How Come Putnam County Is Responsible For Providing ALS?

[x635 4,066]

I'm just curious, how is it that Putnam County is responsible for providing Advanced Life Support, yet BLS falls on the individual muncipality or fire district?

I know here in Westchester, it's up to the municipality to provide and fund ALS.

How was it done that Putnam Co. is reponsible for providing ALS, not the municipality? And is there an ALS tax or ALS district?

[Goose 188]

I suppose that 10 or so years ago a county wide system was proven to be most cost and resource effective. Most municipalities don't have the tax base nor the call volume to support their own fully loaded ALS system - remember most of Putnam is without any real industry/business infrastructure so it would fall on the shoulders of the residents to foot the bill. When your only doing 5,000 calls as a County yearly w/ 1,100 or so being true ALS emergencies i can't see how having in the area of 10+ medics is either appropriate or cost effective.

[Guest]

I think it would be a better idea if each fire/ems district provide ALS service. For example, if Mahopac FD, Carmel VAC, Mahopac Falls FD should go to the town board and ask them to provide one or two medic vehicles to cover for the three towns? Any opinions on this idea?

[helicopper 1,050]

I think it would be a better idea if each fire/ems district provide ALS service. For example, if Mahopac FD, Carmel VAC, Mahopac Falls FD should go to the town board and ask them to provide one or two medic vehicles to cover for the three towns? Any opinions on this idea?

Carmel might be the only town in the County with the population and call volume to support an ALS system but where does that leave everyone else? Where will Carmel get mutual aid if they need it and there's nothing but a vacuum around them (at least in Putnam)? What if Carmel wants ABC and Mahopac wants XYZ - will they meet in the middle or will we wind up with two different programs in those two small districts?

We have enough layers of government, emergency services, and overlapping this or that as it is. A countywide ALS system was (and still is) a good idea for Putnam County. Six towns or worse eleven EMS districts all doing their own thing will not advance a SYSTEM! Moreover, the remaining districts with one or two possible exceptions probably can't support an ALS unit on their own. Let's look at Rockland County as a good model to follow - lots of BLS agencies and ONE ALS provider.

[helicopper 1,050]

I'm just curious, how is it that Putnam County is responsible for providing Advanced Life Support, yet BLS falls on the individual muncipality or fire district?

I know here in Westchester, it's up to the municipality to provide and fund ALS.

How was it done that Putnam Co. is reponsible for providing ALS, not the municipality? And is there an ALS tax or ALS district?

What Goose said! The only thing that I'd change in what Goose was saying is that a countywide ALS program for Putnam was first proposed in the late 1980's. It didn't grow wings and start flying until the 90's. Strictly by statute, the municipality isn't even really obligated to provide EMS. They may provide EMS - pretty soft wording for something so important.

§ 122-b. General ambulance services. 1. Any county, city, town or village, acting individually or jointly, may provide an emergency

medical service, a general ambulance service or a combination of such services for the purpose of providing prehospital emergency medical

treatment or transporting sick or injured persons found within the boundaries of the municipality to a hospital, clinic, sanatorium or

other place for treatment of such illness or injury, and for that purpose may:

NYS General Municipal Law

As for a Westchester/Putnam comparison, they may share a common border but that is where the similarities end. Westchester and Putnam couldn't be more different. Westchester had many existing ALS programs long before Putnam even had ALS intercepts coming in from Westchester or Dutchess.

Putnam is a small county, with a small population and even smaller tax base. To go town by town or EMS district by EMS district wouldn't support an ALS system so the County (and this is probably the ONLY time you'll ever hear me say this) went and did it right.

Look at the demographics:

100,000 or so people

4-5,000 total calls for EMS

1822 ALS (in 2006)

Divide that up by the 11 EMS agencies and there's just not enough volume to support a medic unit nor the money to fund one.

Finally, Westchester has a patchwork of ALS programs that could be very well served by a more regional approach but - as evidenced by the Hackley thread - you'll never see that happen in Westchester County!

[Guest]

Carmel might be the only town in the County with the population and call volume to support an ALS system but where does that leave everyone else? Where will Carmel get mutual aid if they need it and there's nothing but a vacuum around them (at least in Putnam)? What if Carmel wants ABC and Mahopac wants XYZ - will they meet in the middle or will we wind up with two different programs in those two small districts?

We have enough layers of government, emergency services, and overlapping this or that as it is. A countywide ALS system was (and still is) a good idea for Putnam County. Six towns or worse eleven EMS districts all doing their own thing will not advance a SYSTEM! Moreover, the remaining districts with one or two possible exceptions probably can't support an ALS unit on their own. Let's look at Rockland County as a good model to follow - lots of BLS agencies and ONE ALS provider.

The County does not have enough money to pay for a private company to provide ALS, what makes you think they are going to start up a countywide ALS system. The county had plans on doing a countywide system but they still were planning on a budget for it but now since the legislation said that they are not going to increase the budget for ALS, it puts that idea to the backburner for a while. Also it requires the three organizations to compromise and decide on who they want. We shall see what happens in the next couple of months, hope the county hears our protest and gets a little common sense, espically Bob Bondi being the "great volunteer" firefighter that he is.

[SageVigiles 1,194]

Here's an idea, I don't know how well it would work because I don't know how the county is split up exactly, but its a thought:

County Cars are responsible for a certain group of towns. Every district run by a county car (or 2 of them) has 1 medic unit assigned to that area to cover. I mean, if Empire was getting away with 4 medics for the entire county, it really couldn't be that expensive for every FD in the county to split the bill, could it? Even if you billed patients to offset some of the costs?

[paratrooper75 41]

Just a thought but lets see where it goes. I haven't thought this through too much and I'm not sure if it would even work but here it goes. What if there is a system similar to Greenburgh where the County sheriffs office and carmel police had deputies / Paramedics? If there was a known ALS call they could dispatch a patrol as the medic. Patrols respond to all EMS calls anyway. A downfall is if the deputy is tied up in another call but if its thought out right it might be able to work. This system should definitely be cheaper for the county. The problem is finding deputies that would want to play both roles. Lets here what you guys think.

Edited August 18, 2007 by paratrooper75

[JetPhoto 626]

This discussion is great however we are just pieces of fruit coming together to make fruit salad. The bottom line is the county started a program to provide to the community and by stopping this program and allowing the potential for someone to die they are opening themselves up to liability and a lot of bad press.

If they are not going to provided the service then they should be helping all EMS agencies in the county come up with a viable solution.

[pv102 0]

Well if I may, I believe everyone has some good ideas and we all know that something must be done because just ending this current system is about the worst thing that could happen to EMS here in putnam. I mean we are trying to increase the level of service, not decrease it. I think one of the best ideas came from paratrooper75, it would probably cost the least money as far as starting a countywide system which is where I believe the county is heading. But paratrooper75 is also right in saying finding deputies that would function in duel roles is going to be difficult. Although I think Paratrooper75 would have no problem filling both roles along with playing ERT Medic when needed.

[paratrooper75 41]

Shenanigans!!

[dadbo46 50]

Just a thought but lets see where it goes. I haven't thought this through too much and I'm not sure if it would even work but here it goes. What if there is a system similar to Greenburgh where the County sheriffs office and carmel police had deputies / Paramedics? If there was a known ALS call they could dispatch a patrol as the medic. Patrols respond to all EMS calls anyway. A downfall is if the deputy is tied up in another call but if its thought out right it might be able to work. This system should definitely be cheaper for the county. The problem is finding deputies that would want to play both roles. Lets here what you guys think.

Cops should worry about catching the bad guys....not playing medic ! They have enough things to do.

Edited August 19, 2007 by dadbo46

[paratrooper75 41]

Cops should worry about catching the bad guys....not playing medic ! They have enough things to do.

Agreed, but you should know since you live in Putnam that bad guys are few and far between. We get patrols on every call, sometimes more than one car, and on occasion every car in the sector or zone. It works in Greenburgh where there are a lot more "bad guys" why can't it work here. Officers are first responders as it is and most are EMTs why not just upgrade? It would be far better to have paramedic flycars like we do now but if the county doesn't want to pay we have to get creative with some other options. Its just a thought.

Edited August 19, 2007 by paratrooper75

[x635 4,066]

Having Pollice Officers as Paramedics is a good idea, and in the unincorporated section of Greenburgh, that's how our ALS is provided. A Police Officer staffs a Patrol Flycar solo.

A Police Officer-EMT also patrols in an ambulance solo.

Their is a civilian medic ambulance also for the town, that medic rides solo as well.

For the most part, they depend on a sector car to drive the ambulance to the hospital.

Although this allows for rapid response times, it takes police officers off the streets for a good amount of time, for even the most minor call, such as an ankle injury.

On the flip side, if the Police Officer-Paramedic has to make an arrest, he is out of service for a while.

EMS should be an independent, fully staffed civil service agency, just like PD's and FD's. Everyone always tries to get a bargain with EMS. Towns care more about their Sanitation departments then they do EMS. And a lot of it is our own fault, as we cover up our problems and don't do much public education as to who we are and what we need.

[x635 4,066]

Having Pollice Officers as Paramedics is a good idea,ONLY if it does not impact patrol coverage. In the unincorporated section of Greenburgh, that's how our ALS is provided. A Police Officer staffs a Patrol Flycar solo.

A Police Officer-EMT also patrols in an ambulance solo.

Their is a civilian medic ambulance also for the town, that medic rides solo as well.

For the most part, they depend on a sector car to drive the ambulance to the hospital.

Although this allows for rapid response times, it takes police officers off the streets for a good amount of time, for even the most minor call, such as an ankle injury.

On the flip side, if the Police Officer-Paramedic has to make an arrest, he is out of service for a while.

If call volume spikes, then the surrounding communities are relied on to come in and cover, or if a Police Officer isn't available, then a career firefighter is used to drive the ambulance to the hospital, or if it's a cardiac arrest, two are on a rare occasion used. Therefore, taking firefighters away from the community.

EMS should be an independent, fully staffed civil service agency, just like PD's and FD's. Everyone always tries to get a bargain with EMS. Towns care more about their Sanitation departments then they do EMS. And a lot of it is our own fault, as we cover up our problems and don't do much public education as to who we are and what we need.

[NYMedic37 22]

There is no excuse for this! Adaquete Police, Fire and EMS (both bls and als) is essential. Police Officers should do Police work, Firefighters should fight fires and EMT's and Paramedics should do EMS. All of the bullS**t politics and passing the buck should stop and the residents should be given the proper services.

[grumpyff 1,159]

Shenanigans!!

Keep PD/EMS/FD separate. All have different concerns, and finding people to do one job is hard enough, learn something like being a paramedic, after working a tour on patrol. Plus I have been on EMS calls For Overdoses, where the patient did not want to speak about which drug they took out of fear of being arrested. (Been on both sides of calls like that, PD and EMS).

Edited August 20, 2007 by grumpyff

[Remember585 815]

Is there still some DOH rule about ALS and how you decide where/what is allowed based on call volume?

I remember at one point someone telling me you have to do at least 1,000 calls to have your own ALS, not sure if it is BS or real.

If that's the case, sounds like the four Medics Putnam has been working with would be more then sufficient, perhaps either the County can create a Putnam ALS program or another agency, like Empire State, will come in and do it at the price Putnam wants to pay.

Either way, it's a service that has to be there!

[WAS967 97]

or another agency, like Empire State, will come in and do it at the price Putnam wants to pay.

If someone offered you a job that paid less than your cost of living, would you take it?

The problem with a lot of these municipalities is that they just don't seem to comprehend the sheer expense of running an ALS service of ANY kind. Emergency vehicle insurance rates TRIPLED after 9/11. Malpractice insurance rates are pricey because it's the United States of Litigation. Salaries are high because of the medic shortage, so you have to pay well to get quality medics, and/or pay out a ton of overtime to cover shifts. Equipment costs (both acquisition and maintenance) is anything but cheap.

Putnam (the taxpayers that is) needs to step up and make this system Municipal. Make the medics and the vehicles Putnam operated. Putnam (being a municpial agency) would be eligible to purchase the vehicles and equipment tax free AND off state bid (at least the vehicles). The vehicles could be maintained by the county motor pool and fueled from the county refueling system. The medics could be county employees with county benefits and a PENSION, making it an attractive job that would attract quality medics thus offering quality care to the patient. The medics would be accountable to the county and the county would be able to control the system in a way they see fit, not have to go through a third party for disciplinary actions and system changes. The list goes on and on.

Putting the system back out to bid is a waste of time. Any company that bids less than what Empire is being paid now is either 1) Stupid or 2) Trying to lowball to get the contract so they can put putnam in the same position they are in now and force them into a price increase. Our options are Transcare, Empire, MLSS, or Alamo. Not too man options.

What Putnam needs to do in the interim is get a Certificate of Need for ALS Ambulance service for the county and open up bids to other agencies to operate under that CON as a third party. At least then they would have more options available to them.

Edited August 21, 2007 by WAS967

[Ging599 13]

Maybe a system like Nassau County uses, which sounds very similar to Greenburg, would work.

The ambulances operate as a bureau under the Nassau County PD. A/EMTs (we would use medics) are civilian employees of the PD and operate the ambulances alone. Normally two patrol cars are dispatched on an aided unless they are busy and the PO of one of those units becomes the driver of the ambulance to the hospital.

Vollie EMS fits into the system depending on agency. Most vollies act as a back up to the PD buses and will respond as a second, third, fourth, etc. resource as the PD buses get tied up. Some agencies respond primary or piggy backed with the PD. There is always a PD car assigned to aided cases. Vollies NEVER are assigned to "mental aided" cases even if it means taking a PD ambulance from far away. Ambulances are assigned 2 or 3 per precinct depending on call volume. I have been out of Nassau for a while, but I am pretty sure this is still how it runs.

Modify this to the Putnam County Sheriff's office and keep the vollies responding as they do now and maybe it would work with some other modifications. Revenue would offset some of the cost and it would still be county run.

Just a thought.