Newburgh FD wants to start ambulance service

[pd125 0]

City of Newburgh Firefighter Union has an idea to provide ambulance services to the City of Newburgh. In a TH article here is the link. "New ambulance service would make money", chief says

http://www.recordonline.com/apps/pbcs.dll/article?AID=/20100531/NEWS/5310318

[helicopper 1,050]

"Change or die," Vatter said, repeating the Fire Department's new mantra. "There's nothing that's off the table in terms of revenue-generators or places where we can cut without reducing service."

So he's not investigating providing EMS to better serve the residents of Newburgh or because there is an issue with the existing service. He's doing it because he perceives it to be a "revenue generator" and it will save FF jobs. That's just great.

What about the MLSS jobs if the FD takes over city EMS?

How many ambulances can MLSS provide if the city needs them? The city is talking about TWO?

With only four paramedics and two ambulances, you're going to have a very hard time staffing 2 units 24/7. What happens when someone is on vacation or sick?

Who will be the city's mutual aid?

When the system loses money, what happens?

Are the four paramedics going to be FF also or are they going to be stand-alone EMS providers? What benefit is there to the FD if they hire civilians who can't staff the fire apparatus? I guess the perceived revenue

I'm all for streamlining services and there are places where fire-based EMS is working very well. Given that Newburgh is having a hard time sustaining it's FD, I don't see them being as progressive as MLSS has been in the past. MLSS has committed to training, CME's, exploring new treatment modalities, etc., etc. Wanna bet that the FD commits to the bare minimum necessary to meet state standards (which are already too low)?

[Guest alsfirefighter]

If you actually re read the first paragraph it ends with:

that would make money for Newburgh and provide a better service.

Most of you know its no secret that I am a proponent of fire based service as many of the best systems in the country are FD based. I can't speak about MLSS as I have great respect for their agency and have friends that work there and they are top notch Paramedics. What I can say is one of the reasons I do like FD or 3rd Party based (municipal) EMS systems is the fact that you have tighter control over who is providing care in your area.

As far as what happens when they don't make money? Can't answer that however there are few agencies in any town/municipality that makes money for what they do. This includes PD with tickets. If the system can be controlled better and enhance the capabilities of the FD as well I see it as a win win.

While I'm also compassionate (ok so most of you know I have not a shred of compassion in my body)..how about empathetic towards other peoples jobs, MLSS is a large enough system that those who either do permanent shifts in C.O.N. or those who rotate in to fill shifts (getting to my control over who is providing care in your area point) I'm sure will be absorbed back into their system as its pretty vast.

And lunch on me that it never happens. While the thought I like and I do believe to start the system they would do what they need to get it off the ground successfully...that the city will balk when it sees the start up costs that would be needed for equipment. If anything I would look at walking their way into the transport end and start ALSFR via engine and then work their way up if they still see it fit and work with MLSS to get an agreement to recoup some funds for the BLS and ALSFR service they provide to help offset or break even on equipment/training costs. But hey what do I know?

[Goose 188]

Just another ploy to keep the run numbers up and justify staffing levels or contractual desires moving forward.

[16fire5 693]

Just another ploy to keep the run numbers up and justify staffing levels or contractual desires moving forward.

The run numbers are up there already without EMS and staffing is 10 total for 2 engines 1 truck and the Assistant Chief (tour commander). This for a depressed city that sees a large amount of fire duty for it's size.

[Goose 188]

The run numbers are up there already without EMS and staffing is 10 total for 2 engines 1 truck and the Assistant Chief (tour commander). This for a depressed city that sees a large amount of fire duty for it's size.

You are more than welcome to drop all the union talking points you want, i respect that. I just don't buy it....sounds all too similar to the strong arm robbery that occurred in NYC in 1996.

[Bnechis 3,961]

Just another ploy to keep the run numbers up and justify staffing levels or contractual desires moving forward.

In this case no one appears to be concerned with run numbers, they are concerned with maintaining the current budget level, so they can maintain the current level of service (which is already substandard).

The run numbers are up there already without EMS and staffing is 10 total for 2 engines 1 truck and the Assistant Chief (tour commander). This for a depressed city that sees a large amount of fire duty for it's size.

So if they add 4 medics, I am assuming they plan to run a 4 platoon system with on duty 24/7. This would means one of the existing FF's would have to be assigned to an ambulance, thus actually reducing the number of available FF's. This does not help fire response, what I beleive they are trying to do is help pay for ff's who will be laid off as the depts buget is reduced.

You are more than welcome to drop all the union talking points you want, i respect that. I just don't buy it....sounds all too similar to the strong arm robbery that occurred in NYC in 1996.

Ok forget the union points. According to the International City/County Managers Association (ICMA) NFD's staffing is atleast 4 below the standard the the city managers believe is the minimum per shift staffing. The Insurance Industry also says this is understaffing. Neither of these organization has anything to do with the unions. In fact ICMA has services to help city managers plan to reduce staffing.

It is kind of difficult to to compare a dept. with a daily staffing of 10 to one with a staffing of around 2,500.

[bad box 371]

You are more than welcome to drop all the union talking points you want, i respect that. I just don't buy it....sounds all too similar to the strong arm robbery that occurred in NYC in 1996.

The best thing that ever happened to N.Y.C. E.M.S. was for it to become a part of The F.D.N.Y.. The current E.M.S. system in N.Y.C. is far better than it was prior to 1996.

[Boss159 7]

I do not know much about the call volume, logistics or for that matter anything about operrations in the city of Newburg or the Town, but what about the idea of expanding the Town VAC to cover city calls also with ALS fly car back up by MLSS or even City medics?

Does the City have a contract with MLSS, and what is the fee? If anyone knows...

[firefighter36 52]

Our jobs as FD/PD/EMS is to help people. FD-Based EMS is just that, helping people. Whatever the solution, the level of service and response, we have an obligation to put our best foot forward and provide courteous, prompt, and professional service to our respective areas. People and the safety of the community need to come first.

I don't think anything relating to such a venture could be looked at as having to potential to produce a profit. NYS law and several court decisions regarding ideas just like this one clearly state that a municipality cannot engage in EMS billing to create a "Funding Stream." I.E. the municipality cannot create a City Ambulance as a "business" to support the city. The law does however state that a municipality can bill for EMS Services rendered for the sake of "Cost Recovery," meaning that the City has the right to seek reimbursement from a patient's insurance company for the reasonable costs of treatment and transport to definitive care. I think the above description lays forth how the politicos and the city-manager types often view this service.

Second, I would advocate for FD-Based EMS based on another factor: Firefighter Safety. In my estimation, EMS calls do a number of things to help our safety. First and foremost, they get us out in the community and allow us to have our ears to the ground. Through EMS, we can see and understand the human condition in our response areas. Additionally, we see the changes in construction, and we get the opportunity to enter a lot of occupancies, commercial, residential, industrial, etc. that we may not have access to. (Remember, not every FD is empowered with inspection & enforcement powers relating to Codes.) Doing EMS allows us to help people, and be on the look out for dangerous situations that could compromise us should we enter an occupancy during a fire or rescue-type scenario. Knowledge is power, and having the knowledge that can be gained through EMS Calls is another tool in our arsenal that can keep us alive and healthy.

As for call volume, and all the other excuses, in a political system where bottoms lines, numbers, and excel spreadsheets take precedence over than life safety to some, well, I'll let everyone draw their own conclusion.

Just my $.02

[16fire5 693]

You are more than welcome to drop all the union talking points you want, i respect that. I just don't buy it....sounds all too similar to the strong arm robbery that occurred in NYC in 1996.

If you reread my post I did not speak to the provision of the FD performing EMS. I just felt the need to respond to the comments you made about the department. They are a busy department and staffing is inadequete. These are not union talking points they are facts. I do not work there but have friends that do. Many others have discussed what they see as potential flaws in the proposal and the excellent service the city recieves from Mobile Life.

[Guest alsfirefighter]

Just another ploy to keep the run numbers up and justify staffing levels or contractual desires moving forward.

LOL. You're still my boy on most issues but... Can't we come up with some new material? So then what are we doing on my job? Oh that's right providing a highly regarded and respected level of care. So if we were to make a push to get ambulances on my job would I be padding the numbers? Or see that we can provide the service better and at a higher level then what is currently being delivered. Oh no that's right...never mind the fact that most often FD's do and can provide better service and give better benefits to its employees. Or should we instead still pad the pockets of agencies that lets face it are in the business to make money, hence the ever revolving door of contracts. I know who is covering the streets where I work. And the two on duty FF/Paramedics are highly experienced and well respected providers and also firefighters. I wonder who is covering my town right now...is it someone I've either worked with in the past that I respect...or one that I wouldn't even talk to. Is it the one like my job where all of us are trusted and respected by our surrounding receiving facilities staffs and MD's or the one we all talk about with lack of skills? I've worked in every system out there except PD based...so I've pretty much seen a lot of the pro's and con's. And I know companies that put people out on the streets because they have to fill their number of units for what they have contracts for. Some with people I wouldn't let carry my bags...nor even so much as trust a BP or report of lung sounds from.

Get off the FDNY system band wagon already. The ambulance system is fine and is much better then it was. As far as the BLSFR...that is a direct reflection of a management issue and even that has come a long way of the problems I've heard from all sides in it. If its run right and management right and sold right it works period. If your going to do it..you need to do it well and ensure that its being done well and that starts with management. I love how so many want to pull out the FDNY system when FD's talk about doing EMS. Lets not forget that FD's were the first ones to really start EMS particularly ALS. So if you want I'll be more then glad to actually discuss the issue outside of the little FDNY card some of you like to pull out. All one needs to do is go south and west (as usual in most proactive discussions of emergency services of all types). Los Angeles City and County. Nashville, FD's in Horry County, SC, Miami-Dade, Houston. Those are some of the larger ones...I probably couldn't even count the smaller ones like right here close to home in Arlington. (not calling you small brothers...you know what I mean to my close friends there)

So while you want to say numbers need to padded...so be it. But lets not forget some are padding pockets. So if anyone has anything fresh or a different spin to my side...bring it. I look forward to it.

And oh yeah...I'm taking one more off the table..."Why should I have to be a firefighter to be a Paramedic?"

Best answer...get over it. There are plenty of places to work that you don't have to be. I'd love to work certain areas of Westchester/Dutchess etc as a Firefighter/Paramedic that have no paid services you don't see me whining about it. And if any of you wouldn't take a job if offered as a firefighter/paramedic...compared to what most of you are making now and with retirement..you need to have your head examined..or go to a shrink to get over your fear of heights.

Game on?

Edited June 1, 2010 by alsfirefighter

[x129K 1,393]

I wish Poughkeepsie could do the same.....

...it's a tough nut to swallow..but it has to start somewhere...

[sfrd18 360]

I have to say it's a good idea, and it would definitely boost annual call volumes and may even prove itself very effective after all. Unfortunately though, I don't think it will happen.

[helicopper 1,050]

Lets not forget that FD's were the first ones to really start EMS particularly ALS.

Game on?

Game on, dude. Perhaps FD's in the south and west were ALS pioneers but in NY that's not the case. NYC was through HHC as we all remember - NYC*EMS. In other places it was actually the police who were first ALS providers:

Yonkers PD ESU (back when they were called e-rigs)

Greenburgh PD

Nassau County PD

Albany County Sheriff's Office

Guilderland PD

Tonawanda PD

to name a few... I'm sure others can add to this list also. Westchester (and most NY) FD's didn't really start getting into ALS until... ??? Who was that? Hmmm... I don't remember. Perhaps you can jog my memory!

[bad box 371]

Get off the FDNY system band wagon already. The ambulance system is fine and is much better then it was. As far as the BLSFR...that is a direct reflection of a management issue and even that has come a long way of the problems I've heard from all sides in it.

N.Y.C. E.M.S. has improved significantly since it became a part of F.D.N.Y.. I'm not sure what you mean by your comment regarding the F.D.N.Y. First Responder Program, but I do know that Firefighter First Responders save lives everyday in the City of New York. Here's a typical example:

My link

[Guest alsfirefighter]

N.Y.C. E.M.S. has improved significantly since it became a part of F.D.N.Y.. I'm not sure what you mean by your comment regarding the F.D.N.Y. First Responder Program, but I do know that Firefighter First Responders save lives everyday in the City of New York. Here's a typical example:

My link

Chris:

You always crack me up. And you are correct in this area, I'm just trying to point out that there are a lot more systems out there FD based that are some of the best in the country and those who whip out the FDNY system...I'm just a little tired of. They want to base their arguments on the hiccups and some of the issues that occurred when the system first started. Its come a long way since then and NYC EMS isn't truly a FD based system as those who are on the ambulances are not dual role personnel. Hmmmm....what FD was the first in the area to begin ALS services...I have to think about that one for a moment, lol. Oh yeah that's right...Which we're still the only ones that do.

Bad box...don't know what you were reading, but I never said it didn't save lives or that it wasn't important. I'm a proponent of tiered response as studies have shown better survival rates for out of hospital cardiac arrest and it also helps to reduce door to door time at facilities when treatments are started earlier. My point was that when the CFR system started in NYC there were those that were extremely resistant to it and there were large complaints on both sides of doing it and how it was being done..or not done. I was trying to tread lightly through some of the issues that are well known throughout both the fire and EMS professions of some of those things. There are those who are staunch EMS should be 3rd party system fist pumpers who attempt to use some of the issues that happened when FDNY absorbed HHS and the FD started their CFR-D BLSFR program. Only thing I can say is that I understand why CFR is used in the city because of logistics, money etc. But in most systems EMT is more common and to be honest I wish it was the lowest standard of care.

[ny10570 745]

FDNY is definitely not the system anyone wants to model themselves after. Its half way between fire based and 3rd party with all the pitfalls of straddling a fence.

[bad box 371]

FDNY is definitely not the system anyone wants to model themselves after. Its half way between fire based and 3rd party with all the pitfalls of straddling a fence.

F.D.N.Y. is the largest E.M.S. system in the country. The demand for service (including abuse of the service) is immense. Things can always be improved upon in any E.M.S. system, but F.D.N.Y.'s provision of emergency medical services is light years ahead of what it was prior to the merger.

[ny10570 745]

bad box, all correct. But its still way behind other systems and way behind where it should be. Improvements since HHC are a result of increased staffing and newer vehicles. There have been changes in patient care, but you can't say we're leading the way with much of anything right now.

[x635 4,066]

bad box, all correct. But its still way behind other systems and way behind where it should be

And not nearly what it was promised to be in 1996. Pay and schedule I still believe are no where near what they should be.

[bad box 371]

bad box, all correct. But its still way behind other systems and way behind where it should be. Improvements since HHC are a result of increased staffing and newer vehicles. There have been changes in patient care, but you can't say we're leading the way with much of anything right now.

Hey 10570:

I won't even try to debate with you as you are apparently working for F.D.N.Y. EMS currently and as such are up to date on what's happening. I worked for the HHC version of NYC*EMS from 1978 - 1981 at which time I left EMS and went 'on the job'. I will say though that as bad as it may seem to you, it has come a very long way over the years. When I first went on the fire department, it was still not unusual for us to transport critical trauma patients and patients requiring CPR to the nearest hospital in the back of the Battalion Chief's car (on a backboard and in a stokes) due to the fact that EMS either had 'no bus available' or no ETA. In the mid 1970's virtually every 'middle class neighborhood' started a volunteer ambulance corps. because EMS was so poorly run (It was run by two former N.Y.P.D. big shots and they ran it like the P.D. which didn't work at all). So, your job is WAY better than it used to be (the system actually saves lives now!), but I understand your frustration that it's not where you want it to be.

Stay safe.

[ny10570 745]

I don't dispute the dismal past of EMS and it has absolutely come a long way, but its still nowhere near where it should be. All the improvements have been a result of FDNY pumping more cash into the system and EMS collecting more money from its transports. More units, more and newer vehicles, more staffing and more stations. However everything wrong with EMS is still broken. The dispatch system is still horrendous, units are still sitting on street corners, there still aren't enough facilities, something as simple as cleaning the patient compartment is still done with the truck wash and bleach you were using.

[xfirefighter484x 234]

Ladies and Gents... While I do see some good discussion on this, the topic is headed WAYYYYY towards an FNDY*EMS discussion, and not talking about Newburgh, and their interest in starting an EMS Agency. I do acknowledge there is some relative information that might be gathered from that discussion, but the relevance to NFD might be a little astray.

Lets keep in mind some comparisons/differences between FDNY and Newburgh FD:

1) Demographics (is a city, some similarities, compare size of city to go along with #3 below)

2) Budget - Immensely different

3) Department size/City Size

4) Staffing levels to go along with #3 (above)

Fire Chief Michael Vatter said their early research shows the city could make $130,000—$160,000 the first year from insurance, Medicare and Medicaid payments. Those are their low-end numbers, based on the costs of renting two ambulances, hiring four paramedics and buying the necessary equipment. Vatter said they're looking for grants to buy the ambulances and could make $400,000 per year if that happened.

I am no expert in any way, shape, or form, in this area, so I was curious, by reading the article, if it is an ALS service provided by the Fire Department, how can they recoup funds in this way? Will it be an ambulance service "provided for by the FD" or will it actually be a separate agency? I guess what it comes down to is, if it was an FD run operation, how can they bill if they are provided for through taxes, isn't that double dipping??

Just looking for clarification, not pointing any fingers, or throwing any accusations around...

[Guest alsfirefighter]

Ladies and Gents... While I do see some good discussion on this, the topic is headed WAYYYYY towards an FNDY*EMS discussion, and not talking about Newburgh, and their interest in starting an EMS Agency. I do acknowledge there is some relative information that might be gathered from that discussion, but the relevance to NFD might be a little astray.

Lets keep in mind some comparisons/differences between FDNY and Newburgh FD:

1) Demographics (is a city, some similarities, compare size of city to go along with #3 below)

2) Budget - Immensely different

3) Department size/City Size

4) Staffing levels to go along with #3 (above)

I am no expert in any way, shape, or form, in this area, so I was curious, by reading the article, if it is an ALS service provided by the Fire Department, how can they recoup funds in this way? Will it be an ambulance service "provided for by the FD" or will it actually be a separate agency? I guess what it comes down to is, if it was an FD run operation, how can they bill if they are provided for through taxes, isn't that double dipping??

Just looking for clarification, not pointing any fingers, or throwing any accusations around...

There is no restriction on a municipality to bill for any service from what I understand. Fire Districts cannot bill for their services which from what I understand is due to the fact they receive tax money specifically earmarked for fire/ems. Unlike municipalities who while receiving taxes has to split every dollar into what their budget dictates.

[antiquefirelt 994]

There is no restriction on a municipality to bill for any service from what I understand. Fire Districts cannot bill for their services which from what I understand is due to the fact they receive tax money specifically earmarked for fire/ems. Unlike municipalities who while receiving taxes has to split every dollar into what their budget dictates.

While I cannot speak for NYS, I do know that we can bill any rate (EMS rates) we'd like up to the Meicare maximum for your "area band". But the reality is that the Medicare and Medicaid (or whatever state plan)only pays specific reimbursement rates. I'm going to go on a limb and say Newburgh would most likely be looking mostly at the lower Medicaid reimbursement rates which are staggerlingly lower than Medicare or most private coverages. I know in our department that runs heavy on the "Medicaid" side of runs, the total "revenue" from EMS billing doesn't even cover 33% of payroll while EMS accounts for 65% or more of the runs. That's payroll and doesn't account for the cost of soft goods or captial improvements (ambulance replacements, new monitors, stretchers, etc).

So reasons to take on EMS: Better service than current, faster response times, some return on revenue if staffing doesn't increase to cover ambulances. The reasons one should think long and hard: money is not enough to self-sustain, strains current staffing, requires much more training and ongoing training which takes time away from the current primary mission.

I have very little clue about Newburgh's particular situation, and I am a proponent of Fire Based EMS from a service delivery standpoint, but can attest to the pitfalls we face daily from running a Fire based ALS-EMS service.

Edited June 9, 2010 by antiquefirelt

[Guest alsfirefighter]

While I cannot speak for NYS, I do know that we can bill any rate (EMS rates) we'd like up to the Meicare maximum for your "area band". But the reality is that the Medicare and Medicaid (or whatever state plan)only pays specific reimbursement rates. I'm going to go on a limb and say Newburgh would most likely be looking mostly at the lower Medicaid reimbursement rates which are staggerlingly lower than Medicare or most private coverages. I know in our department that runs heavy on the "Medicaid" side of runs, the total "revenue" from EMS billing doesn't even cover 33% of payroll while EMS accounts for 65% or more of the runs. That's payroll and doesn't account for the cost of soft goods or captial improvements (ambulance replacements, new monitors, stretchers, etc).

So reasons to take on EMS: Better service than current, faster response times, some return on revenue if staffing doesn't increase to cover ambulances. The reasons one should think long and hard: money is not enough to self-sustain, strains current staffing, requires much more training and ongoing training which takes time away from the current primary mission.

I have very little clue about Newburgh's particular situation, and I am a proponent of Fire Based EMS from a service delivery standpoint, but can attest to the pitfalls we face daily from running a Fire based ALS-EMS service.

You are correct about the medicare/caid reimbursement rates and you are more then likely correct that the reimbursement rate for them would be lower then some areas. They are not a fire district hence they can do that as well as bill insurance companies which again as an urban municipality they will not have as high of percentage of return as you often deal with those whom have no insurance coverage at all.

Only question I have to ask is when you say "takes time away from the current primary mission." What exactly do you mean by primary mission? Being a fire based BLSFR and ALSFR system and all of us dual role...our primary mission is exactly that...fire and EMS and we do a good job balancing our training to include both topics in our training program in addition to the CME's needed for recert.

Which its obvious that my point is...when you do EMS as FD...one isn't a primary mission over the other. That is where some FD based systems get bad raps. Either do both well...or get out of it.

Edited June 10, 2010 by alsfirefighter

[antiquefirelt 994]

Only question I have to ask is when you say "takes time away from the current primary mission." What exactly do you mean by primary mission? Being a fire based BLSFR and ALSFR system and all of us dual role...our primary mission is exactly that...fire and EMS and we do a good job balancing our training to include both topics in our training program in addition to the CME's needed for recert.

My comment was based on my limited knowledge that Newburgh's FD does not provide any EMS at this time? If their current primary mission is firefighting, adding EMS as an equally important mission without increasing staff will reduce the time previously spent training and fighting fires. My impression is that Newburgh is economically depressed and fairly busy with fire duty? Providing EMS will with no new employees will cut down first due personnel and result in either slower response times to EMS calls when there is afire or the use of an outside EMS provider?

Like your's, my FD is clearly a true Fire/EMS service with both equally being the primary mission. But I cannot say that without EMS our firefighters wouldn't be better firefighters. On the other side, without a fire mission our personnel might be all EMS driven employees helping with some of the "I didn't sign up to be an ambulance jockey" attitudes that come out once in a while.

[16fire5 693]

There are restrictions for billing by fire departments in NYS. GML 209 prohibits it. There have been attempts in the past to change it. I was under the impression that career departments could bill for EMS. There has got to be someone who has full understanding of the rules on here

[Bnechis 3,961]

There are restrictions for billing by fire departments in NYS. GML 209 prohibits it. There have been attempts in the past to change it. I was under the impression that career departments could bill for EMS. There has got to be someone who has full understanding of the rules on here

The only restrictions that I have ever seen is that fire districts (as a direct taxing authority) can not bill for services. Technically fire departments dont bill the municipality does and that is legal. I can not find any mention of billing for service in GML 209.