Putnam ALS 30 day Trial

[RU 911 0]

I heard on Tuesday that Empire State and the county were going to do a 30 day trial.

Medic 4 is to be removed from the Amb and put him in a fly car.

The Amb was them going to be staffed with 2 EMT's.

When a job drops in the Medic 4 response area Medic 4 and the BLS amb will be dispatched and the Primary Agency will be toned as First responders.

The Primary Agency will no longer be transporting the Pt to the hospital during the day.

Wondering if anyone else has heard this.

[Guest MVFD334]

So there will be the same 4 medics, 3 of which will be in flycars 1 in a amb and a seperate emt staffed ambulance? So 5 rigs all together?

[helicopper 1,050]

Is there enough volume in 30 days to really assess the efficacy of this program?

And, not to stir the proverbial pot but, who's paying for this? The County or the local agencies that are unable to cover their own calls?

[Goose 188]

This is the way it should have been since day one, 4 medic fly cars and 2 or 3 BLS trucks but my understanding is that would have been political suicide...

Chris, if anyone is paying for the service it's probably the County...or maybe Empire is swallowing the cost for the 30 days in anticipation of adding this onto the contract?

[Guest MVFD334]

This is the way it should have been since day one, 4 medic fly cars and 2 or 3 BLS trucks but my understanding is that would have been political suicide...

Chris, if anyone is paying for the service it's probably the County...or maybe Empire is swallowing the cost for the 30 days in anticipation of adding this onto the contract?

Well if there is gonna be a staffed emt bus then Empire is gonna benefit due to the fact that the county will be turning over more calls to them. Less mutual aide calls.

[Danger 160]

Does Empire have ANYTHING going on for them besides Putnam?

[trauma74 111]

Although I can not yet state the name, rank and current position of a paramedic chief that I know very well, but he has been hired as the new Senior Executive VP of Empire. If anyone can save them, it will be him.

[ONEEYEDMIC 68]

Sounds like Matt Nolan would be a good fit. How about John Wood? Curtis Mast?

[Guest]

The person is Mike Witkowski from Regional EMS. Gil Stiles tried to straighten things out without success what makes anyone think that Mike will have any. As an employee of the company for over a year now I have lost track of the amount of people that have been in charge. The powers that be are expecting miracles over night and when their expectations are not met they move on to the next schlep that they can find. I wish Mike all the luck in the world but I hope he left the door open to go back to Regional.

[fitzjr11 17]

agencies can still transport if they want, once the empire bls rig is on a call depts will be transporting anyway- w/ the large amount of calls that brewster does they will always be busy, therefore not really affecting the rest of medic 4 area

Not too say Brewster isn't doing a good job-- they just have LOTS of calls

[Guest CRASH]

agencies can still transport if they want, once the empire bls rig is on a call depts will be transporting anyway- w/ the large amount of calls that brewster does they will always be busy, therefore not really affecting the rest of medic 4 area

Not too say Brewster isn't doing a good job-- they just have LOTS of calls

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i have heard the same some agencies are on board to give it a shot aaaaaaaaaand some are not.

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I MYSELF DO NOT LIKE THE IDEA 1 BIT what im expected to get my a** out of bed @ 3am to go package a pt and the empire will come in and bill these people no way .... if my dept gets on board with this weather it be by choice or force of hand i will give up my 2 duty nights....

[Guest alsfirefighter]

Not to be harsh to some of the fine Putnam departments but lets face facts...many haven't been the open minded type to any kind of change..period. That's exactly part of the problem for many areas, particularly with EMS, but fire is catching up now also is that they look at staffing and response as a simple local problem when it needs to be looked at in a regional mind set.

I don't understand what you mean by empire will come in and bill after you package a patient and get your "a**" out of bed at 3am. Can you elaborate a little more? If your agency gets out and you are the one that is there...why would they bill them?

Secondly...why wouldn't your department get on board with something that for the most part will guarantee a response within a certain amount of time? And not to be harsh..but what exactly would you be accomplishing by giving up a duty night or two..or what exactly are you there to do? Isn't what we do about community service and patient care? I get up at 3 am and my department doesn't bill period, but the BLS agency I have to fill in for often does on my heels. I'm not ready to quit or go to a non-EMS house because of it.

If it goes as I've seen many other operations go they will be covering a ton of calls at night, when the why get up when the call will be covered by someone else mindset kicks in.

[tjd1012 5]

is this just for daytime hours?

[Guest jblazing56]

sounds like even if the vol agent gets out empire is still going to be the transporting agency. don't agree with that. If the vol crew bus gets out they should be the transporting agency. They should be just first responders. I am willing to try it but I can already seeing that this is moving to the county starting there own ambulance service and the vol. getting pushed out. I hope that doesn't happen and even though most departments are hurting for man power some departments are gaining man power and this isn't making it look good that a paid agency is doing all the work.

[Guest CRASH]

i am both fire and ems from what i was told and i could be misinformed when empires bus transports they will be billing the pt.

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as i was told we will be more or less first responders where we would assess the pt and care for them until the empire unit arrives and they would then take over and transport the patient i think in no way is the county ready or able to fully fund these fly cars orbls rigs if it goes county wide it would be in the millions to staff 3-5 rigs 24/7/365 so as i stated i signed on as a volunteer and i will not get my A** outta bed @ 3 am to respond to a call if im going to get there and not be caring for the pt. as i was trained to do i will certainly still get outta bed for any firematic call but if the people in this town pay such high taxes now imagine the jump if we staff a paid ems crew full time .

my agency rarely rarely ever goes mutual aid

[grumpyff 1,159]

i am both fire and ems from what i was told and i could be misinformed when empires bus transports they will be billing the pt.

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as i was told we will be more or less first responders where we would assess the pt and care for them until the empire unit arrives and they would then take over and transport the patient i think in no way is the county ready or able to fully fund these fly cars orbls rigs if it goes county wide it would be in the millions to staff 3-5 rigs 24/7/365 so as i stated i signed on as a volunteer and i will not get my A** outta bed @ 3 am to respond to a call if im going to get there and not be caring for the pt. as i was trained to do i will certainly still get outta bed for any firematic call but if the people in this town pay such high taxes now imagine the jump if we staff a paid ems crew full time .

my agency rarely rarely ever goes mutual aid

Maybe its jut me, but this almost sounds backwards? Wouldn't it make more sense for Empire BLS to respond as the first responder since they are already on stand-by, and have a shorter response time, with the volunteer agency doing to the transport if they can get out? If the volunteers can't get out then Empire would transport. Not sure how the billing would work in that situation.

[helicopper 1,050]

i am both fire and ems from what i was told and i could be misinformed when empires bus transports they will be billing the pt.

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as i was told we will be more or less first responders where we would assess the pt and care for them until the empire unit arrives and they would then take over and transport the patient i think in no way is the county ready or able to fully fund these fly cars orbls rigs if it goes county wide it would be in the millions to staff 3-5 rigs 24/7/365 so as i stated i signed on as a volunteer and i will not get my A** outta bed @ 3 am to respond to a call if im going to get there and not be caring for the pt. as i was trained to do i will certainly still get outta bed for any firematic call but if the people in this town pay such high taxes now imagine the jump if we staff a paid ems crew full time .

my agency rarely rarely ever goes mutual aid

Why shouldn't Empire bill for the services they provide? If they fill in where a volunteer crew can't, they should recoup the expense of the service.

As a first responder you're still caring for the patient regardless of who transports. To toss your commitment to the community because of a change in the system where you operate - a 30 day trial at that - is pretty weak. Give it a chance. It may work in your area and improve the system or it may not and eventually go away. Abandoning your role in that system is a sure fire way to see it change and you won't have any say in those changes.

It must also be pointed out that our taxes are already funding the BLS response system that, in many parts of the county, is failing. If that money was redirected into a real EMS system, the additional expense to County residents would be much less offensive.

I'd be far more agreeable to paying additional taxes for guaranteed EMS service than for golf courses and horse farms!

[Guest]

Why shouldn't Empire bill for the services they provide? If they fill in where a volunteer crew can't, they should recoup the expense of the service.

As a first responder you're still caring for the patient regardless of who transports. To toss your commitment to the community because of a change in the system where you operate - a 30 day trial at that - is pretty weak. Give it a chance. It may work in your area and improve the system or it may not and eventually go away. Abandoning your role in that system is a sure fire way to see it change and you won't have any say in those changes.

It must also be pointed out that our taxes are already funding the BLS response system that, in many parts of the county, is failing. If that money was redirected into a real EMS system, the additional expense to County residents would be much less offensive.

I'd be far more agreeable to paying additional taxes for guaranteed EMS service than for golf courses and horse farms!

I have to agree. I used to work in Putnam for an agency and remember sitting on scene sometimes for 30 mins waiting for an ambulance to get there. I also remember listening to 4th and 5th dispatch for an ambulance. I am a volunteer myself, but lets face it, if the system isnt working its time to change. As far as saying you arent going to get out of bed, then you are obviously not there to serve the community. Regardless of what happens, Putnam has needed a major change for many years now and I blame the leadership in the county for failing its citizens.

[Guest MVFD334]

Im for anythig that helps the community out.. We at Mahopac and I know also over at Mahopac Falls take great pride with our EMS companies. I know for Mahopac in which we have a medic stationed at one of our substations, we a majority of the time will still arrive before the medic. But the few times we do go mutual aide I can see the Empire BLS of being great assistance to us. The one thing people often forget about Putnam is the amount of area that is covered by the local volunteer agencies and more importantly ALS. So adding one BLS rig is going to help but it in no way will it be a solution to the problem.

If some people feel threatened that Empire is goin to start buffing calls away from them, then they need to start getting their bus out faster.

[Guest CRASH]

Why shouldn't Empire bill for the services they provide? If they fill in where a volunteer crew can't, they should recoup the expense of the service.

As a first responder you're still caring for the patient regardless of who transports. To toss your commitment to the community because of a change in the system where you operate - a 30 day trial at that - is pretty weak. Give it a chance. It may work in your area and improve the system or it may not and eventually go away. Abandoning your role in that system is a sure fire way to see it change and you won't have any say in those changes.

It must also be pointed out that our taxes are already funding the BLS response system that, in many parts of the county, is failing. If that money was redirected into a real EMS system, the additional expense to County residents would be much less offensive.

I'd be far more agreeable to paying additional taxes for guaranteed EMS service than for golf courses and horse farms!

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Fine let empire bill but if they are going to be staffed 24/7 there should be no need for me to roll outta bed through the night.

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if this stays 30 day trial it has no effect on me its in medic 4's coverage area and im located in medic 3's area my problem is only if this becomes countywide.

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and i was just speeking to someone about this and i believe its going to be a daytime thing only for the trial.

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jerry and i believe its not going to be an additional rig but an additional flycar to replace medic 4.

the rig will now staff 2 emt's .

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as for me not serving my community sirs I do my part and more ,

but if I'm going to drive 2 miles to my hq @ 3am to get on scene with a fully capable crew to treat , care for , package and transport a bls patient for free there is no reason I should then give that pt over to Empires bls unit and have this pt get billed by the transporting agency it makes no sense to me.

Edited April 27, 2008 by DOC22
Edited out inapproprite use of CAPS

[Guest DADAY]

Sounds like someone wants to be in charge of a county wide EMS agency and push out volunteer EMS. I think a lot of his discussion happened when Empire first came in. And I think that most people thought that someday the county would try to take over the EMS and go paid. Very sad. Would like to see some of the stats that the county bases their studies on. Brewster may have to go mutal aid many times, but out of those times how many were 3rd calls in district. Or when BFD on had 1 ambulance in service.

Just a question to through out there - How many agencies have had 2 calls at the same nursing home in the same room at the same time?, when a paid agency has the contract for the Bs, i mean BLS transports.

[ny10570 745]

Yeah, there are agencies that rarely go mutual aid, but how often do those buses get out in a timely manner. If it takes 15 or 20 minutes to get out on the road then you might as well sent it out mutual aid.

If you can get a bus on scene before empire does then you should have no problem transporting your patient. This seems like its there to cover for the agencies that either can't get out or take too long to get out.

[FD828 77]

I understand the need for change especially in EMS in Putnam County. I have worked there as a medic and volunteered there as well. However, these changes if implemented will be the fastest way to get the volunteers out of the EMS "business". Why would they want to get up at any hour to be a first responder? Why would the fire departments buy, maintain, service $100K + ambulances? They should just get their own BLS fly-cars, cause that's all the ambulances will become. What is going to happen to the EMT's skills? Let's face reality, how many times are the Medic and BLS bus going to get to the call first? Most of the time I'd say. And maybe Brewster and Mahopac will get more then 1 call at a time that would require the volunteer ambulance there to transport, (but if everyone is fed up with the system will anyone come?) but what about the towns that don't have the same call volume. I for one can see people getting tired of coming out for a call, getting an ambulance with a crew only to get to the scene and have the patient already being treated by Empire and have no need for the volunteer ambulance. Is it necessary to send both? What if the volunteer dept, God forbid gets into an accident responding to a call that already has a medic and BLS ambulance on the scene?? I guess it's no different then it is now, but to me this is going to make the dedicated EMT's not want to give up their precious time to go to a scene where they aren't going to be needed. What is wrong with the way they are doing it now? If the volunteers don't get a crew the Empire ambulance transports, correct? To me you are getting ALS care immediately (how good is another story - and before I get crucified I know there are some good medics there) in an ambulance that can transport if the volunteers can't get a bus out. My family is there so I do care and want the best for them as well. But I don't think taking the transport responsibility away from the volunteer departments is the answer.

[ny10570 745]

How many calls a day are there in Putnam? Is one paid BLS going to be able to pick up all of those calls?

[helicopper 1,050]

How many calls a day are there in Putnam? Is one paid BLS going to be able to pick up all of those calls?

This pilot is only for one small area of Putnam that suffers from high call volume. I don't believe that 30 days will be enough time to really assess the value of the program but its a step in the right direction.

[Goose 188]

This pilot is only for one small area of Putnam that suffers from high call volume. I don't believe that 30 days will be enough time to really assess the value of the program but its a step in the right direction.

Putnam does like 4,000 EMS calls a year. So, Chris is right, a 90 day trial may yield more realistic data. After all remember what happened the day the contract switched hands? Every agency go out at first or second dispatch. Within 2 weeks things were back to normal.

And what's the point with the comment on the nursing home jobs? Sometimes its BS sometimes its not, whats your point? They are still residents and it's still a job thats got to get covered.

[NWFDMedic 58]

Any addition to EMS for your community is a good thing. Having worked as a medic in Putnam County in the past, I can say there are some great people there in the volunteer departments but most departments are feeling the same effects of just about every volunteer agency in the region.

There have been a lot of particulars about this trial posted here and it seems there are quite a few things that are still up in the air. From what I've gathered though, the most accurate representation of the truth is that ESA will be adding an EMT to staff the former Medic 4 fly-ambulance as a BLS unit and Medic 4 will get its own flycar. This adds a great deal of flexibility into the system while not wasting the limited ALS resources.

As far as the utilization of the unit is concerned, I would make a suggestion. Rather than dispatch the unit simultaneously with the medic, I would set up some sort of tiered response. Maybe something like this: Priority 1 calls dispatch volunteer agency, ESA Medic, and ESA BLS unit; Priority 2 calls dispatch volunteer agency and ESA Medic; Priority 3 calls dispatch volunteer agency and ESA BLS; and Priority 4 calls dispatch volunteer agency only.

Now, with the dispatch procedure I have outlined there would be some ground rules. First, if the first responder (either EMT or Medic depending on priority) gets to the scene and determines that the patient is an emergent transport, they can make an immediate request to respond the ESA BLS rig if the volunteer agency has not responded. Second, if the volunteer agency goes to third dispatch (say 8 minutes for argument's sake) without response, the ESA BLS rig would be automatically dispatched. Third, if the volunteer agency previously turned over calls in the same time period (say a call comes in at 0930 when they turned one over at 0900), PC911 would have the discretion to immediately dispatch the ESA BLS unit. Fourth, the ESA BLS unit would return to service upon response of the volunteer agency (within the third dispatch window) unless the Medic determines the patient needs the most emergent of transports (scoop and run).

The procedure may seem a bit long-winded, but it's actually relatively easy. Each priority would have an appropriate responder responding immediately (with the exception of priority 4, which by definition should not be affected by a delay). The ALS resources are kept in town as much as possible. The paid BLS crew would be returned as often as possible to handle the second call that the volunteer agency may not cover. The BLS unit can be requested as needed and should be able to arrive in Medic 4 area by the time the medic has an initial assessment and treatment done even if they weren't initially dispatched. The system would eliminate undue delays while still allowing the volunteer agency to maintain coverage and transport of their patients (and their skills) if they respond in a timely manner. Finally, taxpayers wouldn't be able to scream about paying taxes for the volunteer ambulance that was sent away causing them to get a bill.

Responsible EMS agencies (paid and volunteer) could make this system work, with the appropriate checks in place to make sure nobody is abusing the privilege of being able to "scoop and run" on the paid ambulance. There are surely better ways to get the job done, but if you're being offered a new resource, procedures should be in place for it's use that will make everyone (including the taxpayer) as happy as possible.

[helicopper 1,050]

Sounds like someone wants to be in charge of a county wide EMS agency and push out volunteer EMS. I think a lot of his discussion happened when Empire first came in. And I think that most people thought that someday the county would try to take over the EMS and go paid. Very sad. Would like to see some of the stats that the county bases their studies on. Brewster may have to go mutal aid many times, but out of those times how many were 3rd calls in district. Or when BFD on had 1 ambulance in service.

Just a question to through out there - How many agencies have had 2 calls at the same nursing home in the same room at the same time?, when a paid agency has the contract for the Bs, i mean BLS transports.

If the impetus for this is the failure to cover calls how can you say they're trying to "push out volunteer EMS"? The "County" is trying to represent its constituents and insure that they all receive adequate medical attention. I don't think anyone is trying to build an empire - there are far more lucrative areas and far less contentious services for that.

Frankly, if the departments that are failing to cover their calls stepped up and did something (as Philipstown did by providing its own paid crews during the day) or if the towns that are ultimately "responsible" (in quotes because the municipal responsibility for EMS is vague at best) did something to insure that calls within its borders were covered the County wouldn't have to. The County is stepping in because nobody else is doing anything about the problem and because it is now a County problem - when 3 towns are getting toned out to cover the same call, that's a big problem and it reduces EMS coverage for the rest of the County. Tell me, does anyone know if the County will now subsidize the Philipstown crews as they are subsidizing the agencies in medic 4's area?

Everyone's upset about becoming a BLSFR - why aren't you upset about getting toned out with two other agencies for mutual aid and then getting cancelled when someone finally covers the call? Doesn't that get old and frustrating?

I would also like to see the stats that the County is using; I'd also like to see the revenue produced by billing to see if a real countywide system could be established without hiking my taxes through the roof!

And finally, nursing home calls are more often than not legitimate calls for service - they may not be as exciting as an extrication call or other trauma but those patients are someones grandparents or parents - maybe even your own. The NH may need to be educated better about how and when to summon ambulances but those patients deserve the same level of care and prompt response as anyone else.

[RH31379 0]

The plan as I have heard it will provide 3 medics in 3 fly cars, 1 bls/als bus, and 1 bls transport bus. the 4 agencies involved in the trial will im theory be dispatched, respond, begin treatment and then give the patient to the transport rig and the vol rig will go back in service... unless of course you want to follow your partient to the hospital then you can get on the "private rig" and ride to the hospital.... can I ? insurance with this????? we all know that brewsters call volume will most likely eat this bus up. just the other night they had 3 calls and 3 medics in brewster at the same time. one transport bus will not work for an effective trial, but cost is always a concern. the reason behind this trial is "the patient" which I dont see how things are going to change your going to be dispatching the same way so if the medic gets there 1st care is there. this really has nothing to do if the volunteer ambulances get out or not, if you do you dont transport if you don't you don't transport. I see that this is a direct benifit to the als provider, giving them the ability to bill every call and recoop the money they aren't making because many time the volunteers companies are getting out, in my opinion this has been a problem but it has gotten better over the last year rather then worse. the understanding behind allowing the als provider to transport will allow them to offset the als contract price by the amount they make over billing. The reason I say "als provider" is I don't want to point the finger at empire, we know the new all know county legislature is questioning the cost of als and is forcing the county to bid again and will probably cost more money.

[helicopper 1,050]

So based on the majority of comments here this is really only going to benefit the Village of Brewster and Town of Southeast. With that in mind, why is the county paying for it and not the town and/or village?

20% of the county's population will enjoy a subsidy from 100% of the population.