS providers, we are in a position to shape the future of EMS by getting involved locally and getting our officials educated. Let's start by asking our towns to ask "What level of service do we WANT from EMS?", "What do we NEED from EMS?" Then we ask "Who should provide the service and how should those costs be allocated?"

So... What do we want? What do we need?

[Guest partyrock]

Excellent post ckroll.

I want a pair of medics on my door 5 minutes after hanging up the phone with the CRO 100% of the time.

I need BLS on scene within 5 minutes of dispatch 90% of the time and ALS within 10 minutes.

[Guest]

For a town like Pawling, i don't think its inconceivable to have a BLS FR Engine and a Paramedic Unit (ALS Ambulance or BLS Ambulance + Flycar) in 5 - 10 minutes after making a 911 call. Also, a second ambulance in district with the capability to meet the above criteria.

[JetPhoto 626]

Poughkeepsie Journal

Editorial

Sunday, April 8, 2007

EMS expenses pose a challenge

The Town of Pawling had to scramble recently to ensure the community continued to have ambulance coverage. The "crisis," as Supervisor Beth Coursen characterized it, was a byproduct of a shortage of trained volunteers, which results in towns being forced to hire private emergency medical services.

Building up and maintaining volunteer ranks has been a concern for numerous communities across the state. A broad-based approach to dealing with the issue is needed, though answers won't come easy. But there's too much at stake to simply let communities slip into relying exclusively on paid services, by default.

Pawling rightly had been working with three other towns - Dover, Beekman and Union Vale - to combine their purchasing power and jointly contract with a single EMS provider for service in all four municipalities, with hopes of starting April 1. When proposals came in at a cost of about $1 million, officials decided to wait until the fall to revisit the idea of a joint contract, Coursen said. That's when they begin crafting their respective budgets for next year. Empire Ambulance Service had been covering Pawling at no cost since December, but pulled out in late March when the four towns decided against signing a contract. The town then hired Northern Dutchess Paramedics to provide service on a per-diem basis until another provider could be found. Northern Dutchess was operating in Pawling under a temporary waiver from the state, but isn't certified to continue working in the town, Coursen said. The three other towns working with Pawling already have arrangements in place for ambulance service.

Stop-gap temporary ambulance service

The Pawling town board voted March 20 to hire Alamo Ambulance Service to cover the town through the end of the year at a cost of nearly $300,000, almost twice as much as the town had planned on spending this year. The town should have realized the potential costs and included the funding when crafting its budget last fall. Still, this move was necessary and will ensure residents can expect a timely emergency response. Pawling has been without volunteer EMS service for about a decade and has contracted with commercial providers to maintain service.

Having these services available is vital in medical emergencies. And how quickly help gets there is a key factor in surviving a life-threatening situation.

Successful approaches to retaining and attracting volunteers have been elusive. The problem is not unique to Pawling, nor Dutchess County for that matter. As the county's population has steadily grown in recent years, so has the number of emergency 911 calls. Still, the number of residents willing to take on the commitment of volunteering to protect and serve their community has continued to dwindle.

Municipalities have tried a number of incentives to increase the volunteer ranks, including property tax exemptions and service award programs, which operate like pension plans. State lawmakers approved forming a task force in 2005 to consider offering health insurance to volunteer and ambulance workers as a way to get and keep more volunteers. But the state Department of State, which oversaw the group, hasn't issued a report.

Pawling and others have the right idea by trying to form a consortium to share the cost of EMS coverage in that part of the county. Other smaller municipalities struggling with the growing costs should be doing the same before they face their own crisis.

For information on volunteering, contact your local fire department or rescue squad, or call the Dutchess County Department of Emergency Response at 845-486-2080, or visit www.co.dutchess.ny.us/CountyGov/EmergencyServicesIndex.htm

[ckroll 101]

OK,

BLS in,--and I am assuming by 'in' we mean on location-- 5 minutes isn't going to be provided by persons who are not already in uniform and in a running response vehicle... and less than 5 miles from the call.

If a town is roughly 100 square miles (10 miles on a side for the mathematically challenged), that's two active response units. As stand alone EMS, the cost is monstrous. It sounds like towns need to consider having all town employees trained to first response, and at least one of them made available day to day. How about the postal employees? I wouldn't mind getting my clipper coupons and electric bill an hour later if it helped out a neighbor? Or put more police on patrol and have them trained to the EMT level and equipped to treat and evaluate?

Early, ACCURATE patient evaluation is key to managing resources.. and those of us in the field can attest that EMD gets it wrong more often than it gets it right. Nothing replaces on scene evaluation.

So, maybe towns need to hire their EMT's in other capacities and get them on payroll and receiving benefits and doing something useful for the town on their down time...or require the existing employees to share FR duties and compensate them for it?

[Guest]

I still see the same penny pinching going on and i think its an absolute sin. I'm not familiar with any of the 4 towns in question, but i assume its a pretty significant chunk of land and decent call volume. I live in Rye Brook, which is covered by Port Chester Rye Rye Brook EMS which does 5K + in call volume, has 4 or 5 ambulances and has a multi million dollar budget. I'm not exactly sure how each town determines their respective payout to the agency, but RB spends 30% of its budget on public safety. Naturally, EMS gets the smallest amount, at roughly 980K for the 06-07 fiscal year. If a 2 square mile town plagued with all sorts of problems can spend 1 million on ambulance service, why cant 4 upper echelon American towns do the same?

And lets not forget that Pawling currently owes money on Ambulance contracts.

Edited April 8, 2007 by 66Alpha1

[orangEMT246 6]

For a town like Pawling, i don't think its inconceivable to have a BLS FR Engine and a Paramedic Unit (ALS Ambulance or BLS Ambulance + Flycar) in 5 - 10 minutes after making a 911 call. Also, a second ambulance in district with the capability to meet the above criteria

66Alpha1 Posted Yesterday, 10:32 PM

Why doesn't the towns of Pawling and Beekman split the cost of a "float ambulance"? (A second ambulance in relation to the one each town has) It would sit in either Pawling or Beekman and if one ambulance goes out, it would move to the town the call is in. This would cut down on the mutual aid from each other. Also how many times are you calling for a second ambulance on an MVA or a second call in the district?

[Guest]

Why doesn't the towns of Pawling and Beekman split the cost of a "float ambulance"?  (A second ambulance in relation to the one each town has) It would sit in either Pawling or Beekman and if one ambulance goes out, it would move to  the town the call is in.  This would cut down on the mutual aid from each other.  Also how many times are you calling for a second ambulance on an MVA or a second call in the district?

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i don't know, i don't live or work in the area so i cant answer any of your questions.

[Danger 160]

The idea of the two towns sharing 3 ambulances seems pretty logical. As far as a BLS first response, perhaps the town (provided that they fund the Volunteer Fire Department) should put some pressure on the VFD to get a crew out on scene. Over here in my direction, FDs without ambulances like New Hamburg, New Hackensack and Hughsonville do a fine job of getting a BLS flycar and some often needed manpower on the scene to assist the commercial agency.

[Guest alsfirefighter]

Alpha...you should know by now that Westchester and anyone else basically doesn't mix. Especially trying to discuss the demographics of Rye Brook vs. the Town of Beekman or Pawling. Completely different life style, surroundings and tax base. I understand your point, but it probably wouldn't play out well.

perhaps the town (provided that they fund the Volunteer Fire Department) should put some pressure on the VFD to get a crew out on scene.

Funded or unfunded the Town and its people have the right to do so. Fire district residents pay fire taxes for that purpose and the town also has the responsibility to ensure that it is happening.

[Beekman 5]

Alpha...you should know by now that Westchester and anyone else basically doesn't mix.  Especially trying to discuss the demographics of Rye Brook vs. the Town of Beekman or Pawling.  Completely different life style, surroundings and tax base.  I understand your point, but it probably wouldn't play out well.

Funded or unfunded the Town and its people have the right to do so.  Fire district residents pay fire taxes for that purpose and the town also has the responsibility to ensure that it is happening.

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I would have to agree with ALS's comments. There are a couple of issues which haven't really surfaced on here, whether you care or not.

Pawling has huge manpower problems and most EMS calls do not get a response from the volunteers, much less a rig. Beekman does get a decent response at most EMS calls but not every call has a rig roll out.

The Town of Pawling and the Village of Pawling have not worked on this issue together. The Village sank it's head in the sand and doesn't even pay for the ambulance. The Town Supervisor has been the front runner on this issue. Yes they owe Alamo money for '05 but Alamo has refused to turn over requested paperwork. The Town pays the whole bill with nothing from the Village.

The floater- Pawling is the one with the problems. Beekman responded mutual aid to Pawling 110 times last year, that we know of (another game) and Pawling only came to Beekman 6 times. Not really mutual is it?

I personally don't trust management at Alamo one bit. We've caught them playing too many games and they get caught every time. They've left Beekman uncovered far too often for far too long. Every time we sit down and have a meeting, its the same issues, different management and "we'll investigate that" and they never do.

The 4 Town was a great idea. The problem is that it's before it's time. Beekman is 36 square miles with 600+ EMS and a population of 14,000 calls and Pawling (V+T) is 44 square miles with 7500 people and 600-700 EMS calls. Beekman is a bedroom community where most of the Town is quiet during the day where Pawling is a more senior aged Town and they are home all the time. Dover and UnionVale didn't help out because their population density and call volume is even less and they only wanted EMS service during certain hours because their District BLS ambulances still get out at night and weekends.

Town employees- We have very few municipal services up here. No Town Police Departments, no garbage pick up etc. Beekman's Town Highway Department consists of 9 men. We've already tried to recruit the Highway Department into driving the fire apparatus and ran into roadblocks which killed off that idea. The white collars don't want to volunteer and the blue collars are too busy working two or three jobs to survive.

Town or Fire District hiring EMTs- First off Pawling sold off their two ambulances. It was also discussed during the 4 Town project and the prices would have varied very little to hire a contractor to man our ambulance. Labor is the cost.

Pawling and Beekman are both Fire Districts. Neither is supported by the Towns.

I tried answering all the comments on here in the interest of letting you know the crapp we've gone through so hopefully someone else will learn from this and not have to go through it.

Shawn Beresford

Chief, Beekman Fire District

P.S. I know Alamo management is reading this!

[Guest]

Alpha...you should know by now that Westchester and anyone else basically doesn't mix.  Especially trying to discuss the demographics of Rye Brook vs. the Town of Beekman or Pawling.  Completely different life style, surroundings and tax base.  I understand your point, but it probably wouldn't play out well.

Funded or unfunded the Town and its people have the right to do so.  Fire district residents pay fire taxes for that purpose and the town also has the responsibility to ensure that it is happening.

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ALS, your right and i do understand that Westchester and many other places often don't mix. However, thats what i know - as far as budgets and funding is concerned - because I'm a resident. I know you understand, just giving my rationale

I spoke with Pawling's Supervisor, briefly, to express my dissatisfaction with the situation and its handling. She defaulted on her political record - but i told her her political record was irrelevant to me if she couldn't guarantee her residents and ambulance in the event that they need one. Don't think she was too happy about that.

At this point its a money game. Thats what aggravates me. It should never be about money, but about providing your residents with the best possible service. Whatever town's have volunteer ambulances should be dealt with separately. If they can handle the calls on the nights/weekends then they need to look into hiring 1 or 2 paid crews (probably 1 given the call volume) to pick up the daytime slack. As far as the areas that don't have their own ambulances the problem becomes far more complicated. I don't understand all the legalities as far as fire districts are concerned, but maybe its time to change that to something which would give either allow for a stand alone or FD based EMS system that can bill. I'm a fan of an Ambulance District - no idea if this conflicts with a Fire District - but i know if run properly, it works very well.

Edited April 11, 2007 by 66Alpha1