Ambulance squads face volunteer shortages, work out new strategies

[ONEEYEDMIC 68]

Journal News

CROTON-ON-HUDSON — When the call for help came into the Croton ambulance squad time and again during much of this year, no one was there to respond.

As volunteer ambulance members were paged and did not respond within nine minutes, due to shortages in staffing that have taken their toll on scores of suburban communities around the region, the call was picked up by a neighboring community, in most cases the Ossining volunteer ambulance squad.

[Remember585 815]

"We give them a sense that they're doing something important, that they're appreciated," he said. In a job where volunteerism has many challenges, gratitude was an important reward.

"Say thank you — a lot," he said.

There's a novel idea...

[Guest FFD 246]

Contract with a staffing company to provide day-time (6a-6p) EMTs. You bill for each transport so you will make $ off the transports that the day-time paid staff covered. Then you have volunteers from 6p-6a.

[vtach39680 23]

Sprung hill is still in the same boat as other volunteer corps. They pay 2 crews from 0700-1900 M-F

[Goose 188]

lets explain cost effectiveness to the 50 year old male who owes his life to an LVAD because it took a bus 20 minutes to get there. Honestly, when is enough enough? How many people need to die (yes, people have DIED...don't act like you don't know) and/or suffer unnecessarily for things to change?

Edited October 11, 2011 by Goose

[ny10570 745]

lets explain cost effectiveness to the 50 year old male who owes his life to an LVAD because it took a bus 20 minutes to get there. Honestly, when is enough enough? How many people need to die (yes, people have DIED...don't act like you don't know) and/or suffer unnecessarily for things to change?

But LVADs are soo cool. Even Dick Cheney has one!

Its disturbing that change is so slow to come, but look at any industry. Substantial change comes with either great profit or after substantial loss. We need to be pushed to change. I hope that changes.

[JFLYNN 681]

Journal News

This was an excellent article on many levels. I have been involved as a concerned citizen in my town- Ossining, as well as Croton, where I have many family and friends, in pushing for improvements in EMS. I have met quite a few great people on the career as well as the volunteer side, and also elected and other community officials who are thinking progressively.

It's hard to be objective about your own organization sometimes, and I have therefore unfortunately found it necessary to go on the record with some constructive criticisms. The battle to improve EMS in my community through regionalization, paid staffing where necessary, clearer lines of authority and accountability, fiscal transparency, as well as bettter transparency in regard to response times, numbers of certified volunteers who actually respond or pull shifts, etc. continues. Many individuals have approached me anonymously (out of fear of retaliation) with serious concerns in regard to their own organization. If anyone on here has information which they feel would aid me in my efforts to have much more transparency in finances and operations of EMS agencies in the above mentioned towns, feel free to contact me.

It's all about providing the best possible service to our communities in a cost efficient (not cheap necessarily) manner. Thank you to all who labor in this oftentimes extremely underappreciated field. Please try not to read more into my comments than there really is. And please, qtip....

Oh, and the oft repeated response of "well, if you think things need improving, then volunteer yourself!" won't put me on the defensive...try to put a bit more thought into your response, thanks...

[BFD1054 1,552]

This was an excellent article on many levels. I have been involved as a concerned citizen in my town- Ossining, as well as Croton, where I have many family and friends, in pushing for improvements in EMS. I have met quite a few great people on the career as well as the volunteer side, and also elected and other community officials who are thinking progressively.

It's hard to be objective about your own organization sometimes, and I have therefore unfortunately found it necessary to go on the record with some constructive criticisms. The battle to improve EMS in my community through regionalization, paid staffing where necessary, clearer lines of authority and accountability, fiscal transparency, as well as bettter transparency in regard to response times, numbers of certified volunteers who actually respond or pull shifts, etc. continues. Many individuals have approached me anonymously (out of fear of retaliation) with serious concerns in regard to their own organization. If anyone on here has information which they feel would aid me in my efforts to have much more transparency in finances and operations of EMS agencies in the above mentioned towns, feel free to contact me.

It's all about providing the best possible service to our communities in a cost efficient (not cheap necessarily) manner. Thank you to all who labor in this oftentimes extremely underappreciated field. Please try not to read more into my comments than there really is. And please, qtip....

Oh, and the oft repeated response of "well, if you think things need improving, then volunteer yourself!" won't put me on the defensive...try to put a bit more thought into your response, thanks...

Chief,

As always, excellent post and great views. I think most of us know that you can take comments from anyone.

I must agree that it can certainly be difficult to admit to faults and shortfalls, especially in your own organization. I have been in the volunteer fire service for about 13 years and about the same in volunteer EMS. Through the years and through maturing, i have opened my eyes to some inefficiencies in the volunteer services.

There are still many volunteer fire and ems agencies that can deliver their services with professionalism and in a timely manner. However, there are many that could use improvement. The first step is admitting that you have an issue. Whether the issue be with staffing, response times or training (or all of the above), the issue needs to be addressed. When lives are at stake (which they are), ego's must be set aside and something needs to be done.

Chief, you mention Ossining VAC. From what i know of them, they seem to be one of the leading VAC's in the County and have been for years. They realized that as their community grew, there was need for better coverage. They then implemented their volunteers with career staffing. OVAC now delivers BLS and ALS coverage through use of career and volunteer staffing. I applaud OVAC, as well as others, for realizing their shortfalls and adressing the issue's.

Its obvious that there are some serious issues with EMS coverage in Westchester (and beyond). Unfortunately, many of these agencies have yet to admit to these issues and continue to "go with the flow." Its not ok to not cover your calls and its not ok to rely on mutual-aid on a regular basis.

It goes without saying that there are issues. The question is, how do we fix it? Consolodation? Career staffing? County-wide system?

[Goose 188]

Chief,

As always, excellent post and great views. I think most of us know that you can take comments from anyone.

I must agree that it can certainly be difficult to admit to faults and shortfalls, especially in your own organization. I have been in the volunteer fire service for about 13 years and about the same in volunteer EMS. Through the years and through maturing, i have opened my eyes to some inefficiencies in the volunteer services.

There are still many volunteer fire and ems agencies that can deliver their services with professionalism and in a timely manner. However, there are many that could use improvement. The first step is admitting that you have an issue. Whether the issue be with staffing, response times or training (or all of the above), the issue needs to be addressed. When lives are at stake (which they are), ego's must be set aside and something needs to be done.

Chief, you mention Ossining VAC. From what i know of them, they seem to be one of the leading VAC's in the County and have been for years. They realized that as their community grew, there was need for better coverage. They then implemented their volunteers with career staffing. OVAC now delivers BLS and ALS coverage through use of career and volunteer staffing. I applaud OVAC, as well as others, for realizing their shortfalls and adressing the issue's.

Its obvious that there are some serious issues with EMS coverage in Westchester (and beyond). Unfortunately, many of these agencies have yet to admit to these issues and continue to "go with the flow." Its not ok to not cover your calls and its not ok to rely on mutual-aid on a regular basis.

It goes without saying that there are issues. The question is, how do we fix it? Consolodation? Career staffing? County-wide system?

Honestly, a county wide system - when done properly - would fix the issue. Unfortunately, that simply is not going to happen for fiscal and political reasons. Until then (if it ever comes) i think regionalization is essential. Regionalization where there are contracted standards - response times, staffing, levels of care, etc.

The biggest issue with EMS coverage in this county is the horrendously (and really, inexcusable disparity) large disparity in the type of service it's residents have access to. You could argue that those that reside in the lower portions of the county have a better chance of surviving injury and illness because those agencies are either completely paid, combination (in such a fashion that there is always coverage) or one of the few all volunteer agencies that get actually crew up and out. You simply can't say the same for the northern most sections of this county. Yes, you get medics on every call but they get tied up on the BLS jobs and on the ALS - while we may be able to stabilize or prevent further harm with some of our interventions - definitive care is still an ireplaceable piece of the puzzle. Paramedics or other first responders shouldn't ever have to consider transport in a flycar, police car or firetruck - unfortunately, it has happened and it will continue to until the problem is solved.

Some agencies have stepped up to the plate and started to place paid EMS providers on first due ambulances during day time hours. This helps - but at 19:00 its often back to the same old nonsense.

The bottom line is that some volunteer agencies do a very good job at maintaing coverage. Those agencies know who they are, and it's fantastic that they do it with such enthusiasm. However, these agencies are becoming few and far between - relying on one member doesn't cut it and is simply not fair. For those that come out of the woodwork to pound their fists and stop their feet in an effort to snuff out any of the things Chief Flynn spoke of...well..i can only say that i hope you are never put in the situation where a lone paramedic responds to you're residence and has to employ you or someone else in you're household to assist him/her in preforming CPR or ventilating a loved one because they are on the third round of mutual aid requests and the only ones answering the dispatcher are those pesky crickets.

Edited October 12, 2011 by Goose

[helicopper 1,050]

Honestly, a county wide system - when done properly - would fix the issue. Unfortunately, that simply is not going to happen for fiscal and political reasons. Until then (if it ever comes) i think regionalization is essential. Regionalization where there are contracted standards - response times, staffing, levels of care, etc.

The biggest issue with EMS coverage in this county is the horrendously (and really, inexcusable disparity) large disparity in the type of service it's residents have access to. You could argue that those that reside in the lower portions of the county have a better chance of surviving injury and illness because those agencies are either completely paid, combination (in such a fashion that there is always coverage) or one of the few all volunteer agencies that get actually crew up and out. You simply can't say the same for the northern most sections of this county. Yes, you get medics on every call but they get tied up on the BLS jobs and on the ALS - while we may be able to stabilize or prevent further harm with some of our interventions - definitive care is still an ireplaceable piece of the puzzle. Paramedics or other first responders shouldn't ever have to consider transport in a flycar, police car or firetruck - unfortunately, it has happened and it will continue to until the problem is solved.

Some agencies have stepped up to the plate and started to place paid EMS providers on first due ambulances during day time hours. This helps - but at 19:00 its often back to the same old nonsense.

The bottom line is that some volunteer agencies do a very good job at maintaing coverage. Those agencies know who they are, and it's fantastic that they do it with such enthusiasm. However, these agencies are becoming few and far between - relying on one member doesn't cut it and is simply not fair. For those that come out of the woodwork to pound their fists and stop their feet in an effort to snuff out any of the things Chief Flynn spoke of...well..i can only say that i hope you are never put in the situation where a lone paramedic responds to you're residence and has to employ you or someone else in you're household to assist him/her in preforming CPR or ventilating a loved one because they are on the third round of mutual aid requests and the only ones answering the dispatcher are those pesky crickets.

I'm a big advocate of regionalization but not necessarily a county level/sized system. Going from 40-something EMS agencies to a single one may create an entirely new set of problems. I'm not sure if that's the answer. In the interim, how about going from 40-something to 12 or 15? That's a huge improvement without a complete loss of local identity.

There's no disputing that people in the bigger, more densely populated cities, have access to a better system than the most affluent but rural communities to the north.

We have no system and until the players realize that and make a move to change it we'll always languish with this patchwork of good, bad, and indifferent agencies providing EMS.

[Goose 188]

I'm a big advocate of regionalization but not necessarily a county level/sized system. Going from 40-something EMS agencies to a single one may create an entirely new set of problems. I'm not sure if that's the answer. In the interim, how about going from 40-something to 12 or 15? That's a huge improvement without a complete loss of local identity.

There's no disputing that people in the bigger, more densely populated cities, have access to a better system than the most affluent but rural communities to the north.

We have no system and until the players realize that and make a move to change it we'll always languish with this patchwork of good, bad, and indifferent agencies providing EMS.

No qualms there. As far as the county sized solution - it clearly works well elsewhere in the country...don't see why it couldn't (politics and money aside) work just as well here, thats all. But things are often very different in other parts of the country

[JFLYNN 681]

Chief,

As always, excellent post and great views. I think most of us know that you can take comments from anyone.

I must agree that it can certainly be difficult to admit to faults and shortfalls, especially in your own organization. I have been in the volunteer fire service for about 13 years and about the same in volunteer EMS. Through the years and through maturing, i have opened my eyes to some inefficiencies in the volunteer services.

There are still many volunteer fire and ems agencies that can deliver their services with professionalism and in a timely manner. However, there are many that could use improvement. The first step is admitting that you have an issue. Whether the issue be with staffing, response times or training (or all of the above), the issue needs to be addressed. When lives are at stake (which they are), ego's must be set aside and something needs to be done.

Chief, you mention Ossining VAC. From what i know of them, they seem to be one of the leading VAC's in the County and have been for years. They realized that as their community grew, there was need for better coverage. They then implemented their volunteers with career staffing. OVAC now delivers BLS and ALS coverage through use of career and volunteer staffing. I applaud OVAC, as well as others, for realizing their shortfalls and adressing the issue's.

Its obvious that there are some serious issues with EMS coverage in Westchester (and beyond). Unfortunately, many of these agencies have yet to admit to these issues and continue to "go with the flow." Its not ok to not cover your calls and its not ok to rely on mutual-aid on a regular basis.

It goes without saying that there are issues. The question is, how do we fix it? Consolodation? Career staffing? County-wide system?

Thanks. You mentioned OVAC. Is there anyone on here who has approximate statistics as to the number of ALS as well as BLS shifts which are being fillled by volunteer vs. career personnel at OVAC?

[JFLYNN 681]

I'm a big advocate of regionalization but not necessarily a county level/sized system. Going from 40-something EMS agencies to a single one may create an entirely new set of problems. I'm not sure if that's the answer. In the interim, how about going from 40-something to 12 or 15? That's a huge improvement without a complete loss of local identity.

There's no disputing that people in the bigger, more densely populated cities, have access to a better system than the most affluent but rural communities to the north.

We have no system and until the players realize that and make a move to change it we'll always languish with this patchwork of good, bad, and indifferent agencies providing EMS.

Thanks Chris. What I have been wondering is...where are the true leaders in EMS in Westchester in regard to this issue? There were some insightful comments elicited from some credible authorities in the Journal News article. Why are these EMS professionals not doing more to educate the public as well as elected leaders and other governmental leaders in regard to the EMS crisis in much of the Hudson Valley? Yes, there is no system, despite individuals holding titles and leadership positions in regional EMS which would seem to indicate that there is a system.

I'm just a dumb fireman but it appears obvious that if some of these people with leadership positions in regional EMS organizations were to identify the problems and propose solutions such as true consolidations and regionalization in certain areas (certainly not an entire County, but rather communities encompassing several towns and / or villages depending on geography, call volume, effectiveness of existing organizations as well as other factors that a stupid firefighta like me can't even imagine), then positive changes would come quickly, lives would be saved, and needless suffering would be averted?

No???

[Bnechis 3,961]

Thanks Chris. What I have been wondering is...where are the true leaders in EMS in Westchester in regard to this issue? There were some insightful comments elicited from some credible authorities in the Journal News article. Why are these EMS professionals not doing more to educate the public as well as elected leaders and other governmental leaders in regard to the EMS crisis in much of the Hudson Valley? Yes, there is no system, despite individuals holding titles and leadership positions in regional EMS which would seem to indicate that there is a system.

I'm just a dumb fireman but it appears obvious that if some of these people with leadership positions in regional EMS organizations were to identify the problems and propose solutions such as true consolidations and regionalization in certain areas (certainly not an entire County, but rather communities encompassing several towns and / or villages depending on geography, call volume, effectiveness of existing organizations as well as other factors that a stupid firefighta like me can't even imagine), then positive changes would come quickly, lives would be saved, and needless suffering would be averted?

No???

Great thoughts Chief. You brought up a couple of different issues;

1) teaching the public about EMS. The Regional council is made up of 30 "volunteers" representing all facits of EMS. None are paid to participate on the council (unless paid by their agency). For example YFD has a rep on the council and I'm sure he is paid by YFD. The council has a great many legal mandates it must delivere and while teaching the public, they try to do some things, but as you know the public pays very little attention to FD, PD or EMS, until they are dialing 911.

2) the politicians. The council has made many attempts to involve the politicians and educate them. Most do not want to know, "its the VAC, the Fire Districts problem, the commercial contractor, etc."

3) identifying the problem: The regional council has, over and over identified the problem, the real issue is the way EMS is set up, they have no authority to change it.

Each EMS agency is required to have a CON (certificate of need) which is issued by the NYS Health Dept. Without one it is illegal to operate. and they are issued for very specific communities, I.e. the village of "X" or the Fire District of "Y" or even a list of the following sections of a community. For Example, at one time (I do not know if they still have it) Eastchester VAC's CON included the Bronxville P.O. in Yonkers.

The region has no say in revoking a con. So if EMS Dept. "A" takes 60 minutes to respond on every call and the region reports it to the DOH, the DOH's only actions are: ignor it or take the CON away. I have yet to see them take it away unless a law was broken. So even with the best leadership at the region, if they find a problem and the agency does not care to address it, not a lot that they can do.

[helicopper 1,050]

Great thoughts Chief. You brought up a couple of different issues;

1) teaching the public about EMS. The Regional council is made up of 30 "volunteers" representing all facits of EMS. None are paid to participate on the council (unless paid by their agency). For example YFD has a rep on the council and I'm sure he is paid by YFD. The council has a great many legal mandates it must delivere and while teaching the public, they try to do some things, but as you know the public pays very little attention to FD, PD or EMS, until they are dialing 911.

2) the politicians. The council has made many attempts to involve the politicians and educate them. Most do not want to know, "its the VAC, the Fire Districts problem, the commercial contractor, etc."

3) identifying the problem: The regional council has, over and over identified the problem, the real issue is the way EMS is set up, they have no authority to change it.

Each EMS agency is required to have a CON (certificate of need) which is issued by the NYS Health Dept. Without one it is illegal to operate. and they are issued for very specific communities, I.e. the village of "X" or the Fire District of "Y" or even a list of the following sections of a community. For Example, at one time (I do not know if they still have it) Eastchester VAC's CON included the Bronxville P.O. in Yonkers.

The region has no say in revoking a con. So if EMS Dept. "A" takes 60 minutes to respond on every call and the region reports it to the DOH, the DOH's only actions are: ignor it or take the CON away. I have yet to see them take it away unless a law was broken. So even with the best leadership at the region, if they find a problem and the agency does not care to address it, not a lot that they can do.

The Regional Councils and Medical Advisory Committees (MAC) do have some statutory authority and the ability to be the impetus for change - if they're not obstructed in their efforts. 15-20 years ago, when Westchester was still part of the Hudson Valley Regional EMS Council, the Westchester delegation (and others) sought to have a response time standard adopted for all EMS calls. The responders and even some council members fought the effort and ultimately succeeded in preventing its passage. Had it been successful and implemented back in 1991 (or thereabouts), we would have had a response time requirement for 20 years that would (in my opinion) resulted in radical changes to the EMS system we have today. Some agencies would have had to change to meet this standard and we might have a more comprehensive effective system than we do.

I also remember battles royale over the training curricula and strenuous opposition to efforts to raise the bar for CFR, EMT, and advanced EMT courses - all because it would "be hard for the volunteers to meet it". So, we were stuck with the bare minimum and now 20 years later we still face the same problem with volunteers not being able or willing to meet the standards.

Jon Politis, career EMS educator and administrator from upstate NY, said it best and I'll paraphrase him. "EMS has long-term problems but short-term leaders". This is true of the fire service as well. It is very hard to be the impetus for change when you have one year to learn the job and one year to do the job before you're "voted out" to make room for the next up and comer. It's also hard to be the guy advocating change that may be unpopular when elected in a popular vote.

Change will have to come from within but it is a challenge to sway the majority from the comfortable status quo regardless of how ineffecient it is.

[Bnechis 3,961]

The Regional Councils and Medical Advisory Committees (MAC) do have some statutory authority and the ability to be the impetus for change - if they're not obstructed in their efforts.

Yes the regional councils have some statutory authority and they can set response standards. However if an agency is anable or unwilling to meet the standard, the council has no authority or ability to force any change. Most of the agencies that meet the national standards already participate with the council. Those that do not tend to be locked in there own little world and do not acknowledge the coucil or the fact that it takes them 30+ minutes to get on the road.

The REMAC on the other hand has much more statutory authority, however they believe its only in relation to ALS. We have tried to broaden this to include epi & albuterol. In the last few months this is slowly changing. I have found that the REMAC is slow to inact any policy change that did not come from a physician, so if they do not see a problem that we clearly point out to them, then nothing happens. In addition all policy changes by REMAC must be approved by the SMAC (state Mac). Which do to state budget only meets 3 times per year (this year only twice, do to Irene).

You know it has been proposed many times and I would love to see it mandated, but without the authority to force it, how do you get agencies that are so backward that they can't even consider that 30+ minutes for a cardiac call is a problem.

Suffolk county mandated a response time policy (for getting on the road). THe difference is they control the 911 system and the dispatch and basicly they said they would automaticlly cancel and send MA. The EMS coordinator recieved multiple death threats and Suffolk PD had to provide 24hr protection. They ended up dropping the policy as non of the depts would accept it.