EMS call coverage

[JJB531 652]

REALLY???? That's why snot-nosed, hot-shot new Medics treat EMTs with over 20 years experience like they are the hired help and know nothing!!!! In my books, 20+ years is both TIME & EXPERIENCE which should be respected!

Sorry Lt. - I got off of your original thread also.

In the line of work we're in time and experience is not enough to earn respect. I don't want to be respected just because I've been a provider for 20+ years... I'd want to be respected because I am a competent provider, not because of the amount of time that I have in the field. I've met plenty of 20+ year EMT's who I don't even trust to take a simple blood pressure, and I've met some EMT's whose ink on their cards is still wet, but I trust them and their skills enough to take a blood pressure or to set up an IV bag for me. IMHO, respect needs to be earned, not granted just based on how many years of experience you have.

Competence is important in our line or work. It's nothing personal. It says nothing about the kind of person the incompetent provider is. They can be the nicest person in the world with their heart in the right place, and I will commend anyone who tries to do the right thing and is willing to learn. But as a provider, I'll respect the 2 day EMT who's competent over the 20 year EMT who's incompetent any day.

Unfortuately the thinking that "I've been and EMT for 20 years" equates to one being a competent provider is a dangerous way of thinking because you don't allow yourself to realize your own deficiencies because providers end up with the "I know it all" attitude. You never stop learning... I find myself sometimes going to younger medics now with questions, especially since I left the field full time, and I am not ashamed to ask or get a second opinion.

Edited February 3, 2010 by JJB531

[ny10570 745]

Yeah, time alone means nothing, but when you meet an experienced provider like GAW on a call for the first time, you have to give them the benefit of the doubt. Instead too often people and especially damn medics come rolling through like our poo don't stink and dismiss the lowly EMTs on scene. Some take the idea that respect is earned a bit too far and demand everyone start at the bottom.

[PFDRes47cue 653]

So how exactly are other Westchester County EMS Agencies staffed to take calls???

[Remember585 815]

So how exactly are other Westchester County EMS Agencies staffed to take calls???

Volunteers, combination of duty crews and pager calls. It's not perfect but it is working.

Our leadership is always analyzing response times, getting feedback from our Medics, our public and our members to see what we can fix. In anticipation of having to use paid personnel one day, we didn't even name our organization a VAC, just EMS. We all know that eventually we may have to use paid personnel to handle the ever-growing call volume, but luckily it's been going well with volunteers only thus far.

MJP is right, ambulances are being abused. People call for things that could easily be handled at a Doctor's office, or by driving one's self to an ER. But a lot of people are under the impression that getting an ambulance ride will get them through an ER faster.

Perhaps creating some form of public information about when to and when not to call EMS is needed? Perhaps Doctors could start answering their phones after hours and not always cop out and tell their patients to call 911.

Or maybe we could all start charging an assload of money for transports until people think twice about calling 911?!

Perhaps when someone calls 911 we can charge them for that too? That would cut down on pointless PD calls, FD calls and EMS calls.

Oh what a wonderful world that would be!

[Goose 188]

Volunteers, combination of duty crews and pager calls. It's not perfect but it is working.

Our leadership is always analyzing response times, getting feedback from our Medics, our public and our members to see what we can fix. In anticipation of having to use paid personnel one day, we didn't even name our organization a VAC, just EMS. We all know that eventually we may have to use paid personnel to handle the ever-growing call volume, but luckily it's been going well with volunteers only thus far.

MJP is right, ambulances are being abused. People call for things that could easily be handled at a Doctor's office, or by driving one's self to an ER. But a lot of people are under the impression that getting an ambulance ride will get them through an ER faster.

Perhaps creating some form of public information about when to and when not to call EMS is needed? Perhaps Doctors could start answering their phones after hours and not always cop out and tell their patients to call 911.

Or maybe we could all start charging an assload of money for transports until people think twice about calling 911?!

Perhaps when someone calls 911 we can charge them for that too? That would cut down on pointless PD calls, FD calls and EMS calls.

Oh what a wonderful world that would be!

Going well? LOL

[Guest alsfirefighter]

REALLY???? That's why snot-nosed, hot-shot new Medics treat EMTs with over 20 years experience like they are the hired help and know nothing!!!! In my books, 20+ years is both TIME & EXPERIENCE which should be respected!

Sorry Lt. - I got off of your original thread also.

And in my experience some of those with 20 years of experience means squat when it comes to good patient care. I respect everyone I come into contact with from 1 day to 100 years. But I also treat everyone the same which is do your job, provide proper treatment and perform skills correctly. I respect people...time and "experience" mean nothing to me if the person can't do what they need to do.

Now with that said...585...we're boys..and lets face it brother...you're right its not perfect...and I hate to tell you its not working either. I've always said this..define "working" or "acceptable" when it comes to a call that truly needs an ambulance to transport. What is an acceptable level of mutual aid? To me its when you have multiple calls, not because members can't get up to answer a radio.

JJB...fantastic posts as always brother.

And as far as volunteer agencies taking "what they can get..." Sometimes that's part of the problem. Volunteer or not EMS is a critical service with critical applications...if you can't lift...you shouldn't be on a bus. If you can't bend over...you shouldn't be on a bus. It doesn't fly where I work..you either do your job completely and you better do it the correct way per protocol and common sense. If not you no longer provide EMS on the BLS or ALS level.

[ckroll 101]

Where we are is, well, where we are. The question I think we are sniffing around is... Is where we are good enough? And that's tricky because 'good enough' is a broad term that changes. Enough resources, enough manpower, enough training, soon enough?

EMS is changing. What was,in suburban/rural communities, 'neighbor helping neighbor' occasionally and in genuine emergencies is becoming a full service, let us bring the hospital to your door operation. My VAC, Putnam Valley, was the first in Putnam to get certified. That had to be early 90's, when just fielding an EMT on every call made us special. Now almost every call gets a medic with a monitor, a box of drugs and the promise of new and exciting toys and techniques coming every day.

It's making a difference. Stabilizing respiratory emergencies, getting trauma to trauma centers, addressing cardiac emergencies is improving length and quality of life. What EMS lacks is consistency and system management. Calls have to be answered. They HAVE to be answered. Mutual Aid cannot be a substitute for primary coverage. If we solve the primary coverage question, the 'how long does it take' question goes away. Somebody has to set a standard for the industry. The same DOH who might put a rig out of service for not having enough oxygen is silent on the subject of not getting a rig there at all. That's a health issue. Town supervisors ought to ask what service does a town need and is their provider delivering it?

Putnam Valley is fortunate to be able to cover, usually, two calls at a time straight volunteer. That said, if 3 members are sick/quit/on vacation, then we probably wouldn't be covering calls. And response times can be long. We could improve service by as much as 10 minutes a call by rostering crews in quarters. It's not a popular idea. "It's too much to ask of volunteers."

For me, this is at the crux of the debate. EMS has progressed to the point where doing it well and on time may be too much to ask of volunteers. It most likely will be too much to ask within the next 5 years.

What service do we need to provide?

How do we get there?

[DaRock98 76]

So how exactly are other Westchester County EMS Agencies staffed to take calls???

In my dept. we have a paid EMT on call from 0600 hours Monday till 0600 hours Saturday. Drivers come down when the pager goes off. (I would have to say that 80% of the time they are hanging out at the firehouse anyway.) We usually don't have a problem getting the first bus out the door during these hours but if we get hit with a second call thats where we get stuck.

Saturday and Sundays are covered by volunteer EMTs and Drivers. We tried to have a sign up for duty crews(for weekends/drivers during the week/and a second crew during the week) but haven't had much luck with people signing up. So I guess my question to all of you is what do you do to get your people to sign up for shifts? And how long is each shift?

[Guest mustangmedic]

I really think bashing any vac is unprofessional, for the most part Pvac is able to get

their calls covered, a few weeks ago they were able to put out 3 bus's with no problem

being a medic in the MT pleasant system I can say I have never not had

Pvac respond, they have a small building with no real sleeping quarters

in most cases Pvac arrive's soon after myself, during the day members leave

their job.. All vac's operate their own way and if it's working leave it alone

and stop bashing each other

[PFDRes47cue 653]

I really think bashing any vac is unprofessional, for the most part Pvac is able to get

their calls covered, a few weeks ago they were able to put out 3 bus's with no problem

being a medic in the MT pleasant system I can say I have never not had

Pvac respond, they have a small building with no real sleeping quarters

in most cases Pvac arrive's soon after myself, during the day members leave

their job.. All vac's operate their own way and if it's working leave it alone

and stop bashing each other

AGREED! People will always bash though.

[PFDRes47cue 653]

In my dept. we have a paid EMT on call from 0600 hours Monday till 0600 hours Saturday. Drivers come down when the pager goes off. (I would have to say that 80% of the time they are hanging out at the firehouse anyway.) We usually don't have a problem getting the first bus out the door during these hours but if we get hit with a second call thats where we get stuck.

Saturday and Sundays are covered by volunteer EMTs and Drivers. We tried to have a sign up for duty crews(for weekends/drivers during the week/and a second crew during the week) but haven't had much luck with people signing up. So I guess my question to all of you is what do you do to get your people to sign up for shifts? And how long is each shift?

DaRock98,

I am pretty sure your EMS program is not the only one with this problem. I can only speak for PVAC with this info. At PVAC we have set night crews for Sunday through Thursday nights. The night crews cover from 7PM to 7AM Friday and saturday nights rotate to the other night crews on a five week basis. Meaning, Sunday crew will do Sunday night as well as Friday and Saturday, the next week, Monday crew will do Monday as well as Friday and Saturday. During the day, we have a duty board on our website, that members when around can sign up and be on duty. Otherwise during the day who ever is around goes. One way that we make sure members sign up is to have an hour per month requirement. For us, an adult member (18+) has to pull 24 hours a month. These can be during the day or on a night crew. For junior corps members, there is a 12 hour per month limit. These can only be during the daytime since JC members can not ride at night. Recently we just started a new method of getting the duty board covered. We have set up a calling list. Each officer has been assigned 5 members. Every two weeks we place a call to our assigned members and help them find times to sign up during. This list also helps us to see who will be coming to meetings/drills. Hope this helps...

Edited February 5, 2010 by PFDRes47cue

[ONEEYEDMIC 68]

I just caught wind of this thread and had to catch up! JJB as usual you are right on the money! When an EMS crew shows up to a call I have no idea how much experience they. It's not like they hand me their resume! To tell you the truth, I don't care how long you have been in EMS, just get to the scene. I am very comfortable on AIDED calls, but some of my collegues aren't. They just want EMS to get to the scene. I/We are sick of explaining to family members at 2am that we are waiting for the ambulance because they are volunteers and they have to drive from their houses to get the ambulance. Or that a the ambulance doesn't have a driver or etc... I could go on and on. Family members don't understand that stuff, they just want the ambulance there. Bottom line, get a crew there and get to the hospital.

[PFDRes47cue 653]

I agree with you and saying that the important thing is getting the bus to the scene and too the hospital. But if run correctly, there should be no problem of having that happen especially at night. If it does happen what is the chance that instead of complaining to the paid medic...the pt just got into the car and drove or had a family member drive them to the hospital. Most problem with EMS response can be fixed by not using EMS as a taxi and driving yourself. Especially if you are in an area that is surround by hospital. many of which are within 5 minutes. I know that the goal is to get the bus out and to transport the pt in a timely manner which luckily my agency does the majority of the time. But if time does matter that much to the pt whether personally or pertaining to the nature of illness, then drive yourself. It does not take a genius to know that if you decide to call 911 (in most of Westchester) and not drive your self right a way, you are choosing to add on extra time. There is no other way that people can think that calling 911 and then having them dispatch an agency paid or vol. will be quicker than driving themselves (if this is possible or safe). Ultimately I feel that if your going to knowingly add extra time bye calling 911 and then taking time to complain about it and work yourself up then skip it altogether and drive yourself. I do not care whether it is vol. or paid. It is not a discussion of that. No matter who comes, 911 adds time which is avoidable if the situation is not serious enough which most of the time is how it is. Whenever you add someone else in to something you need done, you are adding time needed for development. MOST LIKELY (not all the time) is the pt is stable enough to complain and work themselves up, they can get to the hospital on their own. IF there family members are around and complaining, then they can definitely load the person in to the car for the 3 minute ride to the hospital. Of course, elderly people will have trouble with this which is understandable. the same is true for handicap people and people who because of the emergency situation have become so nervous or anxious, can not safely operate a car. By calling 911 you are risking waiting a little more time for the benefit of being in the hands of trained personnel who can help you, make your more comfortable or just hold your hand. I completely understand that it must be annoying to have to explain the reasons you listed to pt's or family members. I am sorry that right now you are in an area where this happens maybe even frequently. I do not think Medics should be responsible for explaining this to pt's. It is wrong. If agencies constantly take a long time to get to scene and pt's are always complaining...why is it vol. where they live. I am sure that most people would take the extra 5 mins or so for the bus to get to their house or work over paying however much their taxes would increase to support a paid agency. It is also possible that since while they are waiting for a bus, they are experiencing an "emergency" to some level. they most likely are panicking or stressed out which science shows and make things seem longer than they actually are which could cause people to complain. I do not know how common this is but it is def. a possibility. Hopefully where you work that is having the response time problem right now, it is just a phase that the agency is experiencing right now. chances are it will not be that way for ever.

Edited February 5, 2010 by PFDRes47cue

[ONEEYEDMIC 68]

I agree with you and saying that the important thing is getting the bus to the scene and too the hospital. But if run correctly, there should be no problem of having that happen especially at night. If it does happen what is the chance that instead of complaining to the paid medic...the pt just got into the car and drove or had a family member drive them to the hospital. Most problem with EMS response can be fixed by not using EMS as a taxi and driving yourself. Especially if you are in an area that is surround by hospital. many of which are within 5 minutes. I know that the goal is to get the bus out and to transport the pt in a timely manner which luckily my agency does the majority of the time. But if time does matter that much to the pt whether personally or pertaining to the nature of illness, then drive yourself. It does not take a genius to know that if you decide to call 911 (in most of Westchester) and not drive your self right a way, you are choosing to add on extra time. There is no other way that people can think that calling 911 and then having them dispatch an agency paid or vol. will be quicker than driving themselves (if this is possible or safe). Ultimately I feel that if your going to knowingly add extra time bye calling 911 and then taking time to complain about it and work yourself up then skip it altogether and drive yourself. I do not care whether it is vol. or paid. It is not a discussion of that. No matter who comes, 911 adds time which is avoidable if the situation is not serious enough which most of the time is how it is. Whenever you add someone else in to something you need done, you are adding time needed for development. MOST LIKELY (not all the time) is the pt is stable enough to complain and work themselves up, they can get to the hospital on their own. IF there family members are around and complaining, then they can definitely load the person in to the car for the 3 minute ride to the hospital. Of course, elderly people will have trouble with this which is understandable. the same is true for handicap people and people who because of the emergency situation have become so nervous or anxious, can not safely operate a car. By calling 911 you are risking waiting a little more time for the benefit of being in the hands of trained personnel who can help you, make your more comfortable or just hold your hand. I completely understand that it must be annoying to have to explain the reasons you listed to pt's or family members. I am sorry that right now you are in an area where this happens maybe even frequently. I do not think Medics should be responsible for explaining this to pt's. It is wrong. If agencies constantly take a long time to get to scene and pt's are always complaining...why is it vol. where they live. I am sure that most people would take the extra 5 mins or so for the bus to get to their house or work over paying however much their taxes would increase to support a paid agency. It is also possible that since while they are waiting for a bus, they are experiencing an "emergency" to some level. they most likely are panicking or stressed out which science shows and make things seem longer than they actually are which could cause people to complain. I do not know how common this is but it is def. a possibility. Hopefully where you work that is having the response time problem right now, it is just a phase that the agency is experiencing right now. chances are it will not be that way for ever.

Wow, you couldn't be more wrong. Listen, this isn't some inner city where people call the 911 the PD for an ambulance just to go to the E.R. Most people are calling for an ambulance because they believe there is something wrong with them. It's not to get you out of bed at night to go and help them. You think I like getting to a call where the PT is waiting at the door? No, but sometimes it happens and often! BTW, if you couldn't tell I live in your jurisdiction so I expect an ambulance and a professional crew no matter what time of day I call!

[PFDRes47cue 653]

Wow, you couldn't be more wrong. Listen, this isn't some inner city where people call the 911 the PD for an ambulance just to go to the E.R. Most people are calling for an ambulance because they believe there is something wrong with them. It's not to get you out of bed at night to go and help them. You think I like getting to a call where the PT is waiting at the door? No, but sometimes it happens and often! BTW, if you couldn't tell I live in your jurisdiction so I expect an ambulance and a professional crew no matter what time of day I call!

I agree with you and hopefully you do get the most professional and competent crew possible 24/7. However, I more so hope you never need the bus. I do agree that when people call 911 they believe something is wrong. But is something always wrong? To them maybe but to others? If i never get hurt then one day sprain my ankle...I to will think something is wrong. But I will not consider calling 911. As for the pt waiting at the door. I do not think anybody wants those calls. But I accept them with open arms if it makes the pt more comfortable. What really gets me is when they pt asks if they can have a quick smoke or make some calls or have a suitcase packed. It more so makes me laugh then get po'ed. I did not mean to make the impression that I think people call 911 just to get out of bed and to get us out of bed. I simply meant that I bet if people stepped back for 5 minutes instead of spending the 5 minutes complaining and getting worked up..they may realize they could have handled the situation themselves. Either way...they call we come. We try to get there ASAP. Sometimes it takes a little longer. All that matters is that we drop our lives, get to the bus, get to the scene, and get the pt to the hospital and are ready for the next call. Key word in you post s MOST. I agree with you. However MOST people also do not complain and actually appreciate us.

Edited February 5, 2010 by PFDRes47cue

[JJB531 652]

I really think bashing any vac is unprofessional, for the most part Pvac is able to get

their calls covered, a few weeks ago they were able to put out 3 bus's with no problem

being a medic in the MT pleasant system I can say I have never not had

Pvac respond, they have a small building with no real sleeping quarters

in most cases Pvac arrive's soon after myself, during the day members leave

their job.. All vac's operate their own way and if it's working leave it alone

and stop bashing each other

i

Who is bashing PVAC? Who said PVAC doesn't do a good job? Who said PVAC doesn't get their ambulances out of the door? I would like to know where in this thread anyone bashed PVAC?

Once again, legitimate statements made about problems inherent with volunteer systems automatically means the agency is being bashed. It's unbelieveable.

FYI I was in the first group of medics to work the Mt. Pleasant system when ALS was introduced into the town. There were plenty of occasions where we'd go through 3 agencies down the mutual aid list before an ambulance would respond within town.

[ONEEYEDMIC 68]

i

Who is bashing PVAC? Who said PVAC doesn't do a good job? Who said PVAC doesn't get their ambulances out of the door? I would like to know where in this thread anyone bashed PVAC?

Once again, legitimate statements made about problems inherent with volunteer systems automatically means the agency is being bashed. It's unbelieveable.

FYI I was in the first group of medics to work the Mt. Pleasant system when ALS was introduced into the town. There were plenty of occasions where we'd go through 3 agencies down the mutual aid list before an ambulance would respond within town.

AMEN TO THAT!!!

[Guest]

Wow, I haven't been on EMTBravo in forever... barely remembered my screen name. But, all I wanted to say, was that obviously everyone has their heart in the right place, or I would hope... and that is for the care and concern of the patient. There is always going to be arguments of paid vs. volunteers, age vs. knowledge, Saints vs. Colts (oops, got all caught up in the Superbowl for a minute!) but I'm sure everyone on here goes to bed at night knowing they are doing the best that they can do, and that is all that anyone can ask for. Egos and attitudes aside, all that should matter is when that patient (either waiting with a suitcase in hand or barely breathing) can look you in the eye and know that you were there to help them.

Enjoy the game everyone! Have those IV bags ready for Monday... hahahaha!

[PFDRes47cue 653]

Wow, I haven't been on EMTBravo in forever... barely remembered my screen name. But, all I wanted to say, was that obviously everyone has their heart in the right place, or I would hope... and that is for the care and concern of the patient. There is always going to be arguments of paid vs. volunteers, age vs. knowledge, Saints vs. Colts (oops, got all caught up in the Superbowl for a minute!) but I'm sure everyone on here goes to bed at night knowing they are doing the best that they can do, and that is all that anyone can ask for. Egos and attitudes aside, all that should matter is when that patient (either waiting with a suitcase in hand or barely breathing) can look you in the eye and know that you were there to help them.

Enjoy the game everyone! Have those IV bags ready for Monday... hahahaha!

Excellent post! Drink on.

[Goose 188]

It boils down to this: career staffing gets you both speed and consistency. Sure, it's all about the patient, but IF the patient was really so important to everyone...wouldn't every agency get out the door in a reasonable amount of time? Wouldn't volunteer organizations move to mitigate staffing and response time issues? One would think.

There are a number of things effecting EMS today, but something i've heard time and time again in all the systems i've worked is that it's the volunteers who are holding us back. Surely, it's not the sole issue, but it is a large part of the issue. All too often, i have to agree with this sentiment.

[Guest alsfirefighter]

OK...let's see...

1. No one bashed any agency. 1a. If your telling the truth how it is, how is it bashing if some aren't doing their jobs?

2. Just showing up to a call isn't enough.

3. I spend more time educated truly ill people who try to drive then I do those who call 911 for nonsense. Guess what...if they are that's on you! Public education is part of your responsibilities. 3a. With thinking that 911 adds time...no way...it can add better response and public service with EMD and pre arrival instructions where warranted. Can drive to the hospital faster? So now what we go back to cadillacs and scoop and run?

4. Maybe stress does add time to untrained people not in our businesses eyes..but my CAD doesn't lie and many of the VAC's in my area...aren't cutting it. And what I have learned is the truth hurts and not dealing with not getting out along with the next 3 mutual aid agencies...but patting yourself on the back because on 1 day in a month you got all 3 buses out is ridiculous. Save 1 of the 3...I'll take one of those when I'm sitting there doing a jig to entertain a patient or debating on whether to ask for a cop to come to take his car or another medic for the flycar or to put them in the back of the engine on scene. You can't make the argument about the person with a suitcase in their hand at 2 am and how it could be quicker to drive when you have to be the one to explain why their loved one is struggling to breath and we're going deeper and deeper into protocol. I should not have to apologize for something that isn't my agencies responsibility.

5. If heart and pride were the root to solve all problems...we'd have no problems at all...but its not just about that. Wanting good consistent patient care has nothing to do with ego's. Work everyday where a high percentage of the time your waiting extended periods of time waiting for an ambulance and then come tell me. Or tell me how happy I should be that I'm on my 6th, 7th or 10th job where I've waited for an ambulance and then I get 1 all day and the EMT or whoever comes in all happy go lucky and wonders why I'm at the end of my rope as their all smiles and even sometimes talking about how great their agency is...spare me.

Yeah..I guess that's enough for now.

[Remember585 815]

We're all human, and there isn't a single Medic, EMT, CFR, Driver or Attendant - paid or volunteer - that doesn't have their grumpy moments. I've had them, I've seen others have them, and I have heard people have them on the radio.

None of us should preach this or that when it comes to "professionalism," because we've all been guilty of our human moments where we let what we are truly thinking out.

Cops waiting on EMS know this.

Firemen waiting on EMS know this.

Dispatchers paging our over and over again know this.

And all of you EMS people know this.

So let's get over ourselves and stop acting better then anyone else. We have to provide the best care with the most professional attitude we can. If this means mixing it up and doing duty crews, chopping dead wood members, hiring people, firing people, WHATEVER - then by God put aside your feelings and do what is needed to provide the best service you can to those that depend on it.

Our calls may not seem like an emergency to us, but the person calling has their reasons for calling. Whether they're in pain, they're sick, they're afraid or they just plain need our help with something, we have to be as respectful as we can.

I always used to think to myself that every elederly person was someone's Grandparent and that someone loves them no matter their flaws.

I'm done... just my perspective as a "retired" EMT. Enjoy the weekend!

[Guest alsfirefighter]

We're all human, and there isn't a single Medic, EMT, CFR, Driver or Attendant - paid or volunteer - that doesn't have their grumpy moments. I've had them, I've seen others have them, and I have heard people have them on the radio.

I sir take offense to that comment implying that I have grumpy "moments." I do not have "moments" I'm pretty much grumpy all the time and have my "moments" of happiness by good people who lift my spirits.

Remember my rule...start the day in a good mood...one butthole can ruin it. Start it off aggravated and anyone can uplift it!

[ckroll 101]

We need to find some common ground here. Volunteers aren't holding anyone back, and speed is relative. Overworked paid systems have long response times as do rural areas.[ In most of the Adirondacks you will almost never get a medic and an ambulance will be coming from 20 miles away to take you to a hospital farther away than that.] And I see in the volunteer EMTs that I work with an enthusiasm and dedication to patient care that is too often lacking in paid services. Volunteers are there because they want to be, and it shows. I just wish they wanted to be there more often.

Paid systems are minimally staffed, so when it gets really busy they have extended response times, too. Volunteers, or those managing them need to step up on the hard issues. Sacrifice requires.... sacrifice. Volunteer EMS agencies have to set minimum standards and meet them. That may mean mandatory rostering in station and/or supplementing with paid staffing.

A distinction that needs to be made is that individuals VOLUNTEER, agencies by and large do NOT. I believe all agencies [locally] are funded by some combination of municipal funding and billing. Either through taxes or billing a patient is seeing the cost of running an EMS system. The money is there. How is it spent? One view is that spending money on ridiculously expensive ambulances with all the bells and whistles, fancy jackets, awards and steak and shrimp dinners will bring in and keep volunteers. If that is working, great. If it isn't, then consider the agencies that bill and use that money to supplement volunteer availability.

Volunteerism is fantastic. We do not need to get rid of volunteers; we need to make it possible for people to volunteer at the same time that we provide consistent, timely, EMS service. Billing was a hard pill to swallow for volunteers, but we got over it. Supplemental staffing or mandatory rostering is just as hard. We need to get over that, too.

[Guest partyrock]

I have family living in Pleasantville, so threads of this nature have a special importance. PVAC may be doing the job most of the time, but certainly not all of the time. If they were why have I seen CVAC and HFD buses in PVACs area? Maybe it was the fourth call in town, but maybe it was the first. Either way these are calls that couldn't be handled. Good intentions are great until they're not enough. Just because you're volunteers it doesn't absolve you of doing the job you've advertised. There are accepted performance standards and if you cannot meet them, take your good intentions and... you know.

Does any agency track and more importantly make available a real breakdown of their response statistics? Average time from dispatch to on scene, # of calls dumped to mutual aid, etc.

[ckroll 101]

...... There are accepted performance standards ....

Does any agency track and more importantly make available a real breakdown of their response statistics? Average time from dispatch to on scene, # of calls dumped to mutual aid, etc.

Part of the complexity is that I don't think there are accepted performance standards. Could you reference them if you can find them? Given that the case in point is rural/suburban, standards need to be for that.

Another is that an agency providing an essential service can't just up and say 'I give up, we're not making it', nor can an agency spend [taxpayer] money it does not have to hire help. Logistically, paid crews only solve the problem of the first call. Staffing second rigs is prohibitively expensive unless a large region is all using the same provider who can ballast multiple call situations.

Towns are paying for EMS. A town can say 'You're not doing a good enough job', put out a contract stipulating level of service required and take bids..... and if memory serves a lot of that happened and towns were unhappy with the result. We are all responsible for our own health care, and that of those we consider family. Consider taking your own good intentions to town board meetings and lobbying your elected officials for more funding or more service.

We all need to know the resources available to us and plan accordingly. If your family has special health needs, are they preplanning how to get a family member out of a house, perhaps drive them privately, arrange for a paid service to respond directly? [When we have friends staying with us in the Adirondacks we know it is an entirely different level of service and plan to take action accordingly.]

If you are looking for statistics, ask agencies. Most can give you call volume and mutual aid information. Response stats come out of dispatching centers so try there or see if your county has someone in charge of coordinating EMS that can help, it's a lot of data entry that most agencies don't have time to do. And that said, what constitutes a response time is a whole new topic. Get involved with your local EMS council. There is a lot we can all do in addition to posting.

[Goose 188]

We need to find some common ground here. Volunteers aren't holding anyone back, and speed is relative. Overworked paid systems have long response times as do rural areas.[ In most of the Adirondacks you will almost never get a medic and an ambulance will be coming from 20 miles away to take you to a hospital farther away than that.] And I see in the volunteer EMTs that I work with an enthusiasm and dedication to patient care that is too often lacking in paid services. Volunteers are there because they want to be, and it shows. I just wish they wanted to be there more often.

Paid systems are minimally staffed, so when it gets really busy they have extended response times, too. Volunteers, or those managing them need to step up on the hard issues. Sacrifice requires.... sacrifice. Volunteer EMS agencies have to set minimum standards and meet them. That may mean mandatory rostering in station and/or supplementing with paid staffing.

A distinction that needs to be made is that individuals VOLUNTEER, agencies by and large do NOT. I believe all agencies [locally] are funded by some combination of municipal funding and billing. Either through taxes or billing a patient is seeing the cost of running an EMS system. The money is there. How is it spent? One view is that spending money on ridiculously expensive ambulances with all the bells and whistles, fancy jackets, awards and steak and shrimp dinners will bring in and keep volunteers. If that is working, great. If it isn't, then consider the agencies that bill and use that money to supplement volunteer availability.

Volunteerism is fantastic. We do not need to get rid of volunteers; we need to make it possible for people to volunteer at the same time that we provide consistent, timely, EMS service. Billing was a hard pill to swallow for volunteers, but we got over it. Supplemental staffing or mandatory rostering is just as hard. We need to get over that, too.

Of course volunteers are going to be excited to go on jobs...thats because they aren't answering every call. If they were stuck in a bus for 12 hours running from job to job then got off their A job to B job it in another bus for 8 or 12 hours, the whole glitz thing would wear off really quick.

That said, just because my coworkers and i draw a paycheck doesn't mean we are not willing to help others or not compassionate to our patients. I really don't know how you figure that career providers are less compassionate. How do you measure that? I mean, you could argue that i am more compassionate than many volunteers because my call received to arrival time is an average of 5-7 minutes, or maybe i'm more compassionate because i don't roll over and turn the pager off?

What boils my blood is stuff that we are talking about right now. The disparity in service is inexcusable - but what is worse than that is the public hasn't the faintest clue. It's the old bait in switch if you ask me, and it makes me want to vomit.

If LOSAP, lobsters and butter sauce, fancy jackets, a stipend per call or town pool passes is keeping you in EMS...you don't deserve to be here.

[ckroll 101]

Of course volunteers are going to be excited to go on jobs...thats because they aren't answering every call. If they were stuck in a bus for 12 hours running from job to job then got off their A job to B job it in another bus for 8 or 12 hours, the whole glitz thing would wear off really quick.

That said, just because my coworkers and i draw a paycheck doesn't mean we are not willing to help others or not compassionate to our patients. I really don't know how you figure that career providers are less compassionate. How do you measure that? I mean, you could argue that i am more compassionate than many volunteers because my call received to arrival time is an average of 5-7 minutes, or maybe i'm more compassionate because i don't roll over and turn the pager off?

What boils my blood is stuff that we are talking about right now. The disparity in service is inexcusable - but what is worse than that is the public hasn't the faintest clue. It's the old bait in switch if you ask me, and it makes me want to vomit.

If LOSAP, lobsters and butter sauce, fancy jackets, a stipend per call or town pool passes is keeping you in EMS...you don't deserve to be here.

That's it..... breathe......let the anger out.

I am reminded of the joke about the woman who when asked if she would sleep with the town drunk for a million dollars said, 'I guess so.' and at 50 dollars showed outrage saying, 'What do you think I am?' The reply was "We have established what you are m'am, we were trying to determine the degree."

Compensation is relative. Whether we do it for $10-$25 an hour or all you can eat shrimp once a year..... we are all underpaid and perhaps we can agree that probably makes us all idiots, just a matter of degree.

I meant no disrespect to paid service, [which I am 60 hrs a week], and if you found it in my post I apologize sincerely. I never said nor meant to imply that paid service lacks compassion. Some days I do not sense the enthusiasm, which you quite adequately addressed in your first paragraph.

In life, in EMS, it is not only where the path takes you, but how you choose to walk it.

[Bnechis 3,961]

Does any agency track and more importantly make available a real breakdown of their response statistics? Average time from dispatch to on scene, # of calls dumped to mutual aid, etc.

Most agencies have the data. Some actually track that data and turn it into useful information. The big question is how many actually make available (particularly without being asked) the info? I would love to see DOH require an annual public report (that might open some eyes).

Average response time is not a good measure. If the agency responds to 10 calls in 4 minutes and one call in 25 minutes, their average is 5.4 minutes, which is very acceptable, except to the person who waited 25 minutes. As the call volume goes up a few really bad call times get lost. Fractile reporting is the standard for EMS and it basically gives a percentage of calls that EMS arrived in 4min, 5min, 20 min, etc.

Part of the complexity is that I don't think there are accepted performance standards. Could you reference them if you can find them? Given that the case in point is rural/suburban, standards need to be for that.

American Heart Association, American Ambulance Association and NFPA have had standards in place for 25 years or more. The case in point has a population of 7,146 in 1.82 square miles (thats 3,929 people per square mile) is suburban. The standard is 4 minutes for BLS (1st response/AED with or without transport) and 8 minutes for ALS (including transport) 90% of the time.

Another is that an agency providing an essential service can't just up and say 'I give up, we're not making it', nor can an agency spend [taxpayer] money it does not have to hire help. Logistically, paid crews only solve the problem of the first call. Staffing second rigs is prohibitively expensive unless a large region is all using the same provider who can ballast multiple call situations.

Many agencies have given up or worst they do not tell the community it needs help and just continues to provided substandard service and hopes it will get better. It clearly can not spend tax money that it never asks for. So in a town that has 5 seperate volunteer ambulance services and a paid ALS service they can not find a solution? Maybe trying to staff 5 ambulances to cover less than 50,000 people is not the best way to make this work. At least 1 agency in town has stepped up to the plate and brought in some paid EMT's. Now if they can cover 5,000 people with paid, maybe it would be more cost effective to cover 50,000 with a few more.

Towns are paying for EMS. A town can say 'You're not doing a good enough job', put out a contract stipulating level of service required and take bids..... and if memory serves a lot of that happened and towns were unhappy with the result. We are all responsible for our own health care, and that of those we consider family. Consider taking your own good intentions to town board meetings and lobbying your elected officials for more funding or more service.

Most towns have no idea what kind of job the local EMS agency is doing. Since many towns in Westchester do not pay for service, its kind of hard for them to complain or go out and contract for another service.

We all need to know the resources available to us and plan accordingly. If your family has special health needs, are they preplanning how to get a family member out of a house, perhaps drive them privately, arrange for a paid service to respond directly? [When we have friends staying with us in the Adirondacks we know it is an entirely different level of service and plan to take action accordingly.]

99% of the general public have no idea what service is or is not provided. All they know is that when they dial 911 in 4 minutes 2 paramedics will be there to save them (its that way on TV).

If you are looking for statistics, ask agencies. Most can give you call volume and mutual aid information. Response stats come out of dispatching centers so try there or see if your county has someone in charge of coordinating EMS that can help, it's a lot of data entry that most agencies don't have time to do. And that said, what constitutes a response time is a whole new topic. Get involved with your local EMS council. There is a lot we can all do in addition to posting.

If agencies were truly proud of the service they provide, you would not have to ask for it. They would have it posted on the web and the annual report would be available at town hall and the library. Most dispatch centers only give that info to the agency, not the public.

[Goose 188]

If county control released info for the agencies they dispatched and all mutual aid requests they coordinated.....my, oh my!