Two Steps Forward, One Step Back

[JohnnyOV 2]

With all due respect to the good intentions of the Regional EMS Council, a 3 three minute response time for volunteer agencies is just not reasonable.

With all due respect to you as well, but I'm sorry, if you cannot adequatly staff and respond in a timely manor you're playing with people's lives. Your community is trusting you to get out and respond in a quick and timely manor. 3 minutes sounds very resonable to me, regardless of the type of call.

[Bnechis 3,961]

I believe that the Medical Advisory Committee for the Regional Council has finally taken steps to mandate that any EMS agency must be "in the ambulance" responding within three (3) minutes of a 911 call being received.

With all due respect to the good intentions of the Regional EMS Council, a 3 three minute response time for volunteer agencies is just not reasonable.

The nation standard for turnout time is 1 minute regardless of the pay status of the responders. Here they are talking about making a local requierment that is substandard to the national standard. The national response standard is BLS in 4 minutes (drive time) and ALS in 8 minutes, both with 1 min for call processing and 1 minute for "turnout time".

Is it reasonable that someones grandparent having chest pain, or a spouse having been struck by a vehicle or someones child with an ubstructed airway can get a timely EMS response?

There are many ways to provide EMS to ones community and in every case the local EMS agency has an obligation to provide a response that meets what the courts say are "reasonable standards".

[SRS131EMTFF 471]

The nation standard for turnout time is 1 minute regardless of the pay status of the responders. Here they are talking about making a local requierment that is substandard to the national standard. The national response standard is BLS in 4 minutes (drive time) and ALS in 8 minutes, both with 1 min for call processing and 1 minute for "turnout time".

Is it reasonable that someones grandparent having chest pain, or a spouse having been struck by a vehicle or someones child with an ubstructed airway can get a timely EMS response?

There are many ways to provide EMS to ones community and in every case the local EMS agency has an obligation to provide a response that meets what the courts say are "reasonable standards".

Outside of any urban center who can actually meet that standard? Does that include any traffic? How much would it cost to meet that standard? Considering the size of the areas covered and the amount of EMS calls vs Fire calls, it would seem like that would cost more than any fire regionalization plans. Im sitting here in my HQ with 2 full 4 person ALS crews and even we cant make that just based on the service area we cover. It is neither cost effective nor practical to have that many EMS units in service.

It seems like that would require more EMS units than fire units, and when we look at the busiest EMS system in the country, they have half as many fire units as ems units and 2/3rds less EMTs/Medics than FFs, yet there are 1.5 millions EMS calls annually in NYC, verse the 300,000 some fire calls.

Uniformed Fire - 10,849

Uniformed EMS - 3,399

Engines 198

Trucks 143

EMS Units: 234 (Morning and Evening) 146 (Overnight)

Edited May 1, 2011 by bvfdjc316

[helicopper 1,050]

With all due respect to the good intentions of the Regional EMS Council, a 3 three minute response time for volunteer agencies is just not reasonable.

What is not reasonable is that we think the application of standards to volunteers is well intentioned and not absolutely essential. Turnout time is a part of overall response times and we never consider that when assessing how well our EMS systems deliver their service. We just let them tell us that their response times are 4 minutes (or whatever) but that's driving time and may actually be 19 minutes if it took them 15 minutes to get the ambulance on the road. In the meantime one of their constituents is waiting, perhaps deteriorating and that is what is not reasonable.

It is 2011 and we have to stop doing things the way we did in 1981. Rostered, in-house crews are one possible solution and I'm sure there are many more.

It is absolutely appropriate for the REMAC and REMSCO to adopt (and enforce) such a standard. If an agency can't meet the standard it's time for them to start thinking about how to better provide service.

[Danger 160]

Engines 198

Trucks 143

EMS Units: 234 (Morning and Evening) 146 (Overnight)

Apples and oranges when you factor in crew size and manpower needs. The average EMS call gets 1 unit, the average fire call gets at least 5.

[SRS131EMTFF 471]

Apples and oranges when you factor in crew size and manpower needs. The average EMS call gets 1 unit, the average fire call gets at least 5.

very true, but the way the standard appears to be written you need more fire units than EMS units because the EMS units all need to be 5 minutes from each other regardless of distance, traffic, call volume etc...

with fire units, the first unit has a time factor associated but all additionally units can come from farther, this is not the case for the sole EMS unit you mentioned who must be there in 5 minutes; the fourth due pumper, while needing to get there ASAP does not have the same standard applied to it.

Edited May 1, 2011 by bvfdjc316

[Danger 160]

With all due respect to the good intentions of the Regional EMS Council, a 3 three minute response time for volunteer agencies is just not reasonable.

I just can't understand how people can continue to think that just because they are volunteer they deserve special treatment. As if cardiac arrest and fire spread decide to stop the clock to give you time to go through three dispatches and 5 minutes to drive from home to get the rig. Three minute response time is very reasonable if you sit in the building that the big red trucks and big white boxes are in, I know this because I do this. Maybe the local VAC should. Maybe if the VAC guys don't wanna do this, they should consolidate with the other 13 VACs in town or hire people.

Edited May 1, 2011 by Danger

[helicopper 1,050]

Outside of any urban center who can actually meet that standard? Does that include any traffic? How much would it cost to meet that standard? Considering the size of the areas covered and the amount of EMS calls vs Fire calls, it would seem like that would cost more than any fire regionalization plans. Im sitting here in my HQ with 2 full 4 person ALS crews and even we cant make that just based on the service area we cover. It is neither cost effective nor practical to have that many EMS units in service.

It seems like that would require more EMS units than fire units, and when we look at the busiest EMS system in the country, they have half as many fire units as ems units and 2/3rds less EMTs/Medics than FFs, yet there are 1.5 millions EMS calls annually in NYC, verse the 300,000 some fire calls.

Uniformed Fire - 10,849

Uniformed EMS - 3,399

Engines 198

Trucks 143

EMS Units: 234 (Morning and Evening) 146 (Overnight)

You're sitting there with full crews and can't get out the door in three minutes? This is not a response time requirement, it's a turnout time requirement. It means that the ambulance has to be on the road within three minutes. Unless you roll over and hit the snooze button when the call comes in if you're staffed in-house you can make that.

You're spewing statistics that have absolutely no bearing on the discussion. Every call in NYC already meets the one minute turnout requirement (unless there's a backlog and that's a different discussion) because the ambulances are staffed and on the road 24/7.

Westchester is considering the adoption of a a three minute turnout requirement. I think that should be met or agencies should change to pizza delivery where you have 30 minutes.

[helicopper 1,050]

very true, but the way the standard appears to be written you need more fire units than EMS units because the EMS units all need to be 5 minutes from each other regardless of distance, traffic, call volume etc...

with fire units, the first unit has a time factor associated but all additionally units can come from farther, this is not the case for the sole EMS unit you mentioned who must be there in 5 minutes; the fourth due pumper, while needing to get there ASAP does not have the same standard applied to it.

Wrong. The fourth due engine still has to turnout in 1 minute.

[Bnechis 3,961]

Outside of any urban center who can actually meet that standard?

Most urban and suburban areas that have rostered or onduty crews do. Thats covering 90% of the population of the country.

Does that include any traffic?

No, because the standard is based on the medical needs of a patient. The standard is intended to make agencies plan how best to deal with issues like traffic.

How much would it cost to meet that standard?

Depends on how it is set up. I know many communities that do it and it costs nothing more than what they are spending right now. Whats the cost to not providing that level of care?

Im sitting here in my HQ with 2 full 4 person ALS crews and even we cant make that just based on the service area we cover. It is neither cost effective nor practical to have that many EMS units in service.

Very few places have the luxury of two 4 person ALS crews.

It seems like that would require more EMS units than fire units, and when we look at the busiest EMS system in the country, they have half as many fire units as ems units and 2/3rds less EMTs/Medics than FFs, yet there are 1.5 millions EMS calls annually in NYC, verse the 300,000 some fire calls.

So NYC has 1/2 the fire units as EMS and Westchester every town has 2-4 times more fire apparatus than EMS units, often in the same dept. Maybe thats part of the problem.

very true, but the way the standard appears to be written you need more fire units than EMS units because the EMS units all need to be 5 minutes from each other regardless of distance, traffic, call volume etc...with fire units, the first unit has a time factor associated but all additionally units can come from farther, this is not the case for the sole EMS unit you mentioned who must be there in 5 minutes; the fourth due pumper, while needing to get there ASAP does not have the same standard applied to it.

Ok Lets look at a comparison of EMS response standards and fire response standards:

EMS:

BLS unit onscene in 4 minutes (90% of the time) not including 1 minute turn out and 1 minute call processing.

ALS unit onscene in 8 minutes (90% of the time) not including 1 minute turn out and 1 minute call processing.

Note: only 1 unit needs to be transport capable and if ALS covers the 4 minute, then BLS must arrive in 8 min.

Fire:

1st Due Engine onscene in 4 minutes (90% of the time) not including 1 minute turn out and 1 minute call processing.

Balance of 1st alarm assignment (minimum 2 engines, 1 ladder or service co. and IC. Minumim of 13-16 responders) onscene in 8 minutes (90% of the time) not including 1 minute turn out and 1 minute call processing.

[SRS131EMTFF 471]

You're sitting there with full crews and can't get out the door in three minutes? This is not a response time requirement, it's a turnout time requirement. It means that the ambulance has to be on the road within three minutes. Unless you roll over and hit the snooze button when the call comes in if you're staffed in-house you can make that.

You're spewing statistics that have absolutely no bearing on the discussion. Every call in NYC already meets the one minute turnout requirement (unless there's a backlog and that's a different discussion) because the ambulances are staffed and on the road 24/7.

Westchester is considering the adoption of a a three minute turnout requirement. I think that should be met or agencies should change to pizza delivery where you have 30 minutes.

Snooze-button...hahaha thats a good joke, between calls, training, community interaction and crew responsibilities I barely have time for nap let alone the time to hit the snooze button. Once we get a call, our average for responding is 26.7 seconds 7a-7p and 49.1 7p-7a for A-1, if A-2 is needed, it is an average of 10 seconds behind A-1.

I was not aware that turn around time referred to the time from dispatch to responding, I was under the impression that turn around time was from responding to a call to being available in-service again.

It was mentioned that there is a "...national response standard is BLS in 4 minutes (drive time)..." My comments were questioning how that is even obtainable without massive investments in EMS. I have spent 4 minutes pulled off to the side of the road in NYC waiting for an ambulance move half a block so how does the busiest EMS agency in the world meet the national standard. Is it with the CFR engines, or do they ignore the standard? That is where the statistics came from, its merely to high-light the scope of the FDNY EMS system in hopes it can be compared to someone else's and illuminate how these standards are meet in different environments.

Edited May 1, 2011 by bvfdjc316

[helicopper 1,050]

Snooze-button...hahaha thats a good joke, between calls, training, community interaction and crew responsibilities I barely have time for nap let alone the time to hit the snooze button. Once we get a call, our average for responding is 26.7 seconds 7a-7p and 49.1 7p-7a for A-1, if A-2 is needed, it is an average of 10 seconds behind A-1.

I was not aware that turn around time referred to the time from dispatch to responding, I was under the impression that turn around time was from responding to a call to being available in-service again.

It was mentioned that there is a "...national response standard is BLS in 4 minutes (drive time)..." My comments were questioning how that is even obtainable without massive investments in EMS. I have spent 4 minutes pulled off to the side of the road in NYC waiting for an ambulance move half a block so how does the busiest EMS agency in the world meet the national standard. Is it with the CFR engines, or do they ignore the standard? That is where the statistics came from, its merely to high-light the scope of the FDNY EMS system in hopes it can be compared to someone else's and illuminate how these standards are meet in different environments.

You're right - turn around time is the time to clear a call and be available again.

Turnout time is the time it takes to put down the TV remote, put your shoes back on, move to the ambulance, and get moving.

That your ageny does that in 26.7 seconds shows that you're meeting the national standard, not Westchester's watered down version.

[Bnechis 3,961]

Snooze-button...hahaha thats a good joke,

Snooze button...I thought Chris calls it an Oberlander button.........184 clairmont.......10-4K

so how does the busiest EMS agency in the world meet the national standard. Is it with the CFR engines, or do they ignore the standard?

They don't, but they pay a lot of attention to it and are always working on it. And yes CFR engines count.

[SRS131EMTFF 471]

You're right - turn around time is the time to clear a call and be available again.

Turnout time is the time it takes to put down the TV remote, put your shoes back on, move to the ambulance, and get moving.

That your ageny does that in 26.7 seconds shows that you're meeting the national standard, not Westchester's watered down version.

Oh I see, I confused the terms, my mistake. I wish we in Westchester were meeting this standard as well. Unfortunately I had to go 300 miles away to find an EMS system that put as much emphasis on response times and standards as they do community service and awards.

[helicopper 1,050]

Here is the actual policy from the Westchester REMSCO website.

If you watch the January 27, 2011 webcast of their meeting, you can hear the discussion and background on this policy and the evolution of QI/QC programs. The relevant discourse starts around the 39:00 minute mark (approximately).

LInk to WREMSCO webcasts

REMSCO Policy-11-02-EMS System Resource Utilization-8-Feb-2011.pdf

[ny10570 745]

I believe Capt Nechis was quoting AHA's guideline for AED capable care within 4 minutes and ALS within 8. NYC is very close to meeting that standard. Since its an AHA standard and it specifically refers to AED capable units I'm going to help our numbers and just refer to our cardiac arrest/choke numbers. At 4:10 for the first EMS or CFR we're extremely close and may actually be there if we chopped our longest %10 from the equation. Manhattan and queens traditionally have the longest response times and last month ALS was averaging just shy of 7 minutes for all call types in Manhattan. The point of all this babble, bvfdjc, NYC is almost there.

As for Westchester, are they planning to stop the clock at the first responding unit (ie: medic fly car or engine) or will the 4 minutes apply to all responding units?? Its an important difference. The difference between status quo and real change.

[Monty 35]

It was mentioned that there is a "...national response standard is BLS in 4 minutes (drive time)..." My comments were questioning how that is even obtainable without massive investments in EMS. I have spent 4 minutes pulled off to the side of the road in NYC waiting for an ambulance move half a block so how does the busiest EMS agency in the world meet the national standard. Is it with the CFR engines, or do they ignore the standard? That is where the statistics came from, its merely to high-light the scope of the FDNY EMS system in hopes it can be compared to someone else's and illuminate how these standards are meet in different environments.

Interesting story on the firegeezer blog about Kansas City ambulance response

When life-threatening medical emergencies strike in Kansas City, the Fire Department’s ambulances are supposed to get to the scene in nine minutes or less at least 90 percent of the time.

The Fire Department has failed in every three-month period since the takeover to meet the council’s response requirement citywide. In fact, the department hasn’t yet reached the mandated response time citywide in any single month

So far, the City Council has largely ignored the Fire Department’s inability to meet the response standard required in 2010.

That’s unacceptable. The International Association of Firefighters and the American Heart Association are among groups that promote the common-sense importance of establishing and meeting standards to save patients’ lives.

The Kansas City Fire Department also does not meet the National Fire Protection Association Standard 1710. It essentially establishes an eight-minute response time by fire-based ambulances to 90 percent of life-threatening incidents.

A laudable goal - but how realistic is this? I don't think any more can be done for less - or even the same. How much are people willing to pay to achieve this level of care?

[SRS131EMTFF 471]

I believe Capt Nechis was quoting AHA's guideline for AED capable care within 4 minutes and ALS within 8. NYC is very close to meeting that standard. Since its an AHA standard and it specifically refers to AED capable units I'm going to help our numbers and just refer to our cardiac arrest/choke numbers. At 4:10 for the first EMS or CFR we're extremely close and may actually be there if we chopped our longest %10 from the equation. Manhattan and queens traditionally have the longest response times and last month ALS was averaging just shy of 7 minutes for all call types in Manhattan. The point of all this babble, bvfdjc, NYC is almost there.

As for Westchester, are they planning to stop the clock at the first responding unit (ie: medic fly car or engine) or will the 4 minutes apply to all responding units?? Its an important difference. The difference between status quo and real change.

So essentially, that means that any responder with an AED in the trunk of their car, once they arrive on scene that stops the clock? Because that is how it makes it sound. If that is the case then many places are most likely meeting that standard if their PD has an AED and responds to EMS calls.

[Bnechis 3,961]

So essentially, that means that any responder with an AED in the trunk of their car, once they arrive on scene that stops the clock? Because that is how it makes it sound. If that is the case then many places are most likely meeting that standard if their PD has an AED and responds to EMS calls.

That only stops the BLS clock. an ambulance and ALS unit still must be there in 8 min and the new Westchester one says the amb. must be on the road in 3 min.

[ny10570 745]

AED and good CPR are the only interventions proven to improve ROSC and the most effective at improving survival to discharge. A cop with a Defib is good enough for the BLS clock.

[helicopper 1,050]

AED and good CPR are the only interventions proven to improve ROSC and the most effective at improving survival to discharge. A cop with a Defib is good enough for the BLS clock.

IF the call is a cardiac arrest. What percentage of all calls is that?

How does the cop (or FF) with an AED benefit the APE or stroke patient? We can't base our system standards on a single call type. We need to be proactive and meet legitimate response time standards for ALL calls.

[M' Ave 1,466]

I highly disagree with you posting the department's name for starters. Second what agency are you in let's see how good you guys are. Everyone has issues there is atleast one dept in that same area that's worse than the one you listed, but everyone has issues no one can be as perfect as your agency.

I'm a little late to the party here, but I read this at the beginning of the thread and I need to call this out.

Why is posting a dept's name such a problem? What is heard over the radio is available to anyone. We're not in the business of keeping secrets here, we're in the business of saving people's lives (or at the very least, being there quickly when they call).

Going after someone's agency because they mentioned a manpower shortage of another is a really short-sighted move. I've heard dept's paging for manpower over and over again without a timely response. This is not acceptable. Some departments are manned well and others are not. Those that cannot field a crew in a respectable amount of time (to me this is less than 4 minutes) do not have the capability to act as emergency response agencies. Even if you can get a crew together MOST of the time, that's not good enough. Calling 911 should never be a crap shoot.

Consolidation Consolidation Consolidation!!!

[ny10570 745]

Because only absence of respirations and circulation will absolutely result in brain damage and likely death within the 8 minutes it takes ALS to get there. Absolutely 15, 30, or 60 minutes waiting for transport is obscene. Sadly another standard directly related to transport response times is needed locally and I'm sure in other areas. However BLS care within 4 minutes and ALS care within 8 will provide the care required to keep people alive to arrive at definitive care.

CVA's currently have 3 hrs from onset for TPA administration. Studies on direct administration via catheter are showing greater than 6 hr effective windows and general TPA administration has enough promise where some hospital shave expanded their onset window to 4 hours.

STEMIs guidelines currently shoot for 40 minutes from ER arrival to catheter, 90 minutes for transport, and 15 minutes for EMS on scene time. All this is without a definitive answer as to how long is too long.

Asthma, APE, anaphylaxis, and lethal cardiac arrhythmia while all necessitating timely transport benefit more from having that oxygen and a BVM standing by in 4 minutes and a medic on scene in 8 minutes rather than an ambulance on scene in 4 minutes and the ER 10 minutes away.