EMS Mutual Aid, Whats wrong and how does it get fixed

[emp305 32]

OK, A county wide mutual aid plan exists and there are ambulances on the road constantly, so why are people still waiting for help. How does your EMS agency, VAC, or FD ambulance deal with the problem?

[emp305 32]

OK, A county wide mutual aid plan exists and there are ambulances on the road constantly, so why are people still waiting for help. How does your EMS agency, VAC, or FD ambulance deal with the problem?

How would your agency manage a larger scale incident? Does the job fall right to the county?

[Guest alsfirefighter]

For one...having a single central 911 center and dispatching would be a help. Then agencies could put units in service that have crews so the CAD could find a staffed ambulance to be dispatched instead of playing the musical chairs of dispatching agencies until (hopefully) one gets out or can piece meal a crew together.

Secondly...I'm not sure what you mean with your second post about handling a major incident and "does it fall right to the county?" Fall in what way? Operations? Unit logistics? Or are you thinking of something else?

Also a question I have is why would any agency have a problem or refuse an agreement with a neighboring mutual aid agency to have a crew sharing agreement? I recently heard of this and I really don't get it, it is about serving your customers..not you. For those that need more clarfication... Killmore VAC has a call and has an EMT only and Leavemdead VAC is dispatched mutual aid and gets a driver only after numerous pages. So instead of going to a 3rd agency and hoping for the best and adding more time to the dispatch time, the EMT goes to the scene and rides on Leavemdead's bus. Seems to make sense right? And if the 3rd agency doesn't have a full crew what do you do then?

So then why would an agency refuse this type of system if you know you and the neighboring agency is having problems?

[xchief2x 79]

Tommy - You make great sense here but liek you mentioned it is for our customers and not about us so the problem I see from my point of view is EGO's.

[Goose 188]

no issues with mutual aid here. Why? We cover 99.99% of our jobs as is, when we request mutual aid its absolutely necessary and our primary mutual aid comes from career agencies.

The two central issue as i see it are as follows:

1) Volunteers - Lets face the facts, the ambulances are just not getting out anymore. The call volume is too high. Start paying for a staffed ambulance so your not requesting mutual aid 3 times a day.

2) County wide dispatch - It would be great to have county wide dispatching makes things far more efficient. I know thats a pipe dream - but i have to say when i talk to 60 (only on mutual aid jobs) they are more than helpful - extrapolate that to the county wide scale and things would be so much easier.

Edited January 18, 2009 by Goose

[ONEEYEDMIC 68]

no issues with mutual aid here. Why? We cover 99.99% of our jobs as is, when we request mutual aid its absolutely necessary and our primary mutual aid comes from career agencies.

The two central issue as i see it are as follows:

1) Volunteers - Lets face the facts, the ambulances are just not getting out anymore. The call volume is too high. Start paying for a staffed ambulance so your not requesting mutual aid 3 times a day.

2) County wide dispatch - It would be great to have county wide dispatching makes things far more efficient. I know thats a pipe dream - but i have to say when i talk to 60 (only on mutual aid jobs) they are more than helpful - extrapolate that to the county wide scale and things would be so much easier.

Amen.

In your number 1 I don't believe that everyone's call volume is too high. I just think that they can't get out. There is no reason that certain agencies should have to be toned out 2-3 times. INSANSE.

#2. I have been saying that for years. COUNTY WIDE DISPATCH FOR AMBULANCES. What is so hard about this?

[Guest EFFP411]

Now coming from Dutchess county, I do not understand how the system in Westchester works. Who else dispatches ambulances/fire apparatus/etc. besides the county??? I'm a little confused here. Dutchess, Ulster, and even Orange seem to have a pretty good handle on the county wide thing, what is so hard about it??

[efdny2003 16]

Now coming from Dutchess county, I do not understand how the system in Westchester works. Who else dispatches ambulances/fire apparatus/etc. besides the county??? I'm a little confused here. Dutchess, Ulster, and even Orange seem to have a pretty good handle on the county wide thing, what is so hard about it??

In Westchester, the main dispatching center is 60-Control in Valhalla. However, certain departments are dispatched by there local police departments or in-house dispatchers. Anything requiring Mutual Aid usually goes through 60-Control.

[Guest EFFP411]

In Westchester, the main dispatching center is 60-Control in Valhalla. However, certain departments are dispatched by there local police departments or in-house dispatchers. Anything requiring Mutual Aid usually goes through 60-Control.

Hmmm, see in Dutchess county, The county 911 Center does EVERYTHING, from training announcements, to mutual aid, to anything and everything you could think of Fire, PD, and EMS. The only other little self sufficient dispatch is City 911 in the City of Poughkeepsie. But, if county requires an engine from the city as M/A, the city station have their own set of tones and a county number as well as a city number for each rig. Nobody else has the capability to self dispatch....

[pasobuff 38]

Also a question I have is why would any agency have a problem or refuse an agreement with a neighboring mutual aid agency to have a crew sharing agreement? I recently heard of this and I really don't get it, it is about serving your customers..not you. For those that need more clarfication... Killmore VAC has a call and has an EMT only and Leavemdead VAC is dispatched mutual aid and gets a driver only after numerous pages. So instead of going to a 3rd agency and hoping for the best and adding more time to the dispatch time, the EMT goes to the scene and rides on Leavemdead's bus. Seems to make sense right? And if the 3rd agency doesn't have a full crew what do you do then?

So then why would an agency refuse this type of system if you know you and the neighboring agency is having problems?

The first EMS call I ever rode on as an EMT was with a neighboring department......I lived in Yorktown at the time, and was listening to a neighboring department tone out for an unresponsive person in a vehicle.....and toning...and toning.....I was able to finish getting ready for work, get in my car and head out.....I had to drive past the road the call was on anyway, and decided to take that road. I was the FIRST EMS provider on the scene - PD was there, but the person was still in the vehicle with his German Shepard (I thinkit was) standing guard.....still remember the dog going NUTS any time you approached the vehicle. PD went and got his wife - house was right down the road - I somehow or other advised I was there I think - and the ambulance rolled with I think just a driver......

Long story short, I think the total time of CPR was around 45 minutes.....unfortunately the person didn't make it.......

I was never asked why I was there, my presence was greatly appreciated I think. It didn't hurt that I knew a lot of people in that FD, I also rode a few calls with other local EMS agencies when they needed the help - I was never refused.

It helps to know your neighbors, have a good rapport with them.....and work together!

[99subi 121]

The real way to solve the problem would be to have paid staff. But to many people wont swallow their pride and let it happen, Its time they start thinking about the people who need the help and not their pride.

[Guest stephentyler20]

Use Connecticut as an example... Individual agencies are dispatched by their municipalities (i.e. Greenwich = Greenwich PD, Stamford = Stamford Fire, etc.), but each unit notifies the countywide dispatch center (CMED) of their call as well, so all mutual aid requests go through the same area. In my experience, mutual aid in Southwest CT has been much, much, MUCH better than anything I've seen in Westchester. Not really even on the same scale, in fact, and the CT system isn't perfect either.

[pasobuff 38]

The real way to solve the problem would be to have paid staff. But to many people wont swallow their pride and let it happen, Its time they start thinking about the people who need the help and not their pride.

It is not a matter of swallowing pride.....as with having ANY paid service - it is a matter of PAYROLL and COST.....some communities cannot afford it. However, I do know that a lot of communities have gone to having paid EMS during the day, when coverage is the lightest due to regular volunteers working their paying job.

Where I live now, the local ambulance corp. went paid a few years back - they just didn't have the personnel to cover calls. Was it a 'fix' - sort of.....I listened to an EMS call one day down the road from me (I don't run EMS here, so I didn't go).......it was close to 20-30 minutes before an ambulance got on scene.....the Vol. FD was there, but they are not a transporting agency - they had to wait for the 'Paid' staff to show up.

This is why unless I absolutely NEED an ambulance, I will either drive myself or have someone drive me. The last ambulance ride I had ended up with a bill of almost $500- for a BLS transport - to a hospital 14 miles away.....the Medic that rode in with me didn't cost a dime (although he was getting paid through the Medi-vac company he works for) - they didn't bill me.

You will always have the possibility of having one more call than the staffing can cover, and then have to wait for backup or MA EMs. When I worked paid EMS we responded to any mutual aid call we received - didn't matter if it was from a VAC or another paid service. And, this WAS in Westchester County - over 10 years ago.

[Guest alsfirefighter]

The first EMS call I ever rode on as an EMT was with a neighboring department......I lived in Yorktown at the time, and was listening to a neighboring department tone out for an unresponsive person in a vehicle.....and toning...and toning.....I was able to finish getting ready for work, get in my car and head out.....I had to drive past the road the call was on anyway, and decided to take that road. I was the FIRST EMS provider on the scene - PD was there, but the person was still in the vehicle with his German Shepard (I thinkit was) standing guard.....still remember the dog going NUTS any time you approached the vehicle. PD went and got his wife - house was right down the road - I somehow or other advised I was there I think - and the ambulance rolled with I think just a driver......

Long story short, I think the total time of CPR was around 45 minutes.....unfortunately the person didn't make it.......

I was never asked why I was there, my presence was greatly appreciated I think. It didn't hurt that I knew a lot of people in that FD, I also rode a few calls with other local EMS agencies when they needed the help - I was never refused.

It helps to know your neighbors, have a good rapport with them.....and work together!

Yes it does. But the call your mentioning you basically got involved by your own choice and by mere self determination. Did the agency you were a member of...have an agreement with the dispatched agency to their call? Chances are they didn't and guess what...they still don't. Perhaps if they had an agreement then you wouldn't have had time to finish getting ready for work, get in your car and head out. Perhaps you would have just went right to the call with the understanding you were going to resource share. But as of right now...taking into account where you say you lived and such I'm going to assume the 2 agencies in that area that I have in mind...both have issues with getting out...one significantly...and no agreement. I'll leave it at that for now.

Now take your experience and put yourself in the shoes of the ALS provider...sitting there awaiting for a bus. And on an arrest...being bailed out by the system and coming driver alone doesn't work unless you have a BLSFR person able to ride with you. Kind of hard to do compressions, bag and push meds by yourself. Even worse...try standing there watching a diff breather that you've pretty much either dumped all available meds into or for the CHF'er your popping nitro like chicklets and wondering when the heck your going to be able to even begin your transport. Then factor in how many agencies bill and then still don't have coverage or can't get another agency to agree to share resources for one reason or another.

Not a matter of swallowing pride? No offense but I don't know when the last time you were involved in any agency or the last time you were in this area, but I hate to be blunt...your flat out wrong. Why else would the so the called leaders of some of these agencies flat out either deny they have a problem...sometimes in public...on public record or turn a blind eye to the issue? Why then are often the first paid staff to work treated with such animosity in many areas or if another emergency service is able and willing to either take on more responsibility or flat out take over a broken system that endangers public safety flat out labeled as "trying to take over." Instead of trying to actually provide adequate service. Yes you might in some aspect have to wait for a bus on occasion. But this is another instance where centralized dispatching with priority labeling helps. Not everyone needs an ambulance within 3 minutes. The finger injury and alike can wait. And I'll take my chances on the paid crew then waiting on the 5th agency being dispatched often from another county.

Enough is enough.

[fire55 3]

Yes it does. But the call your mentioning you basically got involved by your own choice and by mere self determination. Did the agency you were a member of...have an agreement with the dispatched agency to their call? Chances are they didn't and guess what...they still don't. Perhaps if they had an agreement then you wouldn't have had time to finish getting ready for work, get in your car and head out. Perhaps you would have just went right to the call with the understanding you were going to resource share. But as of right now...taking into account where you say you lived and such I'm going to assume the 2 agencies in that area that I have in mind...both have issues with getting out...one significantly...and no agreement. I'll leave it at that for now.

Now take your experience and put yourself in the shoes of the ALS provider...sitting there awaiting for a bus. And on an arrest...being bailed out by the system and coming driver alone doesn't work unless you have a BLSFR person able to ride with you. Kind of hard to do compressions, bag and push meds by yourself. Even worse...try standing there watching a diff breather that you've pretty much either dumped all available meds into or for the CHF'er your popping nitro like chicklets and wondering when the heck your going to be able to even begin your transport. Then factor in how many agencies bill and then still don't have coverage or can't get another agency to agree to share resources for one reason or another.

Not a matter of swallowing pride? No offense but I don't know when the last time you were involved in any agency or the last time you were in this area, but I hate to be blunt...your flat out wrong. Why else would the so the called leaders of some of these agencies flat out either deny they have a problem...sometimes in public...on public record or turn a blind eye to the issue? Why then are often the first paid staff to work treated with such animosity in many areas or if another emergency service is able and willing to either take on more responsibility or flat out take over a broken system that endangers public safety flat out labeled as "trying to take over." Instead of trying to actually provide adequate service. Yes you might in some aspect have to wait for a bus on occasion. But this is another instance where centralized dispatching with priority labeling helps. Not everyone needs an ambulance within 3 minutes. The finger injury and alike can wait. And I'll take my chances on the paid crew then waiting on the 5th agency being dispatched often from another county.

Enough is enough.

AMEN Brother!!!! Been with ya on a few of those calls, waiting and waiting and waiting and having the patient and or family keep asking when the ambulance is coming and having to tell them it's coming from two towns over.

Keep venting on here so I dont have to listen to you bi#%h at the next run Just kiddin bro LOL Be safe

[Goose 188]

It is not a matter of swallowing pride.....as with having ANY paid service - it is a matter of PAYROLL and COST.....some communities cannot afford it. However, I do know that a lot of communities have gone to having paid EMS during the day, when coverage is the lightest due to regular volunteers working their paying job.

Where I live now, the local ambulance corp. went paid a few years back - they just didn't have the personnel to cover calls. Was it a 'fix' - sort of.....I listened to an EMS call one day down the road from me (I don't run EMS here, so I didn't go).......it was close to 20-30 minutes before an ambulance got on scene.....the Vol. FD was there, but they are not a transporting agency - they had to wait for the 'Paid' staff to show up.

This is why unless I absolutely NEED an ambulance, I will either drive myself or have someone drive me. The last ambulance ride I had ended up with a bill of almost $500- for a BLS transport - to a hospital 14 miles away.....the Medic that rode in with me didn't cost a dime (although he was getting paid through the Medi-vac company he works for) - they didn't bill me.

You will always have the possibility of having one more call than the staffing can cover, and then have to wait for backup or MA EMs. When I worked paid EMS we responded to any mutual aid call we received - didn't matter if it was from a VAC or another paid service. And, this WAS in Westchester County - over 10 years ago.

Quarterbacking a job your listening to on your scanner? You're telling me its about payroll and not pride? You had a 500 dollar bill for service. What's your complaint? You called and they rendered you a service and they deserve to get paid for that service. And you complain? Maybe if they were properly funded by the taxpayers they wouldn't have to bill? But you would probably vote that down, right? Police and Fire Departments charge for burglar alarms and automatic alarms - why can't EMS bill?

I'm not sure i follow your point about mutual aid. The purpose of this post is about the ABUSE of the mutual aid system aka an agency who simply does not get out and lets the vast majority of their calls be covered by surrounding agencies. We are not talking about an agency with 4 trucks who cover 4 of 5 jobs that drop all within 10 minutes. We are talking about agencies who do 500 - 1000 calls a year who get 2 - 3 jobs during normal business hours (separated by a reasonable amount of time) who cannot get their ambulance out the door and rely on other communities and their agencies to respond in. I haven't read or head anyone denying mutual aid to an agency - career, volunteer or combined - so not really sure what you're getting out there.

[Guest alsfirefighter]

AMEN Brother!!!! Been with ya on a few of those calls, waiting and waiting and waiting and having the patient and or family keep asking when the ambulance is coming and having to tell them it's coming from two towns over.

Keep venting on here so I dont have to listen to you bi#%h at the next run Just kiddin bro LOL Be safe

LOL. First we've been on far too many of those calls together and they just keep adding up. Unless of course its in a nursing home and then I don't get any extra resources as I await a bus from somewhere to arrive.

Hey Goose. You better be careful we are starting to agree with each other again. LOL. Not that I mind..but you're one of the few that will go head to head with someone with facts and make a great debate.

[Remember585 815]

There's still a couple of agencies in Westchester that are volunteer that cover most of their calls on a first page.

Sadly, it's not that many...

[IzzyEng4 427]

Just like Stephen Tyler said, CT has 5 C-MED (Centralized Medical Emergency Dispatch) regions. I worked for C-MED New Haven both full and part time over the past 9 years.

Each region coordinates all ambulance service, calls and mutual aid responses. The reason is to cut down on the "I want this service to respond instead to that one" though sometimes it still exists. The main function of a C-MED is ambulance to hospital communications and mutual aid. Also each region watched over a time limit which is basically the same throughout the state. Having a regional system, though it has some flaws, is the way to go. First off, a regional system such as a C-MED has the oversight to make sure that response times at dispatch are met and also to provide automatic mutual aid when necessary.

Here is an example; the City of New Haven receives a 911 for a cardiac arrest. They dispatch the closes engine company and their paramedic unit to the scene, these two units when en-route sign on MED channel 10 with C-MED New Haven, the call is now ours to handle. New Haven ERS contacts C-MED New Haven to order an ambulance from AMR and we in return give ARM the information. AMR's ambulance signs on with us. Any updates from the scene are either given over MED 10 (no unit can by pass the dispatcher without asking permission for going car to car, kinda how FDNY operates on their dispatch frequencies) or if they want to got car to car a MED channel (1 - 8) is assigned depending which radio MED tower is the closest top the area. When the ambulance goes en-rout to the hospital, a MED channel is also assigned for their patch to the hospital and they let us know if the FD has anyone assisting into the hospital as well. Now say the ambulance from AMR did not sign on with C-MED after 3 minutes from the time they were ordered, it is the C-MED dispatcher's responsibility to check on the ambulance's status. If they do not sign on a minute after this check, a mutual aid ambulance is dispatch. This ambulance may come from another private service in the region, from a fire department ambulance or an ambulance corps close to the city. There are also special instances where a fire department that has a contract with a private service to perform transports may have a transport capable unit and will transport the patient to the hospital instead of a mutual aid unit.

The same rules apply for a VAC in the region. When a "second tone" is dropped for a call, they have 1 minute to fill that response, if they can't the next closest ambulance service is dispatched, either another town's or private service depending who is closer. The same applies for paramedics. There have been times were an ambulance from Ansonia (western New Haven County) has responded into New Haven depending where the call is, the same with Branford (a shoreline town along the I-95 corridor) and also a New Haven paramedic unit going to North Haven, we control it and make sure no service gets stripped.

The system, though not flawless, does work and has been around since 1973 (yes the same time paramedics came into the picture). Its not about who is responding, its about getting an ambulance to a patient in ample time.

[medic25 0]

Just like Stephen Tyler said, CT has 5 C-MED (Centralized Medical Emergency Dispatch) regions. I worked for C-MED New Haven both full and part time over the past 9 years.

Here is an example; the City of New Haven receives a 911 for a cardiac arrest. They dispatch the closes engine company and their paramedic unit to the scene, these two units when en-route sign on MED channel 10 with C-MED New Haven, the call is now ours to handle. New Haven ERS contacts C-MED New Haven to order an ambulance from AMR and we in return give ARM the information. AMR's ambulance signs on with us.

As of a couple of months ago, New Haven ERS now has a direct CAD to CAD link with AMR dispatch. ERS takes the 911 call, and as the info is entered into the computer it automatically appears on the AMR dispatchers screen. Now FD and AMR get dispatched simultaneously and both call out with CMED enroute. This step has cut several minutes off the ambulance response times in the city; definitely a great step forward.

[pasobuff 38]

Quarterbacking a job your listening to on your scanner? You're telling me its about payroll and not pride? You had a 500 dollar bill for service. What's your complaint? You called and they rendered you a service and they deserve to get paid for that service. And you complain? Maybe if they were properly funded by the taxpayers they wouldn't have to bill? But you would probably vote that down, right? Police and Fire Departments charge for burglar alarms and automatic alarms - why can't EMS bill?

I'm not sure i follow your point about mutual aid. The purpose of this post is about the ABUSE of the mutual aid system aka an agency who simply does not get out and lets the vast majority of their calls be covered by surrounding agencies. We are not talking about an agency with 4 trucks who cover 4 of 5 jobs that drop all within 10 minutes. We are talking about agencies who do 500 - 1000 calls a year who get 2 - 3 jobs during normal business hours (separated by a reasonable amount of time) who cannot get their ambulance out the door and rely on other communities and their agencies to respond in. I haven't read or head anyone denying mutual aid to an agency - career, volunteer or combined - so not really sure what you're getting out there.

At the time (over 10 years ago) for this 'first EMT call' - I had a very good rapport personally with the department that could not get out.....I also belonged to the neighboring VAC as a riding member. It was my choice to detour to the scene and see if I could assisit in any way......

As for tha ambulance ride I had personally a few years ago - I don't have a problem with getting a bill - thankfully my insurance paid almost the entire amount. There are 3 fully paid services I believe that work in this County, and they have specific areas that they cover. If a rig isn't available, I do not know if they will request the next closest or one of hte other agencies. I am not going to take that chance if I am in pain - my last ride I would have had my mother dirve me to the hospital, but I was in such pain I had her turn around and head back to where I KNEW there was a Medic with drugs!

Up here I do have an issue that the ambulances, which are fully staffed by paid personnel - still have VAC on their side....but that is another thread. If a service needs to be paid in order for the citizens to get TIMELY service - I have no issue with that. If there are enough volunteers to staff a VAC, that is great too - it is a cost saving to the taxpayers. They should not be afraid to look into going part or full time paid if they are not able to regularly get out for calls.

Paid services are not always 'better'- they also have issues with staffing, getting rigs to scenes...it is not just a VAC problem.

That being said - I watched someone code one day as we were trying to get him packaged for transport - I was there as mutual aid - after listening to the covering VAC page, and page, and page....the person could have literally WALKED to the hospital faster than it took the VAC to finally call for mutual aid. And, of course, while we were there another call cam ein for an MVA - and that was covered IMMEDIATELY! THAT I have an issue with - picking and chosing calls. With a paid service, you don't have that problem at least.

To me, in a 'perfect world' - you get X number of chances to cover a call (like 2 pages), then it automatically goes to next closest for mutual aid - no picking and chosing who you are 'friends' with that week - or stepping over an agency that pissed you off last week.....that is NOT in the best interest of the patient!

Same thing with the fire service....when I was a dispatcher, I would rather hear a request for mutual aid worded something like 'I need 2 tankers, an engine and ladder' than I want 1 eng from X department, 1 tanker from x dept etc.....where I worked there was a CAD system - and the dispatchers actually knew if other departments were already out - saving time and resources.

[SageVigiles 1,194]

Not all C-MED regions in CT work that way though. Calls can be received and dispatched via C-MED in New Haven's Region, but up here in Region 5, its up to your individual municipality. However, Litchfield County DOES do countywide dispatch, so that covers it, and here in NF we just call Danbury Hospital for our mutual aid, since they have to cover us according to our contract for paid services. Putnam Lake or Sherman might get called if we're in a pinch, but thats a rarity.

Pasobuff, I do agree with something you said. Chief's need to stop dispatching from fire scenes, let the dispatchers call the help. Let your ego go and let the dispatchers do their jobs, you concentrating on getting the fire under control.

Edited January 19, 2009 by SageVigiles

[Guest WCDES636]

There's still a couple of agencies in Westchester that are volunteer that cover most of their calls on a first page.

Sadly, it's not that many...

They also respond right away to MA without question.

[emp305 32]

There has been a lot of good discussion here, thanks to all of you. Some mentioned the picking and choosing of who a given agency might request mutual aid from, in my mind this is a major impediment to the provision of care. It should not matter what it says on the side of the ambulance, one would be nuts to argue that point, right? So why then are agency bosses still picking and choosing? Why is this tolerated? If a call for service can't be covered by the agency with primary responsibility, then the county should be made aware ASAP! Being that a significant amount of time will have passed by this point, the county should quickly contact all of the bordering agencies until they find someone who will go right now!! Not just another agency that will page out, but one with an available unit that will put their lights and sirens on and get to the job.

[Oswegowind 17]

Also a question I have is why would any agency have a problem or refuse an agreement with a neighboring mutual aid agency to have a crew sharing agreement? I recently heard of this and I really don't get it, it is about serving your customers..not you. For those that need more clarfication... Killmore VAC has a call and has an EMT only and Leavemdead VAC is dispatched mutual aid and gets a driver only after numerous pages. So instead of going to a 3rd agency and hoping for the best and adding more time to the dispatch time, the EMT goes to the scene and rides on Leavemdead's bus. Seems to make sense right? And if the 3rd agency doesn't have a full crew what do you do then?

So then why would an agency refuse this type of system if you know you and the neighboring agency is having problems?

Years ago, when I volunteered in Peekskill and in Cortlandt I rode in many a call for other agencies (ie Verplanck, Croton, and Mohegan) when I was riding along with the CRP Paramedic on duty (35m1). I tried to bring an idea up in which all emt's were placed on a list under CRP and could ride on any ambulance regardless of name on side of bus. It never went anywhere! I thought it was silly because people were afraid to give people belonging to other agencies some sort of responsibility. The plan was to have to get approval from a board of persons and then have access to the other depts. quarters to help cover responses but have a home base that followed up on all of your training and such. There were times when I still lived under my parents roof and had a "scanner" that I could have done more, but my hands were tied. I am sure I am not the only one who has experienced or thought of this, would it really be that hard? I am sure it could reduce response and on scene times and limit liability if managed properly. Of course, people would have to put their personalities aside and actually get along with one another...

Secondly, this applies to the major city in Westchester, known as Yonkers. Why is it that the private company is afraid to call for mutual aid ever, even when there are no units available? Everyone gets overwhelmed at some time and it seems like this company does not want to admit it. Unfortunately, I see it first hand, when I am constantly calling for eta's on ambulances for the PD and FD units awaiting them on scene. While I worked there I saw them reduce the number of shifts and since I have left, I am not sure what the staffing levels are now, but they seem "poor". I understand that most of the calls are not true emergencies, however that is nothing new down here and it seems like they are not always prepared for the crap to hit the fan. I would really like to see a solid backup plan in place that shows they are thinking about the people they serve and not their pockets.

Thirdly, the larger scale incident would fall upon the AHJ or locality. It is the responsibility of the first due agency to decide what they need and how to handle it. The county of course is there to help get them equipment and such, but I don't think the county is responsible for taking command of the situation.

Edited January 20, 2009 by Oswegowind

[Goose 188]

Years ago, when I volunteered in Peekskill and in Cortlandt I rode in many a call for other agencies (ie Verplanck, Croton, and Mohegan) when I was riding along with the CRP Paramedic on duty (35m1). I tried to bring an idea up in which all emt's were placed on a list under CRP and could ride on any ambulance regardless of name on side of bus. It never went anywhere! I thought it was silly because people were afraid to give people belonging to other agencies some sort of responsibility. The plan was to have to get approval from a board of persons and then have access to the other depts. quarters to help cover responses but have a home base that followed up on all of your training and such. There were times when I still lived under my parents roof and had a "scanner" that I could have done more, but my hands were tied. I am sure I am not the only one who has experienced or thought of this, would it really be that hard? I am sure it could reduce response and on scene times and limit liability if managed properly. Of course, people would have to put their personalities aside and actually get along with one another...

Honestly thats just prolonging the inevitable. It's like putting Volunteer EMS on life support. Someone just has to step up to the plate and start paying people - if that happened we wouldn't be having this discussion.

[Oswegowind 17]

Honestly thats just prolonging the inevitable. It's like putting Volunteer EMS on life support. Someone just has to step up to the plate and start paying people - if that happened we wouldn't be having this discussion.

I don't think that all EMS has to be paid but I would be for putting on a backup unit that covers a number of localities all at once, similar to the medic programs that are in place that are paid.

[Goose 188]

I don't think that all EMS has to be paid but I would be for putting on a backup unit that covers a number of localities all at once, similar to the medic programs that are in place that are paid.

All EMS doesn't have to be paid, but all EMS in Westchester County has to be paid. The highest taxed County in all these United States and you can't get a halfway decent EMS response in 98% of the towns/villages/hamlets.

[Oswegowind 17]

Yes, it is the highest taxed, that I do agree. However, I believe that there is normally a decent response and that a lot of the responders are trained and care about what they are doing. And it seems that in most places where they have recognized severe deficiencies they have taken steps towards correcting it, such as day time responses in Peekskill and in Hawthorne. As well other localities that depend upon a paid medic to begin caring for someone, and then a unit responds to transport them to the hospital. Since a high percentage of the calls answered probably didn't require a 911 ambulance response at all, I don't see the harm in this system. So what if someone has to wait for an ambulance that doesn't really need one. My problem is that the next person that may actually need one, has to wait longer. I mean come on, how many times is the medic at scene in some towns waiting for an ambulance for transport that is coming 5-10 min later lights and sirens and the patient goes BLS. Why are they responding lights and sirens unless it is a true emergency. I think mutual aid agreements are necessary, but if care is being rendered and the person is stable, waiting isn't that big of a deal. It is the few times where delayed transport hurts the patient's survival chances, and those most likely can be counted on one hand.

Of course, I am part of the problem not the solution, because I gave up on volunteering.

[Goose 188]

Yes, it is the highest taxed, that I do agree. However, I believe that there is normally a decent response and that a lot of the responders are trained and care about what they are doing. And it seems that in most places where they have recognized severe deficiencies they have taken steps towards correcting it, such as day time responses in Peekskill and in Hawthorne. As well other localities that depend upon a paid medic to begin caring for someone, and then a unit responds to transport them to the hospital. Since a high percentage of the calls answered probably didn't require a 911 ambulance response at all, I don't see the harm in this system. So what if someone has to wait for an ambulance that doesn't really need one. My problem is that the next person that may actually need one, has to wait longer. I mean come on, how many times is the medic at scene in some towns waiting for an ambulance for transport that is coming 5-10 min later lights and sirens and the patient goes BLS. Why are they responding lights and sirens unless it is a true emergency. I think mutual aid agreements are necessary, but if care is being rendered and the person is stable, waiting isn't that big of a deal. It is the few times where delayed transport hurts the patient's survival chances, and those most likely can be counted on one hand.

Of course, I am part of the problem not the solution, because I gave up on volunteering.

Like i said, any system like that - while a novel ideal - is just prolonging the inevitable, in my opinion. I'm not pulling this stuff out of my rear end, i see it when i go mutual aid.

I'm not sure what your point about fictitious emergencies vs. true emergencies is. Sure, i respond to tons of things i perceive as complete BS and those things very well may not require an ambulance but who am i (and who are we) to determine that? You can't determine that. So every call gets the same response and is afforded the same evaluations and we go from there. Are you advocating that when i receive a call my partner and i go "hmm, well yeah, someone fell down the stairs...that sounds like BS so we are going to wait around and see if a legit job comes in?" I've been dispatched to a slew of leg injuries that turn out to be cardiac arrests/massive MIs and i've been dispatched to tons of cardiac arrests with CPR in progress only to find a conscious, alert and oriented patient upon arrival.

As far as the Volly bus blazing to an already down-triaged call, thats a problem and it should be dealth with. But i don't work in a system like that.

But, that's not even the real issue the REAL issue is getting an ambulance at all. Both ALS and BLS calls should be afforded an ambulance response in a timely fashion. Period. Just as many times as you have a BLS bus going Code 3 to a down triaged call you have a BLS bus not showing up on a pediatric arrest, severe diff breather, etc, etc, etc...you would need a lot of hands to count those incidents around the County.

I am not advocating that every job receive a Code 3 response. I really wish we had a priority system in this county which would dictate responses it would create a much safe working/volunteering environment for everyone. But even then, on a low priority (no lights/sirens)your not waiting 30 minutes for an ambulance, your waiting 5 - 10 max. The down side to this is volunteers won't show up for a Priority 4 / Alpha Level (i'm using the Putnam and Dutchess system here) job. And that is EXACTLY what happens - i've seen it time and time and time again in the field.

Trust me when i say this - you do not want to 1) feel what it's like when your stuck at a call all alone and you know no one is coming out (despite page after page after page) to drive the ambulance and 2) having to explain to the little old lady who broke her ankle that i cannot take you yet because the volunteers to drive the ambulance don't seem to be showing up and neither are the volunteers from surrounding communities. Needless to say, on that job, i had to have the Medic pulled out of service to drive the truck because i got fed up at 45 minutes.

Edited January 20, 2009 by Goose