More Debate on Putnam ALS

[jps385 0]

http://www.lohud.com/apps/pbcs.dll/article.../803100359/1020

Link to the Journal News Article, more talk of the putnam medic contract.

[celticmedic643 2]

Why is it every time the Putnam ALS contract comes up there is so much drama?? Is it just me or is Putnam the perfect fit for a county wide municible service? I just find it hard to belive that there is not one single commercal serviced based out of Putnam county. I know Empire provides the service but their office is in Fishkill. I just feel sorry for the residents of Putnam county. Some one needs to step up and fix this problem. Otherwise everytime the ALS contract is up the residents of Putnam county could be without a valulable life saving service.

[Goose 188]

Well said Celtic, 100% on target.

Man, today politicians are really getting on my nerves. First our esteemed Gov. and now this garbage. What everyone in Putnam needs to do is let their representation know they are getting a STEAL on their ALS service right now. I'm not an EMS administrator, but the Putnam contract, as it stands now, is probably worth 1 - 3 million dollars, at least. Once the County sends out their RFPs they are going to get a real wakeup call if they think they will get the kind of coverage they have now for under 1 million, it just isn't happening. The days of low-balled contracts is over.

Enough is enough already. Is it going to take the death of a loved one for these politicians to understand that value associated with EMS and those that choose the profession?

Edited March 11, 2008 by Goose

[PVFD233 68]

Well said Celtic, 100% on target.

Man, today politicians are really getting on my nerves. First our esteemed Gov. and now this garbage. What everyone in Putnam needs to do is let their representation know they are getting a STEAL on their ALS service right now. I'm not an EMS administrator, but the Putnam contract, as it stands now, is probably worth 1 - 3 million dollars, at least. Once the County sends out their RFPs they are going to get a real wakeup call if they think they will get the kind of coverage they have now for under 1 million, it just isn't happening. The days of low-balled contracts is over.

Enough is enough already. Is it going to take the death of a loved one for these politicians to understand that value associated with EMS and those that choose the profession?

Goose you the man.

[pd125 0]

Goose you the man.

The "cheap" birds are out again signing their song. 4,700 calls would barley support 1 als ambulance crew no less 4 fly cars without support. How do these pols think you staff pull up to a street corner and hire for the day? As for a county wide model that will cost about the same or more to run as 1.8 mil. The same story in Dutchess town shelling out the money for services they took for granted and then expected 24/7 on the cheap. The only thing better is Gov. and his actions.

[helicopper 1,050]

Well said Celtic, 100% on target.

Man, today politicians are really getting on my nerves. First our esteemed Gov. and now this garbage. What everyone in Putnam needs to do is let their representation know they are getting a STEAL on their ALS service right now. I'm not an EMS administrator, but the Putnam contract, as it stands now, is probably worth 1 - 3 million dollars, at least. Once the County sends out their RFPs they are going to get a real wakeup call if they think they will get the kind of coverage they have now for under 1 million, it just isn't happening. The days of low-balled contracts is over.

Enough is enough already. Is it going to take the death of a loved one for these politicians to understand that value associated with EMS and those that choose the profession?

True enough but why should the County get something for nothing or get something at the expense of someone else. I actually agree that the service should be re-bid and bids should be entertained from ALL potential service providers with the County as the CON holder. This way we get what we pay for, the County has control over the delivery of the system and there is no repeat of this nonsense.

As painful as it may be for the program to go from 900K to 2M, at least we'll be getting the proper level of service and not be held hostage as we were last year when the provider threatened to pull out because they were losing money. Well no kidding Sherlock - you undercut the cost by a large margin!

[Guest]

I have dispatched for a county wide ems in NC. I think Putnam would be a great place for this kind of system. If of course the politicians would get their head out of their you know what and realize that their is a need for it.

[Goose 188]

True enough but why should the County get something for nothing or get something at the expense of someone else. I actually agree that the service should be re-bid and bids should be entertained from ALL potential service providers with the County as the CON holder. This way we get what we pay for, the County has control over the delivery of the system and there is no repeat of this nonsense.

As painful as it may be for the program to go from 900K to 2M, at least we'll be getting the proper level of service and not be held hostage as we were last year when the provider threatened to pull out because they were losing money. Well no kidding Sherlock - you undercut the cost by a large margin!

Chris,

Don't get me wrong. I'm not advocating that the County not put out RFPs for the service, i agree that they should. I just find it amusing that at the very reasonable price of $950K (which is likely an unrealistic low-ball price) they are looking to cut corners. I don't know all the particulars, but the County has had a well publicized fiscal issue, and as you suggest while it may hurt i think they should be realistic about what it costs to provide EMS in 2008. Setting the bar artificially low is only going to limit the County's options as far as providers are concerned.

[helicopper 1,050]

Chris,

Don't get me wrong. I'm not advocating that the County not put out RFPs for the service, i agree that they should. I just find it amusing that at the very reasonable price of $950K (which is likely an unrealistic low-ball price) they are looking to cut corners. I don't know all the particulars, but the County has had a well publicized fiscal issue, and as you suggest while it may hurt i think they should be realistic about what it costs to provide EMS in 2008. Setting the bar artificially low is only going to limit the County's options as far as providers are concerned.

We're in agreement Goose! I didn't think you were suggesting anything but an efficient and cost effective program. Now if we could just get the politicians to agree with us...

[celticmedic643 2]

So why is it the politcians in Putnam dont se the BIG picture? Why does Putnam County seem to have so many issues with emergency services?

[tdc202 0]

I've heard for the last 7 years from various people that they are "Going to hire there own medics".Whatever happened to that idea?

[celticmedic643 2]

I've heard for the last 7 years from various people that they are "Going to hire there own medics".Whatever happened to that idea?

That has been one of longest running rumors in the history of mankind.

[tdc202 0]

seems tome that every time the county gets disguntled with whomever has the contract that rumor pops up then goes away.

[Medic137 6]

That has been one of longest running rumors in the history of mankind.

Once they figure out what 20 civil service paramedics would cost they realize what a good deal they're getting.

[SageVigiles 1,194]

That has been one of longest running rumors in the history of mankind.

And on the Seventh Day, the Lord started a rumor about a Putnam County Medic Service...

Seriously, I'm not holding my breath for that one.

[Guest]

If Putnam County wants to see how fortunate they are to be paying what the county does for paramedic service they should look at Rockland County. Where each town is now paying well over 1.5 million dollars if not more to RPS to provide one to two fly cars with two paramedics. In Rockland's case it is the individual towns who enter in to contract with the ALS provider not the county four towns each with contracts with the same company all paying different prices for almost the same services. Maybe that is what Putnam should do have all four towns put out RFP's for ALS service and see if the cost is lowered.

[NWFDMedic 58]

Why does it seem like every 6 months or so for the past 10 years something comes up about the Putnam ALS contract? The population demographics, the lack of east-west through routes, and only one hospital in the service area make it a very difficult system to cover. Having worked in Putnam back in the Sloper days, I can imagine that a good percentage of the calls cannot realistically be covered in 9:59 with the 4 medic stations. There are places in Medic 2 and 4's coverage areas that can't be safely reached within 9:59 even if the medic is sitting in the station in the flycar and doesn't need to locate the call on a map. I'm not too familiar with Medic 3, but I'd imagine it's the same story. Add in a single call in the county and you're stretching your resources even further.

I don't know too much about the service that ESA provides to Putnam County, but keeping the existing antiquated system would be setting up any commercial service for failure. The first issue that needs to be addressed by the politicians is the problem with the system, not the provider. The county needs to have a professional evaluation of the system and have a list of suggestions from an independent auditor. The auditor will tell them what is needed to provide certain levels of service in certain amounts of time and will provide new coverage ideas that may be beneficial to the communities in the county. Then the politicians have to make a political decision with the right information in hand instead of trying to make the current system work and then blaming the private service when it fails.

[ckroll 101]

Why does it seem like every 6 months or so for the past 10 years something comes up about the Putnam ALS contract? The population demographics, the lack of east-west through routes, and only one hospital in the service area make it a very difficult system to cover. Having worked in Putnam back in the Sloper days, I can imagine that a good percentage of the calls cannot realistically be covered in 9:59 with the 4 medic stations. There are places in Medic 2 and 4's coverage areas that can't be safely reached within 9:59 even if the medic is sitting in the station in the flycar and doesn't need to locate the call on a map. I'm not too familiar with Medic 3, but I'd imagine it's the same story. Add in a single call in the county and you're stretching your resources even further.

I don't know too much about the service that ESA provides to Putnam County, but keeping the existing antiquated system would be setting up any commercial service for failure. The first issue that needs to be addressed by the politicians is the problem with the system, not the provider. The county needs to have a professional evaluation of the system and have a list of suggestions from an independent auditor. The auditor will tell them what is needed to provide certain levels of service in certain amounts of time and will provide new coverage ideas that may be beneficial to the communities in the county. Then the politicians have to make a political decision with the right information in hand instead of trying to make the current system work and then blaming the private service when it fails.

Well said. We lack perspective on emergency health care. Response standards are based on high population density models. Few people in Montana, Wyoming, or the Dakotas would expect to see an ALS unit in 9 minutes or less. One does not have to go farther than the Adirondacks to find vast populated areas that have no paramedics. Putnam is a rural system that looks for urban level service.

I think the choices are to abandon ALS altogether or accept that we have to pay a premium for the service. As a provider, I'd like to keep my job so I am enthusiastic about ALS. As a healthy resident who would rather drive than get caught in an ambulance, I question its value, given the cost.

[NWFDMedic 58]

Well said. We lack perspective on emergency health care. Response standards are based on high population density models. Few people in Montana, Wyoming, or the Dakotas would expect to see an ALS unit in 9 minutes or less. One does not have to go farther than the Adirondacks to find vast populated areas that have no paramedics. Putnam is a rural system that looks for urban level service.

I think the choices are to abandon ALS altogether or accept that we have to pay a premium for the service. As a provider, I'd like to keep my job so I am enthusiastic about ALS. As a healthy resident who would rather drive than get caught in an ambulance, I question its value, given the cost.

Well I wouldn't be the first one to say abandoning the service is a viable option to even consider, however, a restructuring of the system might be appropriate. I would also think that there has to be some more utilization of resources outside the county. In 2001 when I worked for Sloper, the county would have no problem sending a third medic to an accident in Patterson from Medic 2's station or maybe just on the road to relocate while medic ambulances sat in Beekman and Pawling. While it's not appropriate to be using other resources to constantly bail you out, I think it would be worthwhile for the county to enter into discussions with agencies to the north, south, and east to find out what availability they might have for mutual aid and to develop better procedures to use the aid when appropriate. I'm pretty sure this is happening a bit more now; I would hope the days of staging the 4th medic at the TSP and 301 to cover the county are gone.

[Medic137 6]

Another factor causing extended responses is the use of the ALS system to prop up the failing BLS system. It is not at all unusual on a weekday to have Medics 3 and 4 transporting BLS patients and the whole county being covered by Medic 2 sitting at Putnam Plaza and Medic 1 in Garrison. A call on the north end of the Taconic or in Putnam Lake is likely to have a 20 minute response.

As said above, it is the system and not the provider that needs to be examined.

[Goose 188]

Another factor causing extended responses is the use of the ALS system to prop up the failing BLS system. It is not at all unusual on a weekday to have Medics 3 and 4 transporting BLS patients and the whole county being covered by Medic 2 sitting at Putnam Plaza and Medic 1 in Garrison. A call on the north end of the Taconic or in Putnam Lake is likely to have a 20 minute response.

As said above, it is the system and not the provider that needs to be examined.

I've always wondered why they never kept the 4 fly cars and just added 2 BLS ambulances...

[ckroll 101]

I've always wondered why they never kept the 4 fly cars and just added 2 BLS ambulances...

Several individuals pushed the idea aggressively, but Putnam County leadership beat it to death with a stick and burned the remains. Very negative response. It did and still does make more sense than what we are doing.

[Guest alsfirefighter]

Well I wouldn't be the first one to say abandoning the service is a viable option to even consider, however, a restructuring of the system might be appropriate. I would also think that there has to be some more utilization of resources outside the county. In 2001 when I worked for Sloper, the county would have no problem sending a third medic to an accident in Patterson from Medic 2's station or maybe just on the road to relocate while medic ambulances sat in Beekman and Pawling. While it's not appropriate to be using other resources to constantly bail you out, I think it would be worthwhile for the county to enter into discussions with agencies to the north, south, and east to find out what availability they might have for mutual aid and to develop better procedures to use the aid when appropriate. I'm pretty sure this is happening a bit more now; I would hope the days of staging the 4th medic at the TSP and 301 to cover the county are gone.

While that sounds good in theory...you still have to cover home at first. Why should the taxpayers where I work, foot the bill for my unit(s) to intercept or cover calls in Putnam on a fairly often basis if something like this would occur? We have a minimum of 2 medics and 90% or even higher in most cases I'm beign conservative 3 medics to cover my area and Putnam only uses 4. Granted on some levels our call volume in our area is similiar to that of the entire county, but geographically it doesnt' make much sense. Maybe Putnam politicos are too use to the low ball amounts because of the salaries Sloper and Alamo used to pay their employees. I'm all for helping, but we have one scenario right now where we are on automatic dispatch to calls in a territory if their medic is unavailable but our system isn't set up that way. And I mean for anything...stubbed toe to chest pain. Makes no sense to me...or that the majority of the M/A to that area is because they drop to only 1 medic at night and we still staff a minimum of 2 and again majority of the time 3.

[ckroll 101]

I'm all for helping, but we have one scenario right now where we are on automatic dispatch to calls in a territory if their medic is unavailable but our system isn't set up that way. And I mean for anything...stubbed toe to chest pain. Makes no sense to me...or that the majority of the M/A to that area is because they drop to only 1 medic at night and we still staff a minimum of 2 and again majority of the time 3.

To be fair, Putnam and Westchester provide mutual aid for each other. I have no numbers, but working both systems, it sounds like ALS MA in and out is about a wash. In Putnam, Alpha level calls [and I believe Bravo when things get tight] do not get medics either in county or requested MA. Putnam has 4 medics on 24/7. The region, both Putnam and northern Westchester, needs more ALS buffer, but how does one do it? It crosses county and regional lines and involves both contract and municipal services.

The question that NEVER gets answered is who is responsible for provision of EMS, at either the ALS or BLS level. There are economies of scale [ town/county] , there are geographical issues [travel /intercept corridors], but at the end of the day, who is responsible for providing the service to residents and what level of service are they responsible for providing, and at what level of availability?

Follow the money and the responsibility. Until it is established what has to be provided and by whom, there will be no resolution.

[ckroll 101]

And another thing. There's medic number fudging going on on both sides of the border. Putnam has 4 except when they don't..... 2 of them may be driving for BLS calls. Northern Westchester has 2 or 3 except when the fire based medics are on fire calls and then there's one.

On paper it looks like 7 medics when in practice two slip and falls in Brewster and an oil burner backfire in Peekskil and all of a sudden a vast expanse of humanity has 3 medics serving them.

[Guest alsfirefighter]

it sounds like ALS MA in and out is about a wash.

I can't speak for what part of Northern Westchester that you're referring to, but in the area that I work in, our system gives out much more M/A ALS then comes in. I can say that recently it has actually reduced in volume and our bigger issues at this point is the inability to get a ambulance on scene for transport at certain hours. We are regularly waiting extended periods of time where 3rd and 4th agencies are being toned for M/A and even they aren't answering.

On paper it looks like 7 medics when in practice two slip and falls in Brewster and an oil burner backfire in Peekskil and all of a sudden a vast expanse of humanity has 3 medics serving them.

Couple in the rash of diversion issues area hospitals have been dealing with and it takes a further toll on our resources and I couldn't agree with you more. The one issue you mention we have been trying to constructively deal with for quite some time now with little to no understanding or willingness to move forward on the issue. I would love to be brutally honest but some things are better left unsaid on forums like this, plus you and I have had discussions about it and I'm sure you can sense our frustration on certain levels about it. It also isn't much different that we still haven't gone to a priority based dispatching for ALS in our area which would allow more flexibility with our resources, but instead the thought process has been stated that 1/2 of our southern response area is purely volunteer with no guaranteed or systematic BLSFR ability.

I actually sat down and read the article in the paper again yesterday being I still had the paper and was going to throw it out and what still strikes me as odd, is how they keep mentioning the response time issue of 10 minutes. I had to wonder if the politicians in Putnam have any realistic understanding of the system. You have 4 medics to cover the entire county and as each goes out, you shift for the SSM. There are times where you will have extended response times when your down to 2 units covering all that area. 10 minutes is not all that reasonable in my opinion and you still have to factor in driving safely, what the road conditions are etc. Its not about driving fast and just getting there, how come we never see statements that while it took 12 or 15 minutes the care the patient received was superb? Not to mention the bigger issue that everyone wants to put blinders on about is BLS. And if someone does they start getting labeled as anti-volunteer and a groups will start rebel rousing even if their system was not in the toilet but already been processed through the sewage treatment process. Sometimes pride needs to take a back seat to what you really suppose to be the driving force of what our business is, the best interest of the public that we serve. If BLS is on scene and they feel its ALS warranted, start transporting. Also, for the life of me do they look at surrounding areas systems and see what they are paying? Are they used to the old bids where those companies didn't pay their employees a fair/equitable salary? Are they still haven't learned that the low ball bid they may accept next time is only going to lead to a fee increase as well?

[Beekman 5]

It keeps being mentioned about Towns not paying their fair share for EMS. I know of two Towns that are paying 10X and 2x as much for this year's contract and don't think for a minute that the medics or EMTs have seen a dime more.

Also both Towns keep wondering why they are paying big bucks and other Towns in Dutchess are getting 24/7 coverage for free.

[Medic137 6]

It keeps being mentioned about Towns not paying their fair share for EMS. I know of two Towns that are paying 10X and 2x as much for this year's contract and don't think for a minute that the medics or EMTs have seen a dime more.

Also both Towns keep wondering why they are paying big bucks and other Towns in Dutchess are getting 24/7 coverage for free.

What these towns don't grasp is that they're not paying for what an ambulance does. They pay for it doesn't do. When an ambulance is on a call, there's a pretty good chance the service will be paid for the run. What the towns have to pay for is the time the crews are sitting in their stations waiting for a call. A town with a call volume of 5000 per year will pay a lot less than a town with a volume of 500.

[pd125 0]

It keeps being mentioned about Towns not paying their fair share for EMS. I know of two Towns that are paying 10X and 2x as much for this year's contract and don't think for a minute that the medics or EMTs have seen a dime more.

Also both Towns keep wondering why they are paying big bucks and other Towns in Dutchess are getting 24/7 coverage for free.

What towns get their coverage for free? I don't know any district that do not support a system except for the City of Pughkeepsie. If you want a medic or ambulance 24/7 your putting up some money up front. The higher call volume the less up front money.

[MoFire390 118]

The "cheap" birds are out again signing their song. 4,700 calls would barley support 1 als ambulance crew no less 4 fly cars without support. How do these pols think you staff pull up to a street corner and hire for the day? As for a county wide model that will cost about the same or more to run as 1.8 mil. The same story in Dutchess town shelling out the money for services they took for granted and then expected 24/7 on the cheap. The only thing better is Gov. and his actions.

why not? It works for the day laborers.

It just seems to me that no matter what happens to the ALS program out there its still going to be news. Maybe the founder from CRP should go and help them out with makin an ALS program. he did it here and works out wonderful.

Edited March 16, 2008 by MoFire390