Response Times

[ny10570 745]

Thanks to time based performance standards response time is one of the biggest issues in both volunteer and career fire departments. On the career side of EMS response times are also a major issue resulting in being stuck on street corners, moved around at the whim of SSM, and stuck racing after sick jobs just in case they're real emergencies. I never hear anything from volunteer EMS agencies about response times, only the number of calls covered compared to those dumped out on mutual aid. How are you guys doing with response times? Anyone have numbers to put up?

[Guest MVFD334]

I know there are certain times of the day in Putnam county that it would suck to have to wait for an EMS agency to respond. Typically mid day.

[Guest]

I know Mahopac has been averaging 4-6 min. for ems runs for over 3 years now. We also do have the occasional run that goes mutual aid but that equals out to the amount of times we go out to mutual aid calls. We are only as good as our members efforts keep up the moral and everyone performs better. Personally I could not be happier with the job Mahopacs E.M.S. co. and all the emt's and firefighters do for our department. Also to our Fly cars, there efforts are a huge part of the whole deal Keep it up boys and girls...

[helicopper 1,050]

There are times in this region that you'd be lucky to get same day service on an EMS call!

As for response times, I remember some very heated discussions at HV REMSCO meetings (when Westchester was still part of the HV region) when a response time standard for all EMS was proposed and vehemently opposed by those representing agencies who couldn't meet even a 10-12 minute standard the majority of the time. How's that for patient advocacy?

Looking at it another way, define response time for me. Are you considering it from the time the 911 call is placed until a qualified person arrives at the patient or the time from when the ambulance leaves the station and arrives at the house/development/building? Vastly different but odds are there are agencies out there using both and/or their own variations of them.

[AFS1970 504]

What response actually is does need to be defined. EMD has changed allot of that perception. Since one of the original goals of EMD was to get a qualified person on the phone to help the victim that kind of takes care of that first part that starts with the initial call for help. But there are at elast three other sections to response time. The time it takes the dispatcher to get the call out to the department, the time it takes to assemble the crew (regardless of crew size) and the time it takes to go to the call.

As a dispatcher I would hope that the time it takes to get the call out is miniscule, but I know better. While the responders have no control over this, it definately effects patient care as well as incident stabilization on non EMS calls.

In a fully staffed department the assembly time is measured in seconds, if at all. Obviously in a system where the staff is not all together and must meet, this is longer.

The last is the actual on the road response time, which I would bet in most agencies is under 10 minutes, probably more like 3-5 minutes.

I have seen where response times are started from different points depending on the desired result. I got the chance to see an EMS department in the South West that would call units on a different channel and "pre-alert" them to an address then tone them out on a common channel with the FD and use tone out to arrival as the basis for thier response stats. I have also seen times start when the call is processed but not yet dispatched and these statistics used to make the responders look slow.

No matter where we get our numbers from, once we average them together we obscure the really long response times anyway. Remember if I have two calls, one takes 1 minute to respond to and the other takes 15 minutes to responde to, I still have an average of an 8 minute response time. If I have two calls and one take 7 minutes and the other takes 9 I have the same average respons time but noone had to wait 15 minutes for service.

[ONEEYEDMIC 68]

How about the VAC's not being able to cover their calls. Having a call go to Mutual Aid and then that VAC not getting out. Not that is happens alot, but it does happen. I can come up with some solid numbers on this but then people would think that I am picking on them so I won't.

[DaRock98 76]

How about the VAC's not being able to cover their calls. Having a call go to Mutual Aid and then that VAC not getting out. Not that is happens alot, but it does happen. I can come up with some solid numbers on this but then people would think that I am picking on them so I won't.

I would like to hear the numbers that you have. I feel as long as you don't name the agency/agencies no one can claim that you are picking on them right? I would also like to hear how you came up with these numbers if you don't mind.

[ONEEYEDMIC 68]

I would like to hear the numbers that you have. I feel as long as you don't name the agency/agencies no one can claim that you are picking on them right? I would also like to hear how you came up with these numbers if you don't mind.

See that is where the problem is. Being that certain members know who I am they will complain in PM's about what I am saying. I am not out to get anybody on here. I just want the wool to be pulled from peoples eyes.

[smwells 7]

You can make the numbers sound as good or bad as you want or need them to be to prove your point of view. Perception by the patient is always going to be longer than the real time..

It was mentioned about 'time to get treatment to a patient', this number is alway going to be a gray area.

What time should be used:

We have EMD dispatchers Did they start care?,

We have Flycar medics, Does their scene time indicate care started?

We have members like myself (EMT) that will respond to a scene with gear if closer than building, does the clock stop once I arrive?

Or does it wait until the ambulance arrived, I know when I get times for the call from Putnam911 it is the time the ambulance got on scene, not the 10 min before that myself and possibly the medic arrived..

Just the above could be as short as 2 minutes, or 20+ minutes if you are waiting for a Mutual aid ambulance. Did the patient get treated as quickly as possible, YES!!! Do the numbers always show that, NOPE!!!

[ONEEYEDMIC 68]

You can make the numbers sound as good or bad as you want or need them to be to prove your point of view. Perception by the patient is always going to be longer than the real time..

It was mentioned about 'time to get treatment to a patient', this number is alway going to be a gray area.

What time should be used:

We have EMD dispatchers Did they start care?,

We have Flycar medics, Does their scene time indicate care started?

We have members like myself (EMT) that will respond to a scene with gear if closer than building, does the clock stop once I arrive?

Or does it wait until the ambulance arrived, I know when I get times for the call from Putnam911 it is the time the ambulance got on scene, not the 10 min before that myself and possibly the medic arrived..

Just the above could be as short as 2 minutes, or 20+ minutes if you are waiting for a Mutual aid ambulance. Did the patient get treated as quickly as possible, YES!!! Do the numbers always show that, NOPE!!!

Excellent points. Do you have a radio and call whoever you need to let them know you are on scene? When a call comes in and a Medic and Amb are dispatched along with a PO that is when my clock starts. Does the PO stop the clock? Maybe. Does the Clock stop when the Medic gets there? Not altogether. You can hit that button on the side that gives you lap times. Meaning the Medic was there in this amount of time but you still need to txp the PT. That is why you have to keep the other clock going.

[firemoose827 324]

How about the VAC's not being able to cover their calls. Having a call go to Mutual Aid and then that VAC not getting out. Not that is happens alot, but it does happen. I can come up with some solid numbers on this but then people would think that I am picking on them so I won't.

No brother, you are not very far off at all with that post. I will take my area as a prime example for this to help you make your point.

My County is terrible with response times because we are mostly rural areas with farms and such. Our Town is the biggest in the County. We have a village which is large and fairly populated and everything is close. We have a small hospital with a 8 Bed ED that staffs one doctor and 3-4 nurses per shift that cant do very much for the patient. But the town is loaded with farms and large properties. SOme of our members have a 5 minute drive to the Station. So if our crew is responding from the Town, they have atleast a 5 minute response time to the station, let alone getting the rig out the door. Than they may have to travel another 5-10 minutes to get to the scene, depending if its in our district or mutual aid. So the patient could very well be looking at 15-20 minutes before an ambulance arrives....Thats horrible!

I have tried to mention to my squad that maybe we should look into having crews stand by in station for a few hours every evening, so atleast we have a crew THERE at station and will cut down the response time...But the fire chief doesnt want to turn the Station into a social club, so that got shot down.

Now there is a study for our area, and two other districts in our County to check the feasibility of staffing 2 paid Firefighter/EMT's during the weekdays from 6a-6p to run ambulance calls and get engines to fires, but the study just started and may take a while to see any results, let alone any type of action.

Finaly, there are times when we cant even get a crew at all, and have to go mutual aid. But with our County, we go three transmitions 3 minutes apart...so you get toned once, wait 3 minutes, get second tones, 3 more minutes, than finaly 3rd tones. If no one answers after three tones they tone out mutual aid. I think that is a bit too much time to wait for an acknowledgement, but I didnt make the rules here!!

So yes, response times are a problem for us here, and we try to make them better but keep coming up with problems. Our only shot is to have the study completed as soon as possible and look at combination status.

[smwells 7]

Excellent points. Do you have a radio and call whoever you need to let them know you are on scene? When a call comes in and a Medic and Amb are dispatched along with a PO that is when my clock starts. Does the PO stop the clock? Maybe. Does the Clock stop when the Medic gets there? Not altogether. You can hit that button on the side that gives you lap times. Meaning the Medic was there in this amount of time but you still need to txp the PT. That is why you have to keep the other clock going.

That is the problem, people see the time when the ambulance arrived and complain it took 20 minutes to get the ambulance, without realizing the pt was being cared for 10 minutes before they arrived. Giving the incorrect impression that the patient waited the 20 minutes for care when they didn't.

As most EMS people will attest, transport is a priority in very few calls. Having the pt being evaluated and treated, can also minimize the need for an ambulance to rush lights and siren to a scene that is already under control.

[GAW6 66]

As most EMS people will attest, transport is a priority in very few calls. Having the pt being evaluated and treated, can also minimize the need for an ambulance to rush lights and siren to a scene that is already under control.

Excellent comment!! I can't tell you how many times the ambulance crew has had to wait on scene while the Medic is doing their thing. I actually had a Medic say to me once "go ask the homeowner for a garbage bag so you can clean up all my stuff".

Sure we have some poor response times, but as said previously, care has usually already been started by either PD and/or the Medic.

Also, I have been seeing more and more calls where the ambulance should just be painted yellow and have a big sign that says "TAXI" on top. I am sorry, but I don't think these calls warrant people trying to kill themselves getting through town either in their personal vehicles or in the ambulance to find the person there waiting with their bags packed!

[ny10570 745]

A couple of excellent points, but how come no one other than Mahopac has solid numbers to put up? MZVFD, when does your clock start and stop? The numbers games people play really kills me. If anyone has some flexibility with how they come up with their numbers how about dispatch to the ambulance on scene. This is the best measure on that agencies performance. A lone medic, police officer, or EMT on scene should not stop the clock because if its an arrest, until they get some help they might as well be a citizen with a defib. If it is a Cardiac emergency unless they're a medic or are going to transport without the ambulance they're really not doing the patient much good.

Some have brought up that the bus often is not a priority as long as treatment has begun. True, so then is the bus told to slow it down? If you're an agency that consistently has a fly car on scene first, why not roll the ambulance cold until being informed that it is a true emergency? Not breaking balls, just throwing out ideas. The other issue here, is there enough help on scene without the bus to begin treatment of the critical patient or is the lone responder going to be stuck trying to play catch up?

In the spirit of full disclosure, this came about because of a discussion with a VAC officer about how great they were doing this year. They had only had to look to mutual aid once so far this year, but he had no idea and no way to look up how many calls took more than 10 minutes to get a crew on the road.

GAW, a great way to fix that is to switch to 60 and utilize EMD. A tiered response will save you so many of those headaches.

Edited March 26, 2008 by ny10570

[firemoose827 324]

A couple of excellent points, but how come no one other than Mahopac has solid numbers to put up?

I put up numbers, and they are factual enough.

Some have brought up that the bus often is not a priority as long as treatment has begun. True, so then is the bus told to slow it down? If you're an agency that consistently has a fly car on scene first, why not roll the ambulance cold until being informed that it is a true emergency? Not breaking balls, just throwing out ideas. The other issue here, is there enough help on scene without the bus to begin treatment of the critical patient or is the lone responder going to be stuck trying to play catch up?

I have to disagree with that overall approach that transport is not priority. Too many ALS providers are starting to set up Mobile ER's in patients living rooms. What happened to "Dont delay transport waiting for ALS"? Shouldnt the same thing be said for performing your ALS Skills on scene as apposed to in the ambulance enroute to a higher, appropriate level of care? Just curious, honest questions. I believe in rapid transport to the appropriate facility that can provide the highest possible level of care for the patient and performing whatever ALS procedures you can in the back of a moving ambulance. Thats what I did when I was ALS 9 years ago, there was no stay and play, it was treat and transport. Whats everyones feelings on this?

I do agree that the time should be measured when any patient care arrives on scene and initiates treatment.

In the spirit of full disclosure, this came about because of a discussion with a VAC officer about how great they were doing this year. They had only had to look to mutual aid once so far this year, but he had no idea and no way to look up how many calls took more than 10 minutes to get a crew on the road.

I do not understand why this officer had no idea and no way to look up how many calls took more than 10 minutes to get a crew on the road. You would simply check your times on the PCR or your dept run card/sheet and reference the call received time against the enroute to call time...simple enough. With the "B.I.F.R.S" you can even run a querry for that data and produce a list of the calls you mentioned. I have done this before for both my fire dept and my rescue squad on different questions...just enter the data into the querry, click search, voila!!

Being I am not an officer in my current EMS agency I do not have access to the paperwork, but the numbers I posted were based on actuall trials run by myself and other members during a drill night. We drove from the firehouse to the farthest reaching members residence in our district and it was slightly over 5 minutes drive time.

[helicopper 1,050]

I have to disagree with that overall approach that transport is not priority. Too many ALS providers are starting to set up Mobile ER's in patients living rooms. What happened to "Dont delay transport waiting for ALS"? Shouldnt the same thing be said for performing your ALS Skills on scene as apposed to in the ambulance enroute to a higher, appropriate level of care? Just curious, honest questions. I believe in rapid transport to the appropriate facility that can provide the highest possible level of care for the patient and performing whatever ALS procedures you can in the back of a moving ambulance. Thats what I did when I was ALS 9 years ago, there was no stay and play, it was treat and transport. Whats everyones feelings on this?

I do agree that the time should be measured when any patient care arrives on scene and initiates treatment.

I do not understand why this officer had no idea and no way to look up how many calls took more than 10 minutes to get a crew on the road. You would simply check your times on the PCR or your dept run card/sheet and reference the call received time against the enroute to call time...simple enough. With the "B.I.F.R.S" you can even run a querry for that data and produce a list of the calls you mentioned. I have done this before for both my fire dept and my rescue squad on different questions...just enter the data into the querry, click search, voila!!

Being I am not an officer in my current EMS agency I do not have access to the paperwork, but the numbers I posted were based on actuall trials run by myself and other members during a drill night. We drove from the firehouse to the farthest reaching members residence in our district and it was slightly over 5 minutes drive time.

I agree that transport should not be delayed but when ALS is available in the absence of that transportation, the only thing to do is set-up shop on scene. I don't know if it's different up there but down here most medics operate in fly-cars so transportation is not an option. They have to wait for a transporting unit (except now in Putnam where part of the volunteer BLS system is being subsidized by the County's ALS system who do use ambulances during the day).

As for response time measurement - every involved agency should be tracked for accountability but I agree that the clock should stop when competent patient care arrives at the patient's side. The clock should start from the 911 call.

Assertions that volunteer agencies have only 3-4 minute response times makes me wonder how they're tracking that time. It has to take 3-4 minutes (at the very least) just to get members to the ambulance, then they have to drive to the scene (probably another 3-4 minutes). So how they track their time becomes far more subjective.

Great points!

[GAW6 66]

GAW, a great way to fix that is to switch to 60 and utilize EMD. A tiered response will save you so many of those headaches.

We are working on that - having a problem obtaining a frequency - politics as always!!!!

[JJB531 652]

I have to disagree with that overall approach that transport is not priority. Too many ALS providers are starting to set up Mobile ER's in patients living rooms. What happened to "Dont delay transport waiting for ALS"? Shouldnt the same thing be said for performing your ALS Skills on scene as apposed to in the ambulance enroute to a higher, appropriate level of care? Just curious, honest questions. I believe in rapid transport to the appropriate facility that can provide the highest possible level of care for the patient and performing whatever ALS procedures you can in the back of a moving ambulance. Thats what I did when I was ALS 9 years ago, there was no stay and play, it was treat and transport. Whats everyones feelings on this?

It's not necessary to load and go every single ALS patient. Most living rooms are controlled environments, with plenty of space to work and adequate lighting. Many times ALS interventions do play a significant role in patient outcomes and can show immediate improvement in a patients condition. For example, administering D50 to a hypoglycemic patient, Narcan to an opiate overdose, or even Nitroglycerine and Lasix to a patient experiencing exacerbation of CHF... in all of these scenarios it's not uncommon to see either an immediate or slightly delayed improvement in the patient's condition, so why load and go and then have to try performing all of these skills in the back of a cramped moving ambulance? The whole idea of ALS is to bring the ED out to the patient.

I think it's one thing to sit on scene for 45 minutes trying to get an IV... that I'll agree with you is ridiculous, but for a paramedic to conduct a patient exam and baseline treatments while still in someone's residence is not a negative thing at all, especially with medical emergencies where the paramedic's interventions will have a positive outcome for the patient.

[firemoose827 324]

It's not necessary to load and go every single ALS patient. Most living rooms are controlled environments, with plenty of space to work and adequate lighting. Many times ALS interventions do play a significant role in patient outcomes and can show immediate improvement in a patients condition. For example, administering D50 to a hypoglycemic patient, Narcan to an opiate overdose, or even Nitroglycerine and Lasix to a patient experiencing exacerbation of CHF... in all of these scenarios it's not uncommon to see either an immediate or slightly delayed improvement in the patient's condition, so why load and go and then have to try performing all of these skills in the back of a cramped moving ambulance? The whole idea of ALS is to bring the ED out to the patient.

I think it's one thing to sit on scene for 45 minutes trying to get an IV... that I'll agree with you is ridiculous, but for a paramedic to conduct a patient exam and baseline treatments while still in someone's residence is not a negative thing at all, especially with medical emergencies where the paramedic's interventions will have a positive outcome for the patient.

Oh I agree with you completely. I should have clarified my point, sorry!!

Yes, all of the treatments you mentioned should be administered relatively quick and than transport. I was mainly refering to the medics that I have seen in my experiences that try and diagnose and cure the ailment on scene as opposed to performing your basic assesment and treatments like you mentioned. If the basic treatments show no change, or the procedures are missed ( i.e IV Access) than the PT should than be packaged and transported while trying for the second attempt enroute. But you make good points and I agree.

Stay Safe

Moose

[JJB531 652]

Oh I agree with you completely. I should have clarified my point, sorry!!

Yes, all of the treatments you mentioned should be administered relatively quick and than transport. I was mainly refering to the medics that I have seen in my experiences that try and diagnose and cure the ailment on scene as opposed to performing your basic assesment and treatments like you mentioned. If the basic treatments show no change, or the procedures are missed ( i.e IV Access) than the PT should than be packaged and transported while trying for the second attempt enroute. But you make good points and I agree.

Stay Safe

Moose

Now that I agree with!! I think conducting your exam and administering first line treatments are appropriate for on-scene interventions... if you're still on scene and you've reached step 32 of a 33 step protocol sequence, you might want to think about transporting!

[ONEEYEDMIC 68]

I realize that the Medic has their thing to do. But what happens when the Medic is done doing their thing and there is still no AMB on scene. That has happened as well.

I think that ALL the ambulances in WEST should be Dispatched by 60 Control. I think it is ridiculous to have a PD disp AMB. If they can dispatch all the FD's then the AMB shouldn't be a prob. I mean we have to call them to get Mutual Aid AMB don't we?

Other than it being a busy day, how many times is the AMB on scene prior to the Medic? And if that is the case how many times does the AMB CREW just wait for the Medic instead of gettng the PT to the AMB. Around here I don't think I personally have seen a ALS Intercept. But then again, the ER's are right around the corner. Up in Northern West, I used them all the time.

The Medic has the disadvantage of waiting on scence for those delayed reponses from AMB.

[DaRock98 76]

I wish I had exact times but during the day out dept has outstanding response times I would say we are out the door within 2-3 mins and we either pull up the same time as the PO or just as he/she is walking in the door. At night well thats a totally different story b/c we don't have our paid emt in quarters so I would say it takes us about 6-10 mins pending who is on call, a few of our members live on the opposite side of town and it takes a good 4-5 mins just to drive to the station and that doesn't include getting out of bed getting dressed and getting to the car hence the TERRIBLE 6-10 mins to get out the door. I know our ems agency has problems I just wish the higher up's realized that as well. I feel my dept. should not be TRYING to provide a service that we can not provide. Sad to say but what is going to happen when there is a medical emergency right outside our door and our amb. can't get out the door!?!?! Talk about getting caught with you pants down! So not to drag this thread off topic but my question is how do I get theses people to realize we have problems and they need to be fixed?

[ONEEYEDMIC 68]

I wish I had exact times but during the day out dept has outstanding response times I would say we are out the door within 2-3 mins and we either pull up the same time as the PO or just as he/she is walking in the door. At night well thats a totally different story b/c we don't have our paid emt in quarters so I would say it takes us about 6-10 mins pending who is on call, a few of our members live on the opposite side of town and it takes a good 4-5 mins just to drive to the station and that doesn't include getting out of bed getting dressed and getting to the car hence the TERRIBLE 6-10 mins to get out the door. I know our ems agency has problems I just wish the higher up's realized that as well. I feel my dept. should not be TRYING to provide a service that we can not provide. Sad to say but what is going to happen when there is a medical emergency right outside our door and our amb. can't get out the door!?!?! Talk about getting caught with you pants down! So not to drag this thread off topic but my question is how do I get theses people to realize we have problems and they need to be fixed?

Key word, you don't have your PAID EMT at night. How about keeping him/her for 24hrs? Bet your response times will go up won't they? Doesn't do any good if you have a second call, but that is what Mutual Aid is for. Just hope they can get out. At least you acknowledge that your EMS agency has problems. Now it is getting other members or your DEPT or VAC to realize it as well.

I have also seen paid EMT's not being utilized because they can't get a driver. Since we went off the topic a little. I have seen and heard of this as of late.

Medic is on scene and we call them on the radio to find out whether it is ALS or BLS because the AMB only has a driver. They will respond if ALS but Mutual Aid if BLS. I guess that fits into the category or response times.

[DaRock98 76]

Key word, you don't have your PAID EMT at night. How about keeping him/her for 24hrs? Bet your response times will go up won't they? Doesn't do any good if you have a second call, but that is what Mutual Aid is for. Just hope they can get out. At least you acknowledge that your EMS agency has problems. Now it is getting other members or your DEPT or VAC to realize it as well.

I have also seen paid EMT's not being utilized because they can't get a driver. Since we went off the topic a little. I have seen and heard of this as of late.

Medic is on scene and we call them on the radio to find out whether it is ALS or BLS because the AMB only has a driver. They will respond if ALS but Mutual Aid if BLS. I guess that fits into the category or response times.

With out a doubt that will raise our response times and that is also the point I am trying to make! Our vollies just don't want to do the job anymore and thats a HUGE problem. I think the WHOLE ambulance crew should be a paid crew 24/7 365 but it's close to impossible to see that happening anytime soon. I just wish that the decision makers saw it the same way I did instead of running the way we do. Sorry for the rant but I will try to bring this back to the topic at hand. Does any other vollie vacs or depts have any solid numbers on response times? I'm talking from the time the job comes in to the time they call responding?

[ny10570 745]

Moose, you gave me a reasonable estimate of how long it could take to get an ambulance. Sorry, I wasn't accusing anyone of using fake numbers when I said "real numbers", I am just looking for concrete numbers based on documented performances. What was the average response time from dispatch to on scene?

The issue with obtaining response times wasn't one of not knowing where to look, but more of no one was tracking them. If they are not recorded in a system then there is no system to look them up in.

Since there is no EMS response standard that I've been able to find, I'll go with what NFPA suggests Fire Dept based EMS service. A crew of first responders or better in 4 minutes 90% of the time and ALS in 8 minutes 90% of the time. They also suggest a minimum of 2 paramedics and 2 emts. Since I don't think any medics in Westchester work with a medic partner how many agencies can get the medic and three members on scene in 8 minutes 90% of the time?

[helicopper 1,050]

With out a doubt that will raise our response times and that is also the point I am trying to make! Our vollies just don't want to do the job anymore and thats a HUGE problem. I think the WHOLE ambulance crew should be a paid crew 24/7 365 but it's close to impossible to see that happening anytime soon. I just wish that the decision makers saw it the same way I did instead of running the way we do. Sorry for the rant but I will try to bring this back to the topic at hand. Does any other vollie vacs or depts have any solid numbers on response times? I'm talking from the time the job comes in to the time they call responding?

Why paid crews 24/7? Why not roster volunteer crews in your quarters and only use paid personnel when you can't field the vollie crew? Many agencies in this county do (or used to) have on-duty crews in quarters and it worked VERY well.

If you're in a volly organization, you ARE one of the decision makers. Bring it up at the meetings, rally others to correct the problem, educate those who aren't seeing it. Who else do you expect to do it?

[DaRock98 76]

Why paid crews 24/7? Why not roster volunteer crews in your quarters and only use paid personnel when you can't field the vollie crew? Many agencies in this county do (or used to) have on-duty crews in quarters and it worked VERY well.

If you're in a volly organization, you ARE one of the decision makers. Bring it up at the meetings, rally others to correct the problem, educate those who aren't seeing it. Who else do you expect to do it?

I've tried setting up crews to pick up shifts but nobody signs up! I get the same 3 or 4 people every week. I asked if it could be mandatory for emt's and drivers to pick up at least 1 shift a MONTH and I was told "we are a vollie dept and can't force people to sign up" I can see there point on that but seriously 1 shift a month give me a break thats nothing. It's not like we get hammered with calls either we are Lucky if we do 1 or 2 calls in a 24 hour period. (Don't get me wrong we do have theses days of 6-7 calls a day but that is extremely rare) Going paid 24/7 isn't what I want to do I feel it's the only thing we can do. Believe me I've tried to get people to open there eyes and see that we are not doing good I've brought it up at company meetings and I am told sorry that is a district issue and it can't be discussed here. Another member asked if the company could write a letter to the district stating that we do not want to provide that service anymore and we were told do even bother it won't help at all and will probably just be ignored. How could you say something like that?!?!? I've heard my CHIEF even say he wants to get rid of the service and the district refuses to listen! I feel like I'm just spinning my tires with this topic in my dept and I am almost ready to give up I just don't know what else to do. I feel like the best shot I have is to just wait until some of these people are no longer in office and try it again with some new blood.

[firemoose827 324]

I've tried setting up crews to pick up shifts but nobody signs up! I get the same 3 or 4 people every week. I asked if it could be mandatory for emt's and drivers to pick up at least 1 shift a MONTH and I was told "we are a vollie dept and can't force people to sign up" I can see there point on that but seriously 1 shift a month give me a break thats nothing. It's not like we get hammered with calls either we are Lucky if we do 1 or 2 calls in a 24 hour period. (Don't get me wrong we do have theses days of 6-7 calls a day but that is extremely rare) Going paid 24/7 isn't what I want to do I feel it's the only thing we can do. Believe me I've tried to get people to open there eyes and see that we are not doing good I've brought it up at company meetings and I am told sorry that is a district issue and it can't be discussed here. Another member asked if the company could write a letter to the district stating that we do not want to provide that service anymore and we were told do even bother it won't help at all and will probably just be ignored. How could you say something like that?!?!? I've heard my CHIEF even say he wants to get rid of the service and the district refuses to listen! I feel like I'm just spinning my tires with this topic in my dept and I am almost ready to give up I just don't know what else to do. I feel like the best shot I have is to just wait until some of these people are no longer in office and try it again with some new blood.

Dont give up brother! Ive been in your shoes before with my old squad, I was Lt and Captain over there, attained the ALS certificate and speced and put into service a new rig during my tenure. For that squad, we used 12 hour schedules. Each member was supposed to submit their availability for the month at each monthly meeting. Then the Lt (or Co-Captain as I was called) was supposed to make up a 24 hour duty schedule for the month. This usually worked very well and the schedule was 100% covered most months. These crews could hang out in the station if they wanted, but otherwise they were supposed to stay in the district. If they had to leave than they had to find coverage, but if it was an emergency they called an officer and the officer covered them. Just an idea for you to bring up with your members, and keep your chin up. Keep a level head and keep looking for outside opinions...sometimes a fresh look at stuff is all you need!

Moose, you gave me a reasonable estimate of how long it could take to get an ambulance. Sorry, I wasn't accusing anyone of using fake numbers when I said "real numbers", I am just looking for concrete numbers based on documented performances. What was the average response time from dispatch to on scene?

No problem!! lol I just thought you forgot about me!!!

Having been Captain of my old squad, and having done the paperwork, I can shoot you an average response time of 10 minutes from time received to time on scene.

My current squad will probably be worse than that because they do something myself and a dozen other members dont aprove of....BUT I wont go there and take this off topic!!

[ckroll 101]

We're not covering any new ground here. Maybe we need new vocabulary. Response time needs to be defined in a way that is useful, and I think that has to mean useful to the patient. Once a term has more than one meaning-- and 'response' is whatever you want it to mean-- then the debate shifts to semantics, not performance. Consider 'Call to contact' and 'Time to intervention'.

Almost irrespective of emergency, 'call to contact' matters. Stabilizing a scene and evaluating a patient in person, if only to look at them and say 'sick, or not sick' is an important benchmark. We don't measure this and we should.

Next we should look at time to intervention, which is a harder number to pin down. Perhaps look at 'chief complaint' and measure the time until that is addressed. For chest pain that's aspirin and oxygen and perhaps the medic, for an ankle fracture, that might mean a police officer and a pillow.

The last and arguably most important piece of data is a correlation of time to definitive care and outcome. 30 minutes on scene with an alert/stable older individual who has fallen overnight and wants to use the bathroom and go to hospital in fresh clothes is not at all unreasonable. Rushing the call to meet some arbitrary standard is cruel.... even if it was dispatched as unconscious/unresponsive. The information to which we have scant access is outcome, and this is where management can and should be insisting on data. If the outcome is good to excellent, then the call times were appropriate.

We can't make good decisions without good data and what I see here is that we don't have good data. Why don't we come up with a set of times WE think matter, put it together and get it out to interested agencies as a follow up sheet and start tracking some of this stuff? Good decisions need good data and that takes good research. If we start now, in a year we might be able to have an intelligent debate on the subject.

How do we get started?

[helicopper 1,050]

I've tried setting up crews to pick up shifts but nobody signs up! I get the same 3 or 4 people every week. I asked if it could be mandatory for emt's and drivers to pick up at least 1 shift a MONTH and I was told "we are a vollie dept and can't force people to sign up" I can see there point on that but seriously 1 shift a month give me a break thats nothing. It's not like we get hammered with calls either we are Lucky if we do 1 or 2 calls in a 24 hour period. (Don't get me wrong we do have theses days of 6-7 calls a day but that is extremely rare) Going paid 24/7 isn't what I want to do I feel it's the only thing we can do. Believe me I've tried to get people to open there eyes and see that we are not doing good I've brought it up at company meetings and I am told sorry that is a district issue and it can't be discussed here. Another member asked if the company could write a letter to the district stating that we do not want to provide that service anymore and we were told do even bother it won't help at all and will probably just be ignored. How could you say something like that?!?!? I've heard my CHIEF even say he wants to get rid of the service and the district refuses to listen! I feel like I'm just spinning my tires with this topic in my dept and I am almost ready to give up I just don't know what else to do. I feel like the best shot I have is to just wait until some of these people are no longer in office and try it again with some new blood.

I appreciate your position and recognize the difficulties you're facing. BUT, you don't have to do it that way just because that's the way you always did it. Point to agencies that DO require rostered crews - one night a week is NOT a big stretch and nothing says that you can't switch with someone else if something comes up.

There are a LOT of volly agencies that do roster crews so they don't have to wake EVERYONE up for EVERY call.

The by-product is also usually shorter "time-to-intervention" times (thanks CKROLL!).