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

[gpeifer 89]

This has been an ongoing discussion for over 20 years. EMS agencies seem to have this "we don't need mutual aid" attitude. They seem to forget that the only concern they should have is that of timely and quality patient care. Volunteers have a proprietary attitude regarding their response area and commercials are worried about the revenue they might lose if another ambulance transports. 20 years a proposal was made to have a county wide EMS system. It was well designed and would have been a great benefit to citizens and visitors of Westchester. The problem was that nobody was willing to give up providing crappy service so that this county service could be developed. Volunteers complained as loud as the commercials. The people that suffered, and are suffering still are the sick and injured of this county. Think about this the next time it takes 20 - 30 minutes for an ambulance to arrive or a BLS ambulance shows up to cardiac arrest because there was no medic available and the company did not want to call mutual aid. End result.. dead patient.

[Goose 188]

This has been an ongoing discussion for over 20 years. EMS agencies seem to have this "we don't need mutual aid" attitude. They seem to forget that the only concern they should have is that of timely and quality patient care. Volunteers have a proprietary attitude regarding their response area and commercials are worried about the revenue they might lose if another ambulance transports. 20 years a proposal was made to have a county wide EMS system. It was well designed and would have been a great benefit to citizens and visitors of Westchester. The problem was that nobody was willing to give up providing crappy service so that this county service could be developed. Volunteers complained as loud as the commercials. The people that suffered, and are suffering still are the sick and injured of this county. Think about this the next time it takes 20 - 30 minutes for an ambulance to arrive or a BLS ambulance shows up to cardiac arrest because there was no medic available and the company did not want to call mutual aid. End result.. dead patient.

I'm sure much more than a handful have already died or have been negatively effected by the status quo. It will take either someone VERY "important" to die/have to wait an absurd time or a major disaster until anyone does anything and starts holding people accountable.

[emp305 32]

This has been an ongoing discussion for over 20 years. EMS agencies seem to have this "we don't need mutual aid" attitude. They seem to forget that the only concern they should have is that of timely and quality patient care. Volunteers have a proprietary attitude regarding their response area and commercials are worried about the revenue they might lose if another ambulance transports. 20 years a proposal was made to have a county wide EMS system. It was well designed and would have been a great benefit to citizens and visitors of Westchester. The problem was that nobody was willing to give up providing crappy service so that this county service could be developed. Volunteers complained as loud as the commercials. The people that suffered, and are suffering still are the sick and injured of this county. Think about this the next time it takes 20 - 30 minutes for an ambulance to arrive or a BLS ambulance shows up to cardiac arrest because there was no medic available and the company did not want to call mutual aid. End result.. dead patient.

It seems that some people get a little confused about how MA works, especially when it come to EMS. It is true no agency can handle everyting, we all agree on this. Where do you think any potential MA would come from? How long do you think it would have taken?

[emp305 32]

I'm sure much more than a handful have already died or have been negatively effected by the status quo. It will take either someone VERY "important" to die/have to wait an absurd time or a major disaster until anyone does anything and starts holding people accountable.

This takes me back to part of my original question, what happens when something big happens??? How does a small agency deal with a big problem? Why aren't they held accountable for not have the equipment or supplies they need?

[Guest alsfirefighter]

Goose...having priority dispatching in place is who can make the decisions on appropriate response and proper level of response. The misconception far to often is that whether a call is "BS." To the caller the call isn't BS and in our business nothing is as they called for whatever reason it may have been. However...when looking at statistics of vehicle accidents and also taking into account rebound accidents of other vehicles we cause, the answer is not to answer every call with the same level of response. The ankle injury should not get the same response level as stroke, chest pain, SOB, etc. It may be a legit ankle fx, its not BS...but it certainly doesn't need to put me and the others on the road at risk for. If you've been dispatched to a "slew" of leg injuries that are cardiac arrests and this and that (which seems to be the battle cry for many with priority dispatching)...then you have an issue with the PSAP for where you were operating at. Have I walked into arrests when the dispatch was something else...yes...but always for a condition that can lead to that, SOB, CP, Man down, unresponsive, diabetic. I've never walked in for a leg injury and had an arrest...if I do..it will be brought up because someone who picked up the bat phone didn't do their job and I'm willing to bet 60 control never got the caller transferred to them to get better info, etc.

How do smaller agencies handle such things? Depends on the agency. I've been around and worked with smaller ones that have their stuff together and I have others that work by hoping it doesn't happen or talking about what to do once a year in a MCI cme and then there are those that when it does happen, it gets done by piece meal and by accident or someone from another agency coming in an basically by human nature becomes the alpha dog and starts coordinating and running things either directly or indirectly by making "suggestions" to the person who should be. Then on top of it...never discussing the matter because as I've stated about 20 times in my posts in the past week..it isn't about how you get there to enough people its about the overall outcome no matter how inproper it was or inefficient.

[Guest]

a few things while reading -

Dutchess, Ulster, Oranage counties don't have a central dispatch like everyone thinks. All the big EMS agencies have their own dispatch and do things as they please. AND the counties tend to call themselves "Fire Control" for a reason. As an EMS agency I should never be told what to do by a fire chief etc. on a medical call or any type of call other than a FIRE. The counties don't allow any radio traffic other than from the fire chief. Working in all these counties getting more EMS or mutual aid to the scene was always done by wasting time finding the fire chief first and asking for stuff and then finally getting what is needed.

Westchester county is run by mostly volunteer EMS with paid drivers etc. USELESS. The voll'y corps that pay someone to cover have almost all but gone to the paid service because they couldn't get what they needed before and still can't even with the paid guy hanging out waiting and the patient waiting longer.

As for pride and wanting mutual aid and not wanting it from an EMS stand point. Shame on all you thinking that it's just pride or ego about themselves. 99% of what EMS does is patient care etc. PD and FD need these calls to make sure they have the volume at the end of the year to fight for funding etc. I am almost positive that when PD and FD are doing police calls and Fire calls they don't call in mutual aid to cover the first response for EMS runs. If a ladder or the rescue is needed at a fire scene and maybe all the ladders and rescue trucks are needed at a fire scene I am sure that mutual aid is not called in to cover what these peices of apparatus do on a daily basis for that department. Will mutual aid be called in if EMS needs a ladder or a resuce at thier scene for what ever reason. If a police car is needed at an EMS run and all the cars are covering another incident, mutual aid doesn't come in, most departments don't even let cars come from other sectors cover. If you listen to the scanners and to every department you can hear on a daily basis that calls are being held by PD and FD - they are able to prioritize their runs. EMS on the other hand as a national EMD system in place that mandates prioritizing calls but no one is allowed to follow these becasue everyone screams for an EMS unit as soon as they get there. and then mutual aid comes in if needed or authourized.

Why don't we look at the response times from FD and PD first for all calls, including all the BS runs that EMS HAS to respond to in a timely fashion. If your ambulance wasn't wasting time taking the person with the hand nail, or the intox off the street to make sure that the city looks clean I am sure that mutual aid would never be needed.

PD and FD also have to understand that when they clear up from an EMS run, the ambulance still needs to transport the person to the ER 5 - 15 minutes, and then hand that person to the ER staff another 5 - 15 minutes. and that's only if the ER staff isn't in a bad mood etc. The average EMS run might be from 30 to 60 minutes where the average first response run is over in 15 minutes.

I think that the mutual aid system for EMS is great, the procedure works fine. It's the actual aid that doesn't come is the break in the chain. If someone already knows it's not coming then what's the point of asking.

[emp305 32]

Well said....

Along the preparedness line, which goes hand in hand with staffing and MA issues, what happens when something big happens? I have asked this question before but I've seen a very small response, why? Could it be that most EMS agencies in Westchester would need to call for assistance? What happens when that assistance doesn't come? Nobody is requiered to send personnel, equipment, ambulances, MCI trailers, ETC. So then what becomes of the municipality? Is it ok to just shrung thier shoulders and say oops??????

Every agency big or small must may a resonable attempt to respond to forseeable incidents, if they don't they should be held liable.

[JM15 386]

Maybe some attention should be paid as to why some volunteer EMS people don't want or can't go on calls? In some places in Northern westchester and EMS call can take anywhere from an hour or two.

[Goose 188]

Goose...having priority dispatching in place is who can make the decisions on appropriate response and proper level of response. The misconception far to often is that whether a call is "BS." To the caller the call isn't BS and in our business nothing is as they called for whatever reason it may have been. However...when looking at statistics of vehicle accidents and also taking into account rebound accidents of other vehicles we cause, the answer is not to answer every call with the same level of response. The ankle injury should not get the same response level as stroke, chest pain, SOB, etc. It may be a legit ankle fx, its not BS...but it certainly doesn't need to put me and the others on the road at risk for. If you've been dispatched to a "slew" of leg injuries that are cardiac arrests and this and that (which seems to be the battle cry for many with priority dispatching)...then you have an issue with the PSAP for where you were operating at. Have I walked into arrests when the dispatch was something else...yes...but always for a condition that can lead to that, SOB, CP, Man down, unresponsive, diabetic. I've never walked in for a leg injury and had an arrest...if I do..it will be brought up because someone who picked up the bat phone didn't do their job and I'm willing to bet 60 control never got the caller transferred to them to get better info, etc.

How do smaller agencies handle such things? Depends on the agency. I've been around and worked with smaller ones that have their stuff together and I have others that work by hoping it doesn't happen or talking about what to do once a year in a MCI cme and then there are those that when it does happen, it gets done by piece meal and by accident or someone from another agency coming in an basically by human nature becomes the alpha dog and starts coordinating and running things either directly or indirectly by making "suggestions" to the person who should be. Then on top of it...never discussing the matter because as I've stated about 20 times in my posts in the past week..it isn't about how you get there to enough people its about the overall outcome no matter how inproper it was or inefficient.

The leg injury into cardiac arrest / massive MI happened to me in a region WITH priority dispatch. Not the dispatcher's fault, they dispatched according to what they got. And, if it matters, i did call them up once i finished the job just to let them know what it was and to my knowledge it was reviewed.

Other than that i pretty much agree with everything you've said, i think my posts reflect that.

At the end of the day it is clear that EMS within Westchester is in dire straights.

Maybe some attention should be paid as to why some volunteer EMS people don't want or can't go on calls? In some places in Northern westchester and EMS call can take anywhere from an hour or two.

So?

[gamewell45 258]

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.

One thing is a given if we were to follow your rationale of thinking; Westchester would remain the highest taxed county in the United States. Most likely taxpayers would never go along with it. We may as well try to fix the existing system in use and make the best of it.

[emp305 32]

As for EMS in Westchester being in dire straits, well it depends on where in Westchester you live. I suppose that statement alone actually supports your assertion. As for the volunteer issue, all VAC's irrespective of being a Vol. ambulance or a VFD should be required to maintain an established ability to respond. If a VAC or VFD ambulance can not respond in a timely manner that VFD or VAC should be required to either to pay personnel to staff their units or contract with a provider that will guarantee a certain aver. response time. The people of this county deserve an ambulance the same way they deserve a response by the PD or FD. This problem is fixable!! People will have to stop saying "let’s do whats good for the patients" and start actually doing it! Even if they don't like how it’s getting done. Edited January 22, 2009 by emp305

[Goose 188]

One thing is a given if we were to follow your rationale of thinking; Westchester would remain the highest taxed county in the United States. Most likely taxpayers would never go along with it. We may as well try to fix the existing system in use and make the best of it.

The system is not working. Honestly, what is there to fix? What needs to happen is we need to start from scratch. Period.

As far as an increase in taxes there very well may be, but at least we would have something tangible to point and look toward and see those tax dollars going to something worthwhile.

If a county system is created in a thoughtful and intelligent manor i think tax payers would go along with it, not saying it would be easy but it could very well happen. Essentially, the tax payers need to stop having the wool pulled over their eyes and agencies need to come clean about response times and staffing. The problem is that 1 request for service overwhelms the vast majority of agencies in Westchester County. That's not a system i am willing to make the best of.

[emp305 32]

The system is not working. Honestly, what is there to fix? What needs to happen is we need to start from scratch. Period.

As far as an increase in taxes there very well may be, but at least we would have something tangible to point and look toward and see those tax dollars going to something worthwhile.

If a county system is created in a thoughtful and intelligent manor i think tax payers would go along with it, not saying it would be easy but it could very well happen. Essentially, the tax payers need to stop having the wool pulled over their eyes and agencies need to come clean about response times and staffing. The problem is that 1 request for service overwhelms the vast majority of agencies in Westchester County. That's not a system i am willing to make the best of.

Well I'm not quite with you on the start from scratch part. But yes agencies must come clean, should there be hearings? The fact that 1 job overwhelms the majority of EMS agencies in this county is beyond insane, its criminal.

[gpeifer 89]

It seems that some people get a little confused about how MA works, especially when it come to EMS. It is true no agency can handle everyting, we all agree on this. Where do you think any potential MA would come from? How long do you think it would have taken?

True, no one agency can handle everything, but an agency should be able to handle a routine medical call. MCI's, HazMat, etc.. require a large response that an agency is not prepared for on a daily basis, that is why mutual aid was invented. The problem, as you well know, is that the day to day routine EMS runs are often not handled in timely fashion (ie: appropriate response time) and often the proper level of care is not available. When this happens once a year it can be explained, but we are seeing this too often lately.

If you are going to provide a promised service, then just do what you promised.

It seems the fire departments, be it career or volunteer, have no problem calling mutual aid. Why do certain EMS agencies feel it is a black mark if they call someone in mutual aid. For my 25 years as a paramedic my main concern has been quality patient care, I don't really care who delivers it or what color the ambulance is. Leave politics out of it.

[Goose 188]

True, no one agency can handle everything, but an agency should be able to handle a routine medical call. MCI's, HazMat, etc.. require a large response that an agency is not prepared for on a daily basis, that is why mutual aid was invented. The problem, as you well know, is that the day to day routine EMS runs are often not handled in timely fashion (ie: appropriate response time) and often the proper level of care is not available. When this happens once a year it can be explained, but we are seeing this too often lately.

If you are going to provide a promised service, then just do what you promised.

It seems the fire departments, be it career or volunteer, have no problem calling mutual aid. Why do certain EMS agencies feel it is a black mark if they call someone in mutual aid. For my 25 years as a paramedic my main concern has been quality patient care, I don't really care who delivers it or what color the ambulance is. Leave politics out of it.

I would put money that it happens multiple times a day - likely more than it should. Like i said earlier, the problem in Westchester is that many agencies are overwhelmed by 1 call. We aren't talking 2 or 3 dropping at once we are talking the first call of the day.

The thing with Fire Departments is that, at least around here, they can get away with sending just a chief's car to an AFA. You can't do that many other places, but it's acceptable for the vast majority of Westchester. So when MA is called i would venture to say that it is usually on larger incidents (bad accidents and actual fires) so more people are willing to come out and play.

Unlike a fire call, when you turn out for an EMS run you're committing to at least an hour (in many cases, some places have shorter turn around). There are more than enough people that would be willing to drive and ride in an ambulance blazing lights and sirens but when it comes to the meat and potatoes (treating and transporting) many couldn't be bothered.