EMS call coverage

[PFDRes47cue 653]

PFDRes47cue the point Bnechis is making is there are plenty of places with lower population densities than Westchester (we'll leave out St. Lawerence County) in NY that do a better job getting ambulances out and I might add staff them to an advanced level.

I agree with that.

[Remember585 815]

As someone who has worked more EMS jobs then I care to remember, I can tell you this. Every VAC / FD-EMS has changed in the time I've been involved. Some agencies should be proud of themselves, others need to check their egos at the door and come up with a solution FAST! I'm not going to use any agency names, but I will share some examples.

One VAC that I used to belong to is almost not a VAC anymore, rather it is nearly all paid. Part of the problem here was that certain people seemed to want it all to go paid and made it almost fail completely as a VAC. Luckily, some of the volunteers are still there as volunteers and others are there to get paid. Either way, the level of care is one of the best in Westchester.

Another VAC I belonged to barely covered anything for a while. Then some new members came and they were the dependable ones in the area. A change of officers made some of the die-hards almost vanish, and Mutual Aid became more frequent. Another change of officers, back up to covering calls again. Yet another change, and probably one of the worst periods in this VAC's history. A recent change appears to be helping, but I really don't think it will sustain, simply because it seems like more of a "proving a point" thing then anything. Once these people get tired of what they're doing, it will be back to three tones and out.

My current EMS affiliation used to be FD based. People literally raced to get the ambulances out for calls and would stay at the firehouse waiting for them. Some leadership problems, personality conflicts and a lack of trying to resolve things by our leadership sent us down the toilet. I still believe that if certain Chiefs put forth some effort, we could of improved things, but I firmly believe there was always a personal agenda involved and now EMS is on it's own. Ironically, EMS is doing much better. In the beginning it was mostly FD people who were waiting for something to change in order to motivate them, so we were getting out all the time. The open membership started, and the new influx of people have been picking up the ball and running with it. The biggest problem, however, is that the call volume keeps growing, especially during the day when most people are working, and it truly taxes the agency. Especially when almost one call a day is Mutual Aid to someone else - you get tired of bailing others out.

If every VAC could crew every rig they have, then this wouldn't be an issue. It kills me to see VACs with 3 or 4 rigs that allow calls to go Mutual Aid 3,4,5 times a day. Why not sell a rig and hire an EMT/Driver?! ALS knows exactly who I am talking about, and so does anyone with a scanner.

My time in paid EMS revealed all kinds of agencies to me. Some VACs always covered their calls, others were almost non-existent. Sadly, this goes back about 10 years and in some places, IS THE SAME NOW!!!! I remember waiting over an hour once for an ambulance for a nose bleed when working in Heritage Hills. When we finally had an ambulance responding, the gentleman stopped bleeding and said, "Forget it, I'll f---ing drive myself to the ER."

I have heard and been there to dispatch calls that have gone as far as six, seven, eight and even NINE agencies until we covered them. But as long as the rigs are washed, people have new t-shirts to wear and they win parade trophies, they'll never see a problem. I've seen some VACs have 20-30 people at a parade, but two hours later they need Mutual Aid for a nursing home FDGB call. Nah, keep on wishing on rainbows and eating the magical cupcakes....everything is fine....

But I will say this. If ever a family member needs EMS, and that EMS doesn't respond and/or there is a major delay they couldn't avoid (bad weather, etc.) then I guarantee my name will be in a load of letters to the agency, municipality and media. This much I promise!

I know a lot of you commenting on this thread, especially ALS & JJB - and I know how tired of this s*** you are, and being the professionals you are, I know it's getting to a point where you just can't bite your lip anymore.

Stay strong brothers!

Edited February 14, 2010 by Remember585

[JJB531 652]

I know a lot of you commenting on this thread, especially ALS & JJB - and I know how tired of this s*** you are, and being the professionals you are, I know it's getting to a point where you just can't bite your lip anymore.

Stay strong brothers!

Great post Remember, and you're right, it is getting to a point where a lot of us don't want to bite our lips anymore because over the years, while we have seen minor improvements, overall the system is still extremely flawed. I know that certain volunteers commenting in this thread are up in arms over certain comments that myself or others have made, but it is the unfortunate truth. Alot of us speak from experience, and nothing that any of us say is meant to be solely anti-volunteer because there are plenty of problems inherent in paid agencies as well. But as I have said before, and I'll say again, it is the system (or lack thereof) as a whole that is flawed. The lack of coordination, lack of available training, lack of equipment, lack of uniformity amongst agencies, lack of information disseminated to providers, lack of interest by providers to further their training/knowledge/capabilities, lack of interest from political figures to improve EMS within their communities or at the county level. The list goes on and on.

It's unfortunate because Westchester has the potential to be a model system. There are some very talented prehospital medical providers working and/or volunteering in Westchester, and alot of individuals who have a lot to offer EMS. Unfortunately until we get away from the concept of this town is my kingdom and I am "el Capitan" of the Ambulance so don't step on my turf without permission, things here will never change. We also have to lose the "good ole boys" club of EMS who may or may not have their own agendas which are not doing much to improve the system as a whole.

[helicopper 1,050]

If instead of biting their tongues and getting frustrated, if this dedicated band of professionals rallied together and became a vocal advocate for doing it right - without pointing fingers or laying blame, but highlighting how much better it could be - I bet more people would jump on the band wagon and before you knew it instead of being the outspoken minority, we would be a very very powerful majority.

Most people in this business want to do it right. They either don't know how to affect change themselves due to a lack of experience or leadership (a real problem in emergency services but especially EMS) or lack the fortitude to fight the battle by themselves. Once they see that they can be a part of an EMS revolution, I bet most would be onboard.

Imagine being able to bring a dozen knowledgeable EMS professionals or FD professionals to your meeting or to a town/village/city board/council meeting to lobby for your cause. No screaming or yelling, just professionals laying out the case for a model system.

Then you could have the EMS system that works and we can all be proud of AND the t-shirts and parade trophies!

[ems-buff 81]

As someone who has worked more EMS jobs then I care to remember, I can tell you this. Every VAC / FD-EMS has changed in the time I've been involved. Some agencies should be proud of themselves, others need to check their egos at the door and come up with a solution FAST! I'm not going to use any agency names, but I will share some examples.

One VAC that I used to belong to is almost not a VAC anymore, rather it is nearly all paid. Part of the problem here was that certain people seemed to want it all to go paid and made it almost fail completely as a VAC. Luckily, some of the volunteers are still there as volunteers and others are there to get paid. Either way, the level of care is one of the best in Westchester.

Another VAC I belonged to barely covered anything for a while. Then some new members came and they were the dependable ones in the area. A change of officers made some of the die-hards almost vanish, and Mutual Aid became more frequent. Another change of officers, back up to covering calls again. Yet another change, and probably one of the worst periods in this VAC's history. A recent change appears to be helping, but I really don't think it will sustain, simply because it seems like more of a "proving a point" thing then anything. Once these people get tired of what they're doing, it will be back to three tones and out.

My current EMS affiliation used to be FD based. People literally raced to get the ambulances out for calls and would stay at the firehouse waiting for them. Some leadership problems, personality conflicts and a lack of trying to resolve things by our leadership sent us down the toilet. I still believe that if certain Chiefs put forth some effort, we could of improved things, but I firmly believe there was always a personal agenda involved and now EMS is on it's own. Ironically, EMS is doing much better. In the beginning it was mostly FD people who were waiting for something to change in order to motivate them, so we were getting out all the time. The open membership started, and the new influx of people have been picking up the ball and running with it. The biggest problem, however, is that the call volume keeps growing, especially during the day when most people are working, and it truly taxes the agency. Especially when almost one call a day is Mutual Aid to someone else - you get tired of bailing others out.

If every VAC could crew every rig they have, then this wouldn't be an issue. It kills me to see VACs with 3 or 4 rigs that allow calls to go Mutual Aid 3,4,5 times a day. Why not sell a rig and hire an EMT/Driver?! ALS knows exactly who I am talking about, and so does anyone with a scanner.

My time in paid EMS revealed all kinds of agencies to me. Some VACs always covered their calls, others were almost non-existent. Sadly, this goes back about 10 years and in some places, IS THE SAME NOW!!!! I remember waiting over an hour once for an ambulance for a nose bleed when working in Heritage Hills. When we finally had an ambulance responding, the gentleman stopped bleeding and said, "Forget it, I'll f---ing drive myself to the ER."

I have heard and been there to dispatch calls that have gone as far as six, seven, eight and even NINE agencies until we covered them. But as long as the rigs are washed, people have new t-shirts to wear and they win parade trophies, they'll never see a problem. I've seen some VACs have 20-30 people at a parade, but two hours later they need Mutual Aid for a nursing home FDGB call. Nah, keep on wishing on rainbows and eating the magical cupcakes....everything is fine....

But I will say this. If ever a family member needs EMS, and that EMS doesn't respond and/or there is a major delay they couldn't avoid (bad weather, etc.) then I guarantee my name will be in a load of letters to the agency, municipality and media. This much I promise!

I know a lot of you commenting on this thread, especially ALS & JJB - and I know how tired of this s*** you are, and being the professionals you are, I know it's getting to a point where you just can't bite your lip anymore.

Stay strong brothers!

Wow, couldn't of say it better myself. I have to say you hit the nail on the head.

Now me being a volunteer, and a professional makes me see things in a clear light. How do you provide excellent care to the people you serve, with out hurting the ego's of the volunteers? simple You can't.

When is it exceptional to say, this is not the best for the patients.

When I visit my family in PA. The state has a whole entire different way of dispatch. Each ambulance is a station, each fire house is a station, and depending on the incident, the dispatcher dispatches the station, and the department makes the call on what goes. And its amazingly smooth

I personally thing, one county one EMS service. Think about it all civil service, enough money to get what is needed. No one is better then anyone else. In a perfect world. This would be. I guess I gotta go eat some of those magical cupcakes..

[antiquefirelt 994]

As screwed up as EMS in Westchester is, if there was a disaster, Westchester could pull it together and handle it.....textbook, maybe not but the job would get done.

I can appreciate this sentiment, but I have found this same statement is usually made time and again in reference to ICS programs and NIMS. Anyone who's taught ICS in many areas will have heard,"We don't really need all this BS, because when the real Big Job" happens, we'll pull together and get it done. We always have."

Time and again, far more areas all over the country run large scale incident drills only to have major holes found in their plans.Sadly, second and third exercises often reveal most of the previously identified issues have not been corrected. As BNECHIS pointed out, drills tend to show that it takes far longer to get the first critical patient to the appropriate facility that we'd ever consider. Time and again, unit to unit communication cannot take place off the main channels, many agencies fail to follow basic ICS principles and fail to understand them despite mandated training, and a failure of a true Unified Command system leading to multiple individual incident command systems. It seems all agencies have their hands out when the money and equipment is being passed out, but asking them to live up to the expectation that they can function in a 21st century IC system still alludes them.

This is not the case everywhere, but I know we see it in the Northeast corner. Maybe our forefathers set us up for this by imposing a strong sense of "home rule", but we're finding that in emergency services failure to work together well will cause problems. The best thing you folks have going for you there is that a healthy number of people are interacting many times a week, discussing problems. I could only wish the people in our area would even admit there are issues with covering calls, second and third tones, training deficiencies and the silly number of apparatus as compared to the number of incidents.

[Guest 29-Indigo]

I've been reading these forums for a while and tonight I feel a need to speak up.

So far tonight, I have heard almost every Medical call dispatched by 60 Control get multiple tones and then go Mutual Aid.

I've heard Bedford barely cover a call.

I've heard Croton unable to cover two calls.

I've heard Cortlandt (or Peekskill?) not cover two calls too.

When does everyone stop saying "we're just volunteer" and actually address the problem?

Thanks.

Chuck

[gamewell45 258]

I've been reading these forums for a while and tonight I feel a need to speak up.

So far tonight, I have heard almost every Medical call dispatched by 60 Control get multiple tones and then go Mutual Aid.

I've heard Bedford barely cover a call.

I've heard Croton unable to cover two calls.

I've heard Cortlandt (or Peekskill?) not cover two calls too.

When does everyone stop saying "we're just volunteer" and actually address the problem?

Thanks.

Chuck

Chuck,

You said Bedford "barely" covered a call? what do you mean? did they not get out or get out after whatever the prescribed amount of time is? Croton was unable to cover two calls? Were they already out on another call? The same for Peekskill; were they already out or was their bus sitting in the barn? Why don't you give us some more details.

On a side note. are you involved with Fire/EMS where you live? If not why don't you consider joining and being part of the solution?

[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?

Goose,

8 days ago I asked you to respond to this statement. Not seeing any response by you, maybe you missed my question. So I'll ask it again.

"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????? "

[Bnechis 3,961]

"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????? "

I thought about this and I can not think of this during a disaster, but I can think of a number of times that failing to get EMS coverage (including MA) did result in a death. One that comes to mind involves 2 medical calls & 1 MVA with only 1 ambulance that covered 2 of the calls, the 3rd call was transported by PD as no EMS MA was "available" they walked the cardiac patient down 3 flights of stairs and walk him into the ER where he coded.

I think you remember that night. We blew up 2 ambulances and ended up in a cop car (as a flycar).

[LTNRFD 266]

I thought about this and I can not think of this during a disaster, but I can think of a number of times that failing to get EMS coverage (including MA) did result in a death. One that comes to mind involves 2 medical calls & 1 MVA with only 1 ambulance that covered 2 of the calls, the 3rd call was transported by PD as no EMS MA was "available" they walked the cardiac patient down 3 flights of stairs and walk him into the ER where he coded.

I think you remember that night. We blew up 2 ambulances and ended up in a cop car (as a flycar).

Yes I do. A career (commercial) EMS system in an urban setting. If there was a system in place that allowed the career(commercial) and the volunteers to work together, maybe the system wouldn't have gotten overloaded. Lucky there is a system in place today.

[Guest alsfirefighter]

Goose,

8 days ago I asked you to respond to this statement. Not seeing any response by you, maybe you missed my question. So I'll ask it again.

"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????? "

I'm not goose...and I just got to read this. So I have to ask...what are we the FAA? Would you rather wait to figure this out?

With that I can tell you that I have been part of and sat and watched people suffer longer then they should and deteriorate to the point that they need serious aggressive treatment that puts them at a higher risk of mortality based on treatment outcomes while I've waited for an ambulance. I've transported people in my own flycar, police cars and a few times in the back of engine. Is that acceptable? And I'm not talking a handful of times over the 13 years I've been an EMS provider...I'm talking a few times a year.

If a disaster were to happen, don't worry I'm sure we'll have people coming our of our ears and ambulances just showing up. Spare me. Get me a bus to the person I'm in front of that I go from dumping front line meds into, to bagging, to then intubating. But its ok...I'm just a complainer, or anti volunteer, or a pain the a**. I guess I'd have to first say...I don't give a crap what anyone thinks...then I'd have to say I'd rather be all those then in denial or ignorant.

[LTNRFD 266]

I'm not goose...and I just got to read this. So I have to ask...what are we the FAA? Would you rather wait to figure this out?

With that I can tell you that I have been part of and sat and watched people suffer longer then they should and deteriorate to the point that they need serious aggressive treatment that puts them at a higher risk of mortality based on treatment outcomes while I've waited for an ambulance. I've transported people in my own flycar, police cars and a few times in the back of engine. Is that acceptable? And I'm not talking a handful of times over the 13 years I've been an EMS provider...I'm talking a few times a year.

If a disaster were to happen, don't worry I'm sure we'll have people coming our of our ears and ambulances just showing up. Spare me. Get me a bus to the person I'm in front of that I go from dumping front line meds into, to bagging, to then intubating. But its ok...I'm just a complainer, or anti volunteer, or a pain the a**. I guess I'd have to first say...I don't give a crap what anyone thinks...then I'd have to say I'd rather be all those then in denial or ignorant.

Goose made a statement "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." This county had far less resources 35 years ago, long before you or Goose were born. Even back then there was never a problem getting the resources needed to handle a disaster. In 2010 there are 10x's the available resources available.

Can we treat the patients better today....YES. Can we handle disasters easier....YES. I just can't accept someone in the EMS field making a blanket statement as Goose did.

FYI...I was 1st ambulance on the scene to a MCI on I-95 years back. The call was in NYC and I was working in Westchester. When it was determined that 4 additional ambulances were neededd for 9 patients (5 critical) a call was placed to NYC EMS for the buses. Only 1 BLS bus was available in the entire Bronx. And they asked if we could handle the MCI. The BLS was requested and 3 additional ambulances from Westchester responded. My point here is that even the great NYC EMS could not "field the resources" for a small scale disaster. BTW, no one died because NYC could not get the resources to a disaster.

When you talk about long delays waiting for an ambulance to respond, please give the specific area in question. There are many areas in Westchester that do not have the problems that you and Goose speak of.

[FDVA356 23]

Ah, EMS.....It's gotten totally ridiculous. I agree with every point made by REMEMBER585 as we have worked many calls together same with ALS. As an EMS officer for CEMS, I feel like a drastic change needs to be made, as in if we can't fill the duty roster, hire a emt or crew so we can provide the best timely patient care that we can. Thats what we are supposed to be their for correct?? It's time to do what we should be doing, COVERING CALLS 100% OF THE TIME, not 95% or whatever each agency is doing. My question is why isn't the County EMS coordinators stepping in or even NYS DOH, maybe it's time for that, so changes can be implemented. Speaking from my experiences, the agency I'm actively involved in has attempted and has made progress, but we are still in need of changing our ways and dropping PRIDE/TRADITION and make the needed changes. Suck it up, and hit your issues as in answering 100% of your calls. It's ridiculous that the medics and some FD first responder agencies, are waiting up to 1 hour for a ambulance to arrive I speak from first hand on this and its mind boggling that we continue to allow this to happen. 1 hour??? This is definitely an issue in reference to getting our customers (patients) the timely medical care possible that they need.

Bottom line, change is needed now let's step up to the plate and make the changes. As much as we all think our agencies are succeeding, were totally wrong!!! Theres always room for improvement, and to those agencies that have improved keep it up, but let's think reality and once we cover 100% of our calls. Then at that time we can say we succeeded. Until then, keep your mouthes shut and let's make a difference and improve overall patient care. Whether it be volunteer or career staffing. Both jobs do a hell of a job, and no one should knock those volunteering their precious spare time. But with the economy and members having 2 or 3 jobs to make ends meet, its hard and we need to really think about what we are doing, and if it's for the best for our customers. Those of you doing what they can, keep it up but theirs always room for impreovement. I come from both sides of the field VOLUNTEER and CAREER, so I hope I didnt' piss off anyone. It's no bad blood towards either side, just need to make necessary changes ASAP.

Jim Ferguson

1st Lieutenant- CROTON EMS

Career Firefighter/EMT FDVA

EMT/Driver Cortlandt VAC

Edited February 21, 2010 by FDVA356

[Goose 188]

Goose made a statement "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." This county had far less resources 35 years ago, long before you or Goose were born. Even back then there was never a problem getting the resources needed to handle a disaster. In 2010 there are 10x's the available resources available.

Can we treat the patients better today....YES. Can we handle disasters easier....YES. I just can't accept someone in the EMS field making a blanket statement as Goose did.

FYI...I was 1st ambulance on the scene to a MCI on I-95 years back. The call was in NYC and I was working in Westchester. When it was determined that 4 additional ambulances were neededd for 9 patients (5 critical) a call was placed to NYC EMS for the buses. Only 1 BLS bus was available in the entire Bronx. And they asked if we could handle the MCI. The BLS was requested and 3 additional ambulances from Westchester responded. My point here is that even the great NYC EMS could not "field the resources" for a small scale disaster. BTW, no one died because NYC could not get the resources to a disaster.

When you talk about long delays waiting for an ambulance to respond, please give the specific area in question. There are many areas in Westchester that do not have the problems that you and Goose speak of.

I guess you are going to have to accept it, because i made it, i stand by it and i believe that it would happen if there is a disaster. This isn't my illusion either - i've worked a number of systems and have friends and acquaintances who work across the county in varying provider capacities - AND they all have the same feelings. Forget me for a second and look at some of the comments here from some highly respect forum members, they have essentially verified my concerns (albeit a bit less bluntly).

I never asserted we were a system living in the stone age, or we haven't made improvements over the years. My assertion is that we are not up to snuff today. It is 2010 and one (1) ambulance call taxes most EMS systems in this County. I acknowledged there were areas that are very well covered, but again, those are local solutions and when you look at the big picture we are still behind the 8 ball.

Here are just a couple of fundamental issues this county has yet to hash out (which will be critical in a disaster senerio)

1) There is no centralized dispatch (while the new radio system has helped, there is still MUCH ground to cover)

2) There exists no response-time goal for life threatening emergencies (it is my belief that this is something that should be established and enforced at the county level)

3) There exist no economies of scale across the EMS system, in other words we have an over abundance of ambulances and not enough available providers to ever staff all of them ( i think there are something like 150 ambulances in Westchester compared to Pinellas County, Fl which has a similar population and operates with 54 ambulances)

4) Staffing - lets look at paramedics, most work two jobs and many work that second job within the county. Whats the problem? You have multiple agencies pulling from the same small pool of paramedics.

I could go on, but i really don't have the time right now. The above are just some of my concerns and from where i stand, they are issues that should have been solved years ago. Again it's 2010 - how much longer are we going to play this game?

[Bnechis 3,961]

This county had far less resources 35 years ago, long before you or Goose were born. Even back then there was never a problem getting the resources needed to handle a disaster. In 2010 there are 10x's the available resources available.

Can we treat the patients better today....YES. Can we handle disasters easier....YES. I just can't accept someone in the EMS field making a blanket statement as Goose did.

Lets go back 25 years, both of us were volunteer paramedics at L/TM VAC and it was very common to get 3 or 4 medics to respond for a cardiac arrest. I remember many times we could staff both ambulances with multiple paramedics. Can the same be said today?

Having been involved in the mutual aid planning for disaster response since the 1980's I can tell you we have about 5% more ambulances county wide now than then, but we have more that can not get out the door every day. The south end of the county is almost completely paid now. THe north end it is common to wait forever to get a bls unit. What has improved is everyone gets medics now and thats a big improvement, but the addition of a bunch of flycars does not help when we need transport.

[JJB531 652]

When you talk about long delays waiting for an ambulance to respond, please give the specific area in question. There are many areas in Westchester that do not have the problems that you and Goose speak of.

Why not speak to some active paramedics working fly car systems in Westchester County. Most will be more then happy to tell you plenty of specific instances where they have had to wait an extended period of time for an ambulance to arrive on scene. I refuse to "shout out" specific agencies here in a public forum, nor do I think anyone should "shout out" publicly a specific agency to satisfy your request.

Without naming the agency, just last night I had to wait almost a half hour for an ambulance, on a Saturday night, when everyone is supposedly home. How does that happen?

First, it was a BLS level call. No big deal, I like BLS calls, less work for me to do! While I'm stuck on scene waiting for an ambulance, another request came in for a neighboring jurisdiction which I am responsible for to respond to an ALS level call. Sorry, but I was unavailable to respond because I can't abandon a patient once I initiate care. Had an ambulance been on scene, I would have been available to respond. So now the second paramedic working had to respond mutual aid to the second call and was no longer available to respond within his primary area of response. The second ambulance then had to respond mutual aid to the call that I was tied up on, so now an entire town is without EMS coverage because one agency couldn't get a crew together for a call in their district. It's basically a snowball effect that affects more then just the patient laying on the floor waiting for an ambulance.

Based on the patients condition as a result of an old injury, there was really not much that I can do in the prehospital setting other then transport the patient to the hospital for diagnostic and continuing medical care. One problem, need an ambulance to transport. So now I'm left doing a song and dance in front of the family asking when I plan to pick up their family member off the floor. While I refuse to intentionally "bash" an agency to a patients family, I have to be honest with them and tell them that an ambulance is coming from further away then their own town because their ambulance is "unavailable" to respond.

Fortunately this was in fact a BLS level call. Although the patient was in significant discomfort, by no means was he in need of any immediate life-saving interventions. That doesn't make it acceptable though. My simple BLS call could have been a train wreck medical patient who required aggressive prehospital medical treatment and rapid transport to an emergency department. What happens then?

This is not a "once-in-a-while" occurence in Westchester. It happens more frequently then most people think. And with most systems, they go through months of horrendous service, and then begin to improve when they get new membership, more EMT's, etc., and then cycle back to horrendous service when they start having manpower issues again. The only way to solve the manpower issue is to hire per-diem or full-time EMT's to staff ambulances in the event the volunteers are unavailable. Harrison did it, and they have a functioning system. Port Chester/Rye/Rye Brook did it, and they have a functioning system. Ossining did it, and they have a functioning system. A lot of places have recognized the problems inherent within their own agencies and taken the appropriate steps to correct it. Unfortuantely, a lot of other places are merely hanging on by a small handful of active members, but what happens when those members move onto bigger and better things?

If you would like specific agencies and occasions where I have had to wait upwards of 45 minutes to an hour for an ambulance, please feel free to PM me and I will be more then willing to provide you with the specific information you have requested.

[helicopper 1,050]

My question is why isn't the County EMS coordinators stepping in or even NYS DOH, maybe it's time for that, so changes can be implemented.

Just on this point - it's because we're a home-rule state and any time the County or State tries to do anything even close to progressive it is shot down by the very same people who so desperately need the assistance and direction.

In the late 1980's there was an effort at the Hudson Valley Regional EMS Council to adopt a response time standard in accordance with the AHA guidance on the topic. I think it was something like 8 minutes 90% of the time. It was met with such resistance it never even came up for a vote. Where did the resistance come from? From the EMS agencies (commercial and volunteer alike).

We're our own worst enemies.

[FDVA356 23]

I totall agree Chris, we are our worst enemies.

[helicopper 1,050]

Lets go back 25 years, both of us were volunteer paramedics at L/TM VAC and it was very common to get 3 or 4 medics to respond for a cardiac arrest. I remember many times we could staff both ambulances with multiple paramedics. Can the same be said today?

Having been involved in the mutual aid planning for disaster response since the 1980's I can tell you we have about 5% more ambulances county wide now than then, but we have more that can not get out the door every day. The south end of the county is almost completely paid now. THe north end it is common to wait forever to get a bls unit. What has improved is everyone gets medics now and thats a big improvement, but the addition of a bunch of flycars does not help when we need transport.

25 years ago there was also that series in the Journal News about the very same issue "Where you live could cost your life" and what's changed besides the calendar?

We have many ambulances sitting idly by that cannot be staffed on a day to day basis and we lack the discipline and organization to staff them right if are confronted with a major disaster. We'll have 4 people on the ambulances that do get out, BLS fly-cars, and POV's showing up and empty ambulances sitting in stations that are being passed by mutual aid ambulances coming from long distances away.

At the northern end of the county we do have staffing issues because of dwindling numbers of volunteers but on the south end of the county we have mostly "low-bid" providers who have the bare minimum number of resources for the day to day stuff let alone a "big one".

[Guest alsfirefighter]

Goose made a statement "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." This county had far less resources 35 years ago, long before you or Goose were born. Even back then there was never a problem getting the resources needed to handle a disaster. In 2010 there are 10x's the available resources available.

Can we treat the patients better today....YES. Can we handle disasters easier....YES. I just can't accept someone in the EMS field making a blanket statement as Goose did.

FYI...I was 1st ambulance on the scene to a MCI on I-95 years back. The call was in NYC and I was working in Westchester. When it was determined that 4 additional ambulances were neededd for 9 patients (5 critical) a call was placed to NYC EMS for the buses. Only 1 BLS bus was available in the entire Bronx. And they asked if we could handle the MCI. The BLS was requested and 3 additional ambulances from Westchester responded. My point here is that even the great NYC EMS could not "field the resources" for a small scale disaster. BTW, no one died because NYC could not get the resources to a disaster.

When you talk about long delays waiting for an ambulance to respond, please give the specific area in question. There are many areas in Westchester that do not have the problems that you and Goose speak of.

Actually I was born then when you entered EMS as I'm 35 and I appreciate your service and time in the field and have to thank you or not adding on that you guys carried the stretchers bare foot in the snow, lol. Can we handle disasters easier? LOL. Define "easier?" And yes I'm talking for the majority of the county and not a couple of municipalities that have it together more then the others. I didn't take any sides in any comments made by another member, or the question you asked. I gave an insight into 1 of the several areas I work or worked in. Some facts are facts for a large part of Westchester in fire AND EMS. Lack of use of IMS, agency island syndrome, lack of coordinated common sense mutual aid and far too many that put pride and ego over service.

And one thing stands out about the MCI you were involved in many moons ago...you did say you were "working" on an ambulance if I read it right. Enough said. I have agencies who are supposed to be my transport component who now don't get out on MVA's, penetrating trauma, pediatric calls, etc. Even the Johnny come latelies would get up for those. So I can't say that with a disaster people would needlessly die, because as I said...people will come out of the woodwork that haven't been around for 2 free jacket cycles. I don't care about the disaster, they have their natural progression and people can and may die. The issue I have is people are needlessly awaiting definitive care because of ridiculousness and yes whether any directly died due to that wait versus their condition is arguable and often unattributable. But the fact of the matter is..I should not have judge how long I'm waiting for a bus by how many tv shows have ended on TV. PERIOD. I should not have to be thinking of transport decisions in vehicles not designed or used for such, including a medevac because I couldn't get a bus from 4 agencies for a stabbing. But never mind the big picture...it was just a problem with the repeater...but meanwhile co workers farther away heard me on my portable and were thinking of the ramifications if they went and got an ambulance somehow to come assist me and the BLSFR on scene. Its nuts...I'm tired of excuses...I'm tired of those in the agencies who are not performing the way they should running their mouths behind the pro's backs, but then again I have balls and I say nothing I don't say to their or anyone's face.

[LTNRFD 266]

Lets go back 25 years, both of us were volunteer paramedics at L/TM VAC and it was very common to get 3 or 4 medics to respond for a cardiac arrest. I remember many times we could staff both ambulances with multiple paramedics. Can the same be said today?

Having been involved in the mutual aid planning for disaster response since the 1980's I can tell you we have about 5% more ambulances county wide now than then, but we have more that can not get out the door every day. The south end of the county is almost completely paid now. THe north end it is common to wait forever to get a bls unit. What has improved is everyone gets medics now and thats a big improvement, but the addition of a bunch of flycars does not help when we need transport.

Barry what ambulances are you counting???? Are you looking at the local ambulance only or do you include the commercials???? Just in the sound shore area alone there has been a 50% increase in actual ambulances. The area went from 10 ambulance to 15 ambulances. The south county is different from the northern part and should be separated when these statements are made. You wouldn't want put N.R. and Yonkers to be lumped in with the smaller slower departments up north when you talk about fire department responses. Compare apples to apples.

I just wish when all these numbers and statements are thrown around that they are explained. Just like JFLYNN always asks for general statements to be explained further, I too wish that numbers and statements don't get all lumped together and generalized.

[Bnechis 3,961]

Barry what ambulances are you counting???? Are you looking at the local ambulance only or do you include the commercials???? Just in the sound shore area alone there has been a 50% increase in actual ambulances. The area went from 10 ambulance to 15 ambulances. The south county is different from the northern part and should be separated when these statements are made. You wouldn't want put N.R. and Yonkers to be lumped in with the smaller slower departments up north when you talk about fire department responses. Compare apples to apples.

Ok

1985ish

L/TM VAC 2

MEMS (Rescue) 2

NR 1.8

MV 2

SVAC 2

EVAC 2

HVAC 3

PC/R 3

15.8 ambulances (staffing?)

Today

L/TM VAC 2

MEMS (Rescue) 2

NR 2.5

MV 1

SVAC 2

EVAC 3

HVAC 3

PC/R 3

plus a couple of fly cars

18.5 ambulances (but can some actually be staffed? I know many of them can not) and the call volume has gone up at least 30% as the poulation increases and ages.

Thats an increase of 2.6 ambulances, but can most of those agencys staff the full compliment?

I left Yonkers out, becuase with S.S.M. it is unclear without their data to figure out what they actually have operating.

[Remember585 815]

NR 1.8

Was it missing a wheel?!

[Bnechis 3,961]

Was it missing a wheel?!

LOL. 1 was 24 hrs the other was 7am - 12mid or 1am (depending on the year).

[mreis95 77]

Chuck,

You said Bedford "barely" covered a call? what do you mean? did they not get out or get out after whatever the prescribed amount of time is? Croton was unable to cover two calls? Were they already out on another call? The same for Peekskill; were they already out or was their bus sitting in the barn? Why don't you give us some more details.

On a side note. are you involved with Fire/EMS where you live? If not why don't you consider joining and being part of the solution?

Listening to the scanner it happens a lot usually they go the full three sets of tones and then mutual aid gets requested and then end up canceling them and get a driver and emt. The fire goes the same way a decent amount of time or just get a chief on the road thats it.

[ems-buff 81]

County EMS coordinators stepping in or even NYS DOH, maybe it's time for that,

if you don't mind me asking, what could they do.. Well I know the state could pull a C.O.D., what are some ideas you would have..

[Goose 188]

if you don't mind me asking, what could they do.. Well I know the state could pull a C.O.D., what are some ideas you would have..

I'm not sure that BEMS has the resources to enforce anything more than it enforces today. While it would be nice if the state took a larger role in oversight, it's probably wishful thinking given whats going on up in albany.

ems-buff, i think you are referring to a CON

[ems-buff 81]

I'm not sure that BEMS has the resources to enforce anything more than it enforces today. While it would be nice if the state took a larger role in oversight, it's probably wishful thinking given whats going on up in albany.

ems-buff, i think you are referring to a CON

Wow.. You are correct sir.. Missed type on that one.. Thank you for pointing that out.. Ha ha..