EMT Fly Car - Would It Help?

[Remember585 815]

I was reading this thinking, "Didn't we talk about this once before" - when I realized it is an old topic revisited...

Only a couple of things have changed since a year ago.

1. Croton EMS is no longer a part of Croton FD.

2. I gave up being a member of two EMS agencies.

3. The problem is WORSE!

4. Nobody has done anything - STILL.

I remember when we used to have one EMS agency in our area that usually covered anything they were dispatched to. When AVAC couldn't get out, the old reliable would be BVAC. CVAC may have been bad at covering calls, but DVAC was excellent.

Now, it almost seems that ALLVACS are in a bad, bad way. I think the time has come for each agency with staffing issues to figure out the best solution.

I think everyone's call volume continues to grow and their membership base remains the same, if not worse. Time for the local municipalities to speak up, since it doesn't appear the leadership of most EMS agenices is doing anything to fix the problem.

[x635 4,066]

EMS is never going to improve in Westchester anytime soon. There are too many factors holding EMS down, with some being....

-Egos

-Pride

-"Tradition"

-Commercial services with dollar signs in their eyes

-Municpalities that aren't even aware where the ambulance comes from when they call 911

-Band aid solutions that cover up the problems, preventing real solutions

-Westchester County (County AND REMSCO) not taking steps to lay down the law, or do something to force change and improvement

Oh, did I mention egos?

[ny10570 745]

I know I'm just repeating what was said a year ago, but I think this point keeps getting missed. What good is an EMT without an ambulance? To go with the shared resource idea, instead of staffing a fly car why don't the agencies rotate responsibility for an a staffed ambulance? You example of what if a family member were having an MI, is an excellent example of how useless an EMT is without an ambulance. Time is muscle. The longer it takes to get that patient to definitive care the more damage to the heart. How about the chronic asthmatic with their own home albuterol nebulizer and O2 concentrator, what do you have to offer them? How about the CVA, the OD, arrhythmia, etc. The list goes on and on for medical problems that an EMT's greatest tool is their ability to recognize the problem and efficiently get them to more advanced care. Everyone that an EMT can help on scene dosen't NEED the EMT in the first place unless your talking cardiac arrest. So your going to put an EMT flycar in service for a group of people who best case scenario are looking at a 4% survival rate. You do more good for more people by making sure that EMT is on a staffed vehicle.

[Bnechis 3,961]

Sometimes an EMS call will go from one VAC to Mutual Aid VAC X 2, 3, 4, and yes every

now and then a 5th M/A EMS agency. 15, 25, 35 + minues to be transported to the ER!

Would this be acceptable if YOU were the 911 caller and Mom or Dad was

having a Heart Attack?

Do YOU think having a Volunteer EMT Fly Car that could be staffed by local VAC's

to help cover calls is a good idea? (I say this only because most VAC's can get a Driver)

In other words sharing of VAC EMT's to cover this Fly Car

If every VAC kicked in some $$$ it can and would help cover calls in your area.

Do you think it's worth a shot?

THOUGHTS?

If my mom or dad was having a heart attack and the 1st 5 vacs didnt get out, what good is a BLS fly car?

Have them share getting one AMBULANCE out that can Transport!!!!

If they can not or will not do that, hire staff

If they can not or will not do that, hire a commercial service

If they can not or will not do that, TELL the community the truth...YOU CANT HELP THEM and instead of calling 911 and waiting 35+ minutes call a taxi...you'll be in the ER in less time and have a chance.

[Bnechis 3,961]

EMS is never going to improve in Westchester anytime soon. There are too many factors holding EMS down, with some being.... -Westchester County (County AND REMSCO) not taking steps to lay down the law, or do something to force change and improvement

Seth, You've blamed the County before and again I ask you how do you expect them to "lay down the law" when State law prohibits them from doing so?

[OoO 24]

I like the idea of a BLS fly car. In my VAC, we have more drivers than EMTs and if a call gets paged out a second time (which is infrequent), it is usually at the request of a driver waiting for an EMT. A fly car would only need to be staffed by 1 person, whereas an ambulance must be staffed by a minimum of two but ideally 3 or 4. It would be much easier to find 1 person to commit to a multi hour shift vs 4 people. Likewise, the agency where the call originated would only need 1 or 2 members to respond. For most any call, my VAC has at least one member who has responds, even if the call goes to mutual aid.

[Guest EFFP411]

I kinda like the idea of ALL the VACS getting together, and trading spaces, so to speak. If AVAC has a driver on, but no EMT, and BVAC has an EMT, but no driver for the day, put the two of them together on one ambulance and share! If they put their heads together and created designated "mix zones", when AVAC and BVAC cover both areas with one ambulance, and C and DVAC cover the next area, etc, It might actually work to their advantage. And switch up, if the crew from A and B VAC use BVAC's ambulance today, if they do it again tomorrow, use AVAC's ambulance. How many ambulance agencies are in the courtland area of Westchester??

Just an idea, but it might have some promise if the right people are paying attention

Edited August 2, 2008 by EFFP411

[gamewell45 258]

EMS is never going to improve in Westchester anytime soon. There are too many factors holding EMS down, with some being....

I've got some news for you; EMS is never going to improve unless the public demands it and then, and only then are the politiicans going to get off their collective butts and cause change to happen.

Unfortunatley, most people are happy with the way things are now, until they need EMS assistance, then for them it suddenly becomes a priority. Look for any meaningful changes to be a long way off.

[Guest alsfirefighter]

Do YOU think having a Volunteer EMT Fly Car that could be staffed by local VAC's

to help cover calls is a good idea? (I say this only because most VAC's can get a Driver)

I have to go with a couple of the other brothers and say no and not that its not a good "idea," but it won't help at all. As a person who is a zone 7 provider and is out on the street there are earmarked times of the week and times of day that you know you are probably going to be waiting for the 2nd, 3rd, 4th and even 5th agency to get a bus. So most are not even getting drivers at most times. Unless that flycar is going to get the bus, it isn't going to overall help the problem. Let's remember that a lot of calls where the VAC's get a driver and its ALS the medic will ride it in without having a full crew on board from the other agency. Depending on policy and such, some will ride in the BLS calls. While I don't always totally agree with this, it does come down in some cases to customer service and about the patient.

Would this be acceptable if YOU were the 911 caller and Mom or Dad was

having a Heart Attack?

No its not, the one fortunate thing I can say is my parents live in an area that has FD BLSFR (despite not having the strongest policy that takes customer service into account), a higher percetage of the time 3 medics staffed and if during the day depending on volume a staffed ambulance w/ 1 EMT/driver. So care is going to get there. The heart attack I will manage best I can with my resources...its the severe CHF, stroke (time critical), severe respiratory issues/arrest, trauma, etc. that challenges your resolve and customers patience. But when you even have politicians that have seen this first hand either let it go or get a misrepresented answer from the agency themselves...what do you do then? Lets not forget as well that EMS is the only emergency service that even when your doing everything but dance a jig to keep your patient's attention, the ambulance shows up 15 to 20 mins. after the intial dispatch...many still say "thank you so much for coming." Apparantly that is what some in society are in tune with.

As far as NY, "the county," REMAC and REMSCO...I don't fault them and as pointed out several times..NY is a wonderful home rule state. Although I love how they find ways to dictate other regulatory and statuatory items on municipalities...but don't worry about your emergency services. My brothers in blue can correct me if I'm wrong, but I believe there is a minimum police officer per population requirement by NY State...but nothing for the other big 2 emergency services.

What I do not understand is how is it that they can tell me (and I know its a health law thing but work with me here) what medications I can give, what hospital I have (should) go to, what to do for certain patient conditions...but no EMS region can dictate what is acceptable level of service and response times before you get your a** yanked to answer questions or be required to do something about it.

[helicopper 1,050]

Without rehashing all the points that have been addressed last year and again now, let me say the following. The responsibility for insuring that the service mandated by the agency charter rests with the Boards and Officers of the agencies involved. To knowingly ignore staffing problems and allow mutual aid to cover their shortcomings is a failure of MANAGEMENT. It is not a failure of vehicles or the membership.

If A-VAC, B-VAC, C-VAC, and D-VAC all rostered a crew from 0600-1800 on weekdays, it would be immediately apparent when they wouldn't get out immediately. If these four VAC's took their respective rosters and agreed to staff a single ambulance on those weekdays they could cover the majority of their calls.

Monday - Driver A / EMT B

Tuesday - Driver B / EMT C

Wednesday - Driver C / EMT A

Thursday - Driver D / EMT D

Friday - Driver B / EMT A

Voila, covered.

Throwing a new BLS fly-car out there won't solve the problem with management nor will it insure that the victim gets transported. BLS agencies number one concern should be transportation so if you want to do it, put the people in an ambulance and call it a fly-car. That way somebody's bringing a stretcher to the scene!

[Raz 14]

As someone who lives in Zone 7, I know that my a** is calling a taxi if I have an MI. They'll get me to the hospital quicker, and charge me less than the VACs.

A fly car won't do anything but put another useless body/vehicle combination on the scene. Now I'll have a paramedic in a fly car, Police Officer in a cruiser, EMT in a fly car, and possibly a Firefighter in a firetruck. None of those are going to get me to the hospital. If it's not a bus, I don't need to see it.

[OoO 24]

The problem with the staffed ambulance is that 1 ambulance will not be enough to cover an entire zone. This would be a problem with a fly car too but the fly car would be used to supplement the VACs not replace their response.

[Bnechis 3,961]

I like the idea of a BLS fly car. In my VAC, we have more drivers than EMTs and if a call gets paged out a second time (which is infrequent), it is usually at the request of a driver waiting for an EMT. A fly car would only need to be staffed by 1 person, whereas an ambulance must be staffed by a minimum of two but ideally 3 or 4. It would be much easier to find 1 person to commit to a multi hour shift vs 4 people.

What good is sending just a driver?

Whats the purpose of send someone (particularly using lights and siren, putting the public and themselves at risk) when they are of no use to the person that requested an ambulance?

If thats the best you can do, save the money, don't buy and equip a fly car, don't put the community at risk by driving RLS. Use the money to pay for a cab, they will drive the patient to someone that can actually help them.

Just thought of something......In 1966 the US DOT wrote the "white paper" it basically said people were dying on the nations highways because of no pre-hospital system. At that time "EMS" was basically a driver (with no training) in a vehicle that could drive fast to the hospital.

Now 42 years later agencies are want to put a driver (with no training) in a vehicle that could drive fast to scene and not even to the hospital.

I've always said "if you are not part of the solution you are part of the problem"............If this is the solution to the problems in EMS, then EMS is doomed.

[Bnechis 3,961]

The problem with the staffed ambulance is that 1 ambulance will not be enough to cover an entire zone. This would be a problem with a fly car too but the fly car would be used to supplement the VACs not replace their response.

Ok so one ambulance is not enough...............but having no ambulances is better?

Please Help ME with the MATH................The VAC's cant get out so you take away one responder to respond in a flycar, how does this help?

What is the purpose of sending anyone on a medical emergency who does not have any medical training?

[mfkap 0]

I just wanted to throw in my $.02 because, about 4 years ago, my agency was having a very high % of calls going MA, and I was Captain (some might say the two were related). We had a situation where everyone had a driver around (village employees) during the day but EMT's were in short supply, or there was an EMT/Driver only. We proposed the idea of a BLS flycar, had 5 agencies sign onto it, and even had a insured emergency vehicle provided to us (for free) if we could staff it using Volly EMT's from the 4 or 5 villages that would participate. Unfortunately, like most progress, it was shot down at the last minute by the same people that cause most of these problems in the first place. The argument against it then was that same silly argument that "If you can staff a flycar, you can staff a bus". But when Dobbs Ferry has a driver, and Ardsley has an EMT, it can take 10-15 minutes to navigate that 1.5 miles during the day because of traffic and lights. A flycar is a great, productive way to pool resources. But the recurring, nonsensical idea that "Well, if you can get one person from two villages, you can get two people from one village" never seems to go away. I think that is a reason that the Westchester Volly EMS system is a great way to kill people, and is fighting tooth and nail to stay that way. Why fix something when it has been broken like this for so long?

[Bnechis 3,961]

I like the idea of a BLS fly car. In my VAC, we have more drivers than EMTs

Then why not require your drivers to become EMT's?

They did join a V AMBULANCE C.......Maybe at a minimum they should know what to do on an EMS call.

[mfkap 0]

I've always said "if you are not part of the solution you are part of the problem"............If this is the solution to the problems in EMS, then EMS is doomed.

This certainly isn't the solution.. but it is a step towards fixing things. I have read a few articles here or there about EMS around the country, and one thing I am consistently amazed at, is how incredibly stupid the Westchester system is.

Take the villages that Greenburgh ALS covers. This system has a total of 11 front-line, volunteer ambulances. Of these 11 ambulances, they belong to 6 different agencies, so really they need a total of 12 crew members available at any time for basic coverage, and 22 crew members to fully staff the very expensive ambulances they all have. At any time, up to 4 or very rarely 5 of these ambulances can be out on calls, but usually it is around 0-3. So, for example right now, there is one village out on an ambulance call. There are 12 people that need to be available for that one call to be covered, because you don't know which village will have that 1 call.

Now, with over $1 million in ambulances sitting around, to cover 30K people, there are coverage and mutual aid problems all over the place. Tell me that the system isn't broken at the core (keep in mind that ALS manages to cover the entire 5 villages from any one central point). Two stations, with 2 ambulances each, on different sides of the villages, could cover just about everyone. And these 6 villages together could piece together 4 crews (really, 2 would do, with a backup crew or mutual aid). And with the $600K you saved in buying ambulances (never mind insurance, workers comp, etc) you could pay to staff those ambulances if the volunteers vanished.

And I will eat my hat if something like this even comes close to being planned. A village would rather have an ambulance roll up with two senior citizens as the crew than work with other villages. And ego is what will keep people waiting for 45 minutes for an ambulance. Just imagine a system without ego... what a dream that is!

[Raz 14]

It's funny to see all of the people pushing for regional EMS in this thread, when so many people shriek when they hear the words "regional fire service"

[HCFRFF 0]

Why doesnt the County start a Fire/Rescue Department. Westchester County Fire/Rescue. Start staffing stations with people and staffing ambulances. No to get rid of all vollies but us them to supplement the career staff

[Future Fireman 4]

Why doesnt the County start a Fire/Rescue Department. Westchester County Fire/Rescue. Start staffing stations with people and staffing ambulances. No to get rid of all vollies but us them to supplement the career staff

Simple answer: Too many EGOS. People are too proud of their piece of 'turf.' That would be a great idea, but egos and pride are 2 big roadblocks.

Mike

Edited August 2, 2008 by Future Fireman

[OoO 24]

Then why not require your drivers to become EMT's?

They did join a V AMBULANCE C.......Maybe at a minimum they should know what to do on an EMS call.

I have thought of suggesting that, but many of our drivers do not have the time to commit to an EMT course. If we enforced this policy, we would lose many or most of our drivers.

[Bnechis 3,961]

Why doesnt the County start a Fire/Rescue Department. Westchester County Fire/Rescue. Start staffing stations with people and staffing ambulances. No to get rid of all vollies but us them to supplement the career staff

Because it is illegal.

Counties do not have the legal authority to run FD's in NYS (Only City's, towns, villages and non-profits)

The county can run EMS, but they need a CON (certifict of need) that shows an area does not have coverage. Currently each VAC or community has a CON. So for the county to do this they would need the approval of the agencies, and they can't even agree to the fact that they can handle it...no way they will agree to give it up

[helicopper 1,050]

I just wanted to throw in my $.02 because, about 4 years ago, my agency was having a very high % of calls going MA, and I was Captain (some might say the two were related). We had a situation where everyone had a driver around (village employees) during the day but EMT's were in short supply, or there was an EMT/Driver only. We proposed the idea of a BLS flycar, had 5 agencies sign onto it, and even had a insured emergency vehicle provided to us (for free) if we could staff it using Volly EMT's from the 4 or 5 villages that would participate. Unfortunately, like most progress, it was shot down at the last minute by the same people that cause most of these problems in the first place. The argument against it then was that same silly argument that "If you can staff a flycar, you can staff a bus". But when Dobbs Ferry has a driver, and Ardsley has an EMT, it can take 10-15 minutes to navigate that 1.5 miles during the day because of traffic and lights. A flycar is a great, productive way to pool resources. But the recurring, nonsensical idea that "Well, if you can get one person from two villages, you can get two people from one village" never seems to go away. I think that is a reason that the Westchester Volly EMS system is a great way to kill people, and is fighting tooth and nail to stay that way. Why fix something when it has been broken like this for so long?

How about taking the two people you're referring too and put them BOTH in an AMBULANCE. Problem solved.

As for the issue of a response area being too large for a single staffed ambulance I'd submit that the response time across "town" will be comparable if not better than waiting for the 3rd, 4th or 5th agency to get toned out on mutual aid and respond.

The bottom line is we need AMBULANCES on the road, not more fly-cars.

Because it is illegal.

Counties do not have the legal authority to run FD's in NYS (Only City's, towns, villages and non-profits)

The county can run EMS, but they need a CON (certifict of need) that shows an area does not have coverage. Currently each VAC or community has a CON. So for the county to do this they would need the approval of the agencies, and they can't even agree to the fact that they can handle it...no way they will agree to give it up

Illegal is a bit strong. The County could operate an EMS system using the municipal "exemption" to the CON process or simply act as the facilitator of service on a regional basis for the existing agencies. Much like a "contract" servce would do it, no? For all those who already think the County is unncessary, you could have a consortium created to oversee the "system" and manage this process for you.

[Engfire 0]

AS many problems that you have in your area I think it would be time for some of the fire depts to staff the buses, and make the ems run by the fire dept, Here in Ohio we run EMS as part of the fire dept and it is manned 24/7 ALS, I cant think of many depts that don't at leasr get the primary bus out the door on a regular basis, that why u have to be a medic to get a full time fire job. Now their are a few depts in the state that are fire only but that few and far between.

[Bnechis 3,961]

Illegal is a bit strong.

Thats on the Fire Side Only. When the counties wanted to run hazmat teams in the early 1980's the state passed legislation allowing for it (but no other fire response service) then later they did the same for Tech rescue.

The County could operate an EMS system using the municipal "exemption" to the CON process

The county politicians would never go for it. The intent of the Muni-CON was that a City, Town, village or Fire District that was not happy with its coverage did not have to go before the REMSCO and get the approval of the agency that currently provided the service to be replaced. This made it easy for a local government to replace commercial services that held the local contract. For our county to do it it would p*ss off to many local services and local politicians. They would never go for it.

or simply act as the facilitator of service on a regional basis for the existing agencies. Much like a "contract" servce would do it, no? For all those who already think the County is unncessary, you could have a consortium created to oversee the "system" and manage this process for you.

While this is technically possible, I think it is highly unlikely do to the turf issues in Westchester.

Turf is such a big deal that when Suffolk County suggested mandating minimum response times the providers threatened the Head of the REMSCO, who end up recieving PD protection.

[mfkap 0]

How about taking the two people you're referring too and put them BOTH in an AMBULANCE. Problem solved.

Because one guy is working the Parks Dept in village 1 and the other guy is working parking in village 2. One has an ambulance, the other has a flycar. Heck, in our system I think that the flycar responded to the HQ to get the ambulance with the local driver. It is a 15 minute drive with traffic lights between the two, and about 3 minutes with hats n horns. By no means a good system. But better than the crap we have now.