EMS call coverage

[Bnechis 3,961]

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

I would love to see that in a spread sheet. I think a number of agencies would drop county dispatch before allowing that info to go public

[ckroll 101]

I would love to see DOH require an annual public report (that might open some eyes).

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.

Bnechis makes an excellent point about annual reports. QA/QI should also have QR-- quality of response. If we quantify the problem we can better address it. Towns have an obligation to their taxpayers to ask agencies what level of response they are getting for their money. At one time the Putnam County EMS Council was providing data from dispatch on response times at their monthly meetings, which is tantamount to public disclosure.

The point about standards is flawed. The AHA standard is based on responses to cardiac arrest compared to survival rates. The research is good, but one should not confuse ideal response times for cardiac arrest in an urban setting with 'reasonable' response times for EMS overall. 4 minutes BLS and 9/90 ALS transport was studied in an urban setting. Staffing to that level would be cost prohibitive in almost all suburban settings. Even in the weakest EMS systems 'CPR in progress' or 'PIAA, blood running in the streets.' usually gets a rapid response.

If one were to poll taxpayers, asking if they wanted an ambulance at their door in 4 minutes I have no doubt the answer would be 'Yes'. If at the same time one asked them to fund an additional $250,000 a year to pay for it, I also have no doubt the answer would be 'No'.

[Bnechis 3,961]

Towns have an obligation to their taxpayers to ask agencies what level of response they are getting for their money.

Only if the town helps support local EMS. To many officials do not believe that EMS needs to be supported.

The point about standards is flawed. The AHA standard is based on responses to cardiac arrest compared to survival rates. The research is good, but one should not confuse ideal response times for cardiac arrest in an urban setting with 'reasonable' response times for EMS overall. 4 minutes BLS and 9/90 ALS transport was studied in an urban setting. Staffing to that level would be cost prohibitive in almost all suburban settings. Even in the weakest EMS systems 'CPR in progress' or 'PIAA, blood running in the streets.' usually gets a rapid response.

While it it was based on Cardiac arrest, it also works, for respiratory, chocking, serious bleeding, overdose, etc. Can you tell me the difference between EMS in an Urban setting vs. suburban? I have worked both (as both vol & career) and found meeting the response time standard is much harder in the urban. Particularly since they stop the clock at the curb and do not consider verticle response time. I also find it amazing that taxpayers in wealthy villages should be held to a lower standard than those nontaxpayers who live off the public or live below grade.

Staffing would not be cost prohibitive if towns did not attempt to suport multiple agencies with multiple buildings and multiple vehicles and multiple budgets. Additionally, volunteer coverage would be easier with fewer ambulances to staff, but the same size pool of potential volunteers.

I have worked as a flycar medic in both week and strong systems and while they "usually" get out, it is not almays rapid and I had to listen many times to "any available emt or driver".

If one were to poll taxpayers, asking if they wanted an ambulance at their door in 4 minutes I have no doubt the answer would be 'Yes'. If at the same time one asked them to fund an additional $250,000 a year to pay for it, I also have no doubt the answer would be 'No'.

In a number of towns taxpayers in Westchester were asked to pay, by creating an ambulance district, most (if not all) agreed. The question they were asked is not 4 minutes, it was do you want an ambulance, otherwise you may have to find your own way to the ER (as has been sugested here).

[PFDRes47cue 653]

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.

I am not saying it never happens. But most of the time other agencies take our calls because we are having them cover us for a PVAC function, stuck at a fire scene for extended periods of time, or spending that day at a car accident such as the terrible Taconic incident. Now, that is just an example. For the record we did not have another call while at the Taconic incident, but we did have 1 full crew standing by in quarters to man our third bus if such an incident arose. But of course, every once in a while we can not get a bus out. I believe last year we were mutual aided less than 10 times. Even though not even getting mutual aided once is the goal and the only acceptable breakdown but for 980 some odd calls I get over it. I also believe 2 of the mutual aided calls came when we had that freak ice storm on a sunday in december when we had 16 calls in 2 hours. 60 control contacted us for our 4th bus (which we don't have) for a mutual aid on the parkway which we could not provide. But it happens, every agency gets overloaded at least once a year.

[JJB531 652]

I am not saying it never happens. But most of the time other agencies take our calls because we are having them cover us for a PVAC function, stuck at a fire scene for extended periods of time, or spending that day at a car accident such as the terrible Taconic incident. Now, that is just an example. For the record we did not have another call while at the Taconic incident, but we did have 1 full crew standing by in quarters to man our third bus if such an incident arose. But of course, every once in a while we can not get a bus out. I believe last year we were mutual aided less than 10 times. Even though not even getting mutual aided once is the goal and the only acceptable breakdown but for 980 some odd calls I get over it. I also believe 2 of the mutual aided calls came when we had that freak ice storm on a sunday in december when we had 16 calls in 2 hours. 60 control contacted us for our 4th bus (which we don't have) for a mutual aid on the parkway which we could not provide. But it happens, every agency gets overloaded at least once a year.

I'm going to pose this question again, only because it wasn't answered the first time. If PVAC only requested mutual aid a maximum of 10 times last year, how come you stated the agency was looking into per-diem EMT's to cover calls just 5 months ago?

[GAW6 66]

I'm going to pose this question again, only because it wasn't answered the first time. If PVAC only requested mutual aid a maximum of 10 times last year, how come you stated the agency was looking into per-diem EMT's to cover calls just 5 months ago?

As the Captain of said agency, I feel it is my responsibility to answer the question since it appears to be so important to people. First of all, if you read a previous post of mine, it was in fact a year ago, not 5 months ago. The majority of our mutual aids for 2009 occurred in the first 2 months of the year. I went to our Board of Directors and said that an RFP needed to be sent out for daytime EMT services on a per diem basis when needed. By the time the RFP went out and quotes came back, we had an influx of new EMTs and we were covering calls.

We also had an agreement worked out with Hawthorne. A couple of our EMTS are "mutual aid" members (myself included) with HFD and we were responding to their calls on nights and weekends (they only had a paid daytime EMT at the time); therefore they were helping us out during the day and mutual aiding for us when needed. We have NEVER had to mutual aid at night (we have set night crews, weekend nights included) or on the weekend (unless we were already tied up).

This thread should not have become an inquest of PVAC. But any other further questions about my department I would be MORE THAN HAPPY to answer; please PM me. Thank you.

[INIT915 1,119]

It boils down to this: career staffing gets you both speed and consistency.

I think we need to agree that this is not a constant.

There are career EMS agencies which are run professionally and efficiency.

There are career EMS agencies which are run with a lack of both professionalism and efficiency.

There are volunteer EMS agencies which are run professionally and efficiency.

There are volunteer EMS agencies which are run with a lack of both professionalism and efficiency.

This sentiment can also be used when considering fire and law enforcement agencies.

[ckroll 101]

Can you tell me the difference between EMS in an Urban setting vs. suburban?

Ooh, ooh I can answer that. Call volume, population density, square miles per agency, and length of roads.

My volunteer corps answers about 700 calls a year, serves just over 10,000 residents, covers 43 square miles. Rostered in station and driving like a bat out of hell, it takes 15 minutes to get from the station to our farthest population center. To meet 4 minutes BLS and 9/90 ALS transport, we would need two more stations and another medic unit. And I don't think it would improve outcome.

[Bnechis 3,961]

Can you tell me the difference between EMS in an Urban setting vs. suburban?

Ooh, ooh I can answer that. Call volume, population density, square miles per agency, and length of roads.

My volunteer corps answers about 700 calls a year, serves just over 10,000 residents, covers 43 square miles. Rostered in station and driving like a bat out of hell, it takes 15 minutes to get from the station to our farthest population center. To meet 4 minutes BLS and 9/90 ALS transport, we would need two more stations and another medic unit. And I don't think it would improve outcome.

You gave the correct deffinition, but you lose points on the example, which is clearly rural and not suburban. Yes the standards for a rural area will never match suburban or urban, but my point was that their is no excuse for suburban services to be worst than urban.

[JJB531 652]

As the Captain of said agency, I feel it is my responsibility to answer the question since it appears to be so important to people. First of all, if you read a previous post of mine, it was in fact a year ago, not 5 months ago. The majority of our mutual aids for 2009 occurred in the first 2 months of the year. I went to our Board of Directors and said that an RFP needed to be sent out for daytime EMT services on a per diem basis when needed. By the time the RFP went out and quotes came back, we had an influx of new EMTs and we were covering calls.

We also had an agreement worked out with Hawthorne. A couple of our EMTS are "mutual aid" members (myself included) with HFD and we were responding to their calls on nights and weekends (they only had a paid daytime EMT at the time); therefore they were helping us out during the day and mutual aiding for us when needed. We have NEVER had to mutual aid at night (we have set night crews, weekend nights included) or on the weekend (unless we were already tied up).

This thread should not have become an inquest of PVAC. But any other further questions about my department I would be MORE THAN HAPPY to answer; please PM me. Thank you.

It's not a matter of it being "so important to some people", but more an issue of discussing how agencies are dealing with staffing troubles. Nobody has bashed PVAC, and your response brought up some positive points, such as the sharing of resources. In this case, manpower through your agreement with Hawthorne FD. I think that's a positive idea that other agencies might possibly be able to look into implementing within their own systems.

The thread became an inquest of PVAC because PVAC was the agency that was brought up by one of its own members, hence the reason PVAC became the topic of discussion. Don't take it personal...

[ONEEYEDMIC 68]

If you are sharing resources with another Agency, why not just form a TOWN WIDE EMS SYSTEM instead of 3 different Agencies? I know it would take alot of you to play nice in the sandbox, but it may benefit the taxpayers of the Town which is the most important thing. There can be an Election and everything for who would reign supreme of the EMS system!!

[ckroll 101]

You gave the correct deffinition, but you lose points on the example, which is clearly rural and not suburban. Yes the standards for a rural area will never match suburban or urban, but my point was that their is no excuse for suburban services to be worst than urban.

And yet a life is just as precious in the boondocks. Why is it acceptable to have a different standard for rural service and demand one service standard for urban/suburban?

As a matter of semantics, population density makes a huge difference, not in what level of service [a.k.a. response times] is acceptable, but in what level of service is possible. Consider White Plains. With a resident population of about 60K and a daytime population of 250K, this is an urban example where a lot of people are in a small area that might expect to have multiple ambulances and with that, short response times. In a bedroom community that feeds WP, a resident population of 10,000 becomes 5,000 during the day.

In that situation one might even argue that all ambulances should be in WP and none in the suburbs. A 4 minute response time for 250K and 15 minute response time for 5K might be a good use of resources. Which by the way is exactly what happens when there is paid service. Units are placed where they will do the most good. High density areas see better response times than less populated areas ... at least they do if someone is managing the system properly.

All of which speaks to the need for some minimum level/standard of service. I would expect that in urban situations that standard might be exceeded by a significant amount.

[ONEEYEDMIC 68]

When Northern Westchester started their Fly Car service back in 1999 0r 2000, I happened to be the first medic in the fly car. I happened to know the area from just driving around as a teen being bored. Anyway, I was amazed of how long it took from NWHMC to say a job in Vista or North Salem. Granted the fly car I was in was a piece of garbage and could not go over 60mph. It still took me a good amount of time to get amount of time to either get to the residence or intercept. Luckily, they now have 3 fly cars up in that area! I am not sure how many residents that covered and I only used those two towns as and example. But for the bigger picture, 1 Fly car to cover New Castle, Mt Kisco, Bedford Hills, Katonah, Somers, Lewisboro, Vista, North Salem and there are a great deal more. What a crazy time that was! Not sure if that has anything to do with what we are talking about but it might!

[WAS967 97]

Correct me if I'm wrong, but as a county agency, isn't 60 control's data accessible via FOIL requests? Couldn't anyone go to the county office building and file a request for say "all response time information regarding EMS in year XXXX" or whatever?

[ny10570 745]

Correct me if I'm wrong, but as a county agency, isn't 60 control's data accessible via FOIL requests? Couldn't anyone go to the county office building and file a request for say "all response time information regarding EMS in year XXXX" or whatever?

One step ahead of you. Sent it in earlier today. We'll see what it turns up.

[ny10570 745]

Correct me if I'm wrong, but as a county agency, isn't 60 control's data accessible via FOIL requests? Couldn't anyone go to the county office building and file a request for say "all response time information regarding EMS in year XXXX" or whatever?

One step ahead of you. Sent it in earlier today. We'll see what it turns up.

[antiquefirelt 994]

Rostered in station and driving like a bat out of hell, it takes 15 minutes to get from the station to our farthest population center. To meet 4 minutes BLS and 9/90 ALS transport, we would need two more stations and another medic unit. And I don't think it would improve outcome.

I find it interesting that a medic would not see the potential for an 11 min. difference to positively change some patient outcomes? My agency has been approached on numerous occasions about taking on EMS in a neighboring town. We are not interested because we could not arrive within what we consider a reasonable time frame to ensure the best outcomes possible.

[PFDRes47cue 653]

I'm going to pose this question again, only because it wasn't answered the first time. If PVAC only requested mutual aid a maximum of 10 times last year, how come you stated the agency was looking into per-diem EMT's to cover calls just 5 months ago?

One reason was to make it so he people who were leaving work to cover the calls could not have to do that so often. It more so served as a threat to some of the less active members than a serious topic of discussion. Starting the day after the possibility was brought up...what do you know some less active members started keeping the board covered.

[PFDRes47cue 653]

One step ahead of you. Sent it in earlier today. We'll see what it turns up.

Will this also include agencies not dispatched by 60 control???

[Goose 188]

Will this also include agencies not dispatched by 60 control???

Remember, we live in a bubble. There is no centralized tracking of response times. If 60 control dispatched an agency they have data on that agency, if they don't dispatch you then they don't have any data. Period.

The county has no authority over local municipalities - thats the biggest problem. If it was legal - you would have three public safety agencies : Westchester Fire, Westchester EMS an Westchester PD and we would never have to split hairs over this stupidity.

It's all been studied...and guess what, we do things so a** backward its embarrassing. God forbid there is a moderately sized disaster, people will unnecessarily die. Hell, i don't want to even think about all the people that have suffered irrevocably because the vollies couldn't get out.

Edited February 13, 2010 by Goose

[LTNRFD 266]

God forbid there is a moderately sized disaster, people will unnecessarily die.

Just a little curious about your statement. What do you consider a "moderate sized disaster"?

Edited February 13, 2010 by LTNRFD

[Goose 188]

Just a little curious about your statement. What do you consider a "moderate sized disaster"?

Disaster is a disaster i suppose, the semantics are irrelevant. Figure something along the lines of the hudson landing, plane down in a residential neighborhood, natural disaster, a steam or other vapor leak from indian point...you can really insert whatever you want.

[LTNRFD 266]

Disaster is a disaster i suppose, the semantics are irrelevant. Figure something along the lines of the hudson landing, plane down in a residential neighborhood, natural disaster, a steam or other vapor leak from indian point...you can really insert whatever you want.

"God forbid there is a moderately sized disaster, people will unnecessarily die."

So in your above statement you are refering to people will die due to the diaster and not because of the EMS resources available. Am I correct?????

[Goose 188]

I think you're misunderstanding what i wrote. This is what i said:

"It's all been studied...and guess what, we do things so a** backward its embarrassing. God forbid there is a moderately sized disaster, people will unnecessarily die. Hell, i don't want to even think about all the people that have suffered irrevocably because the vollies couldn't get out."

I stated that in the event of a disaster people will UNNECESSARILY die, when i say unnecessarily i'm inferring that people will die due to the inability of this county to field the resources and personal necessary to deal with said disaster. So, sure people may die from a disaster sized event itself but there will be additional death/injury because most of this county cant properly respond to a basic aided-case (and fire alarm for that matter)...if we can't handle the ordinary how can we expect to handle the unexpected?

Edited February 13, 2010 by Goose

[x635 4,066]

Hell, i don't want to even think about all the people that have suffered irrevocably because the vollies couldn't get out.

Or because there was an young inexperienced "career" EMT with a huge ego who's not eager to learn from others that really didn't give a crap about the patient.

[JJB531 652]

"God forbid there is a moderately sized disaster, people will unnecessarily die."

So in your above statement you are refering to people will die due to the diaster and not because of the EMS resources available. Am I correct?????

I'm assuming Goose is referring to the number of unnecessary casualties because of the inability of the EMS system in Westchester County to properly and adequately respond to a "larger scale" disaster or mass casualty incident. EMS in Westchester County is a disaster in itself. Personally, I don't think it has anything to do with volunteer or paid services, but rather the system as a whole.

First problem is an overall lack of coordination. With all of the different agencies out there, all of the different Captains and Chiefs, all the different dispatching agencies, and all of the different unit designations that don't follow the County's designation system, in the event of a larger scale disaster, coordinating a multi-agency response would prove to be rather difficult.

60 Control has manpower to handle their current workload (or at least I guess they're supposed to!). If more agencies became a part of the 60 Control dispatching system, 60 Control would have to hire more dispatchers to handle the increased workload. With their current manpower and technology, can 60 Control handle the increased workload if there is now a significant county-wide disaster where they are attempting to coordinate a number of agencies, especially agencies that do not utilize 60 Control as a dispatching resource?

I think the second problem is a lack of training and education. This is a problem that doesn't just fall on the County or any of the County agencies, but it also falls on the EMS providers. I think it's great that everyone goes through NIMS compliance training, but how many EMS providers are truly confident with responding to an MCI in terms of establishing sectors and following the standards for MCI response? In the event of a disaster, how many EMS responders are properly trained or equipped (even in terms of basic personal protective equipment) to handle treating patients in an austere environment, whether it be a collapse or confined space environment, operating in the warm zone of a hazardous materials environment, or operating within the warm zone of a tactical environment in the event of an active shooter scenario?

A lot of of this training is not readily available to EMS providers. The OFPC won't allow you to take a Rescue Tech-Basic course or a number of other courses they offer unless you have completed basic firefighter training. So what's the alternative, pay hundreds of dollars out of your own pocket to recieve this training through private training organizations? And then when this training does become available, how many EMS providers will actually take advantage of the opportunity? I know myself along with a handful of other providers will, but unfortunately the majority won't. So now what happens when that large scale disaster happens, everyone is out there doing their own thing, and then someone gets hurt because they didn't have the proper training or equipment? Now those untrained providers are becoming more of a hinderance then a help.

The County handed out these Level B hazmat packs a few years ago, I believe 10 or so to each agency. Has anyone ever looked inside of them? How many EMS providers know how to properly don and doff the equipment in those packs? When was the last time anyone checked the filters for expiration dates or damage to the foil packaging they come in to ensure that they are still in good working condition? How many agencies have trained with the equipment?

The County went out and purchased and equipped MCI trailers. Does anyone know what's inside of them? What are the capabilities of the equipment inside of them? Who is responsible for ensuring that these trailers make it to where they get to get to in the event of a disaster?

This is the kind of half-a** provisions that the County makes for its EMS providers. But what else can they do? They have no real authority when it comes to EMS. As long as EMS providers go to a bunch of CME's and pointless call audits, it's all good, we're doing a good job. Let's go celebrate at Playland everyone!

In the event of a large scale disaster, we can really only count on active EMS units that are currently in service to respond. I'm confident that a number of volunteer agencies will staff their ambulances and be ready to respond, but we can't count on every agency having the appropriate manpower to staff EMS units. Commercial providers will more then likely pull transport units to provide extra assistance as well, in addition to mutual aid units from outside counties as well (Rockland, Putnam, etc.).

[LTNRFD 266]

I stated that in the event of a disaster people will UNNECESSARILY die, when i say unnecessarily i'm inferring that people will die due to the inability of this county to field the resources and personal necessary to deal with said disaster. So, sure people may die from a disaster sized event itself but there will be additional death/injury because most of this county cant properly respond to a basic aided-case (and fire alarm for that matter)...if we can't handle the ordinary how can we expect to handle the unexpected?

Can you in ALL your years in the EMS field tell us how many people died because of inadequate EMS response to any size disaster in Westchester County?????

[PFDRes47cue 653]

Remember, we live in a bubble. There is no centralized tracking of response times. If 60 control dispatched an agency they have data on that agency, if they don't dispatch you then they don't have any data. Period.

The county has no authority over local municipalities - thats the biggest problem. If it was legal - you would have three public safety agencies : Westchester Fire, Westchester EMS an Westchester PD and we would never have to split hairs over this stupidity.

It's all been studied...and guess what, we do things so a** backward its embarrassing. God forbid there is a moderately sized disaster, people will unnecessarily die. Hell, i don't want to even think about all the people that have suffered irrevocably because the vollies couldn't get out.

There has got to be some reason why there are so many vollie agencies in the county...something must be working or must have worked in the past or something. I would sure like to think about all the people who have been helped by the vollies!

[Bnechis 3,961]

There has got to be some reason why there are so many vollie agencies in the county...something must be working or must have worked in the past or something.

Because nobody was (or is) willing to let anybody else play in their sandbox.

[JJB531 652]

There has got to be some reason why there are so many vollie agencies in the county...something must be working or must have worked in the past or something. I would sure like to think about all the people who have been helped by the vollies!

There are so many vollie agencies in Westchester County because EMS is still a very young field when compared to Law Enforcement and the Fire Service, and paid services were obselete for a very long time in Westchester. EMS still is not a priority to a lot a communities in Westchester. As long as an ambulance shows up from somewhere, I personally don't believe that the politicians in a lot of these towns and villages really care how their own EMS system is doing. Especially now that the whole county has ALS level service available, any agency can look good in the eyes of the public when a paramedic unit arrives on scene before an ambulance and initiates care.