45 Medics - Are 3 enough?

[firedude 985]

This week may be a bad example with the storm but it seams that they are constantly running low on medics. They cover a huge part of the county (Coverage map bellow), with increasing call volumes. I know they may put a Medic-4 in service, but only on certain occasions. They even go mutual aid, like they did with Vista today, when a Norwalk Medic was not available. They do a great job, but is 3 enough?

Just looking for you thoughts

Westchester EMS

45-Meidc Coverage Area - Courtesy of Westchester EMS

Edited November 1, 2011 by firedude

[INIT915 1,119]

In a word, no. And that's more a function of sheer geographical area then anything else.

[prucha25 76]

the 45 medics I believe are supplemented by the westchester ems ALS units, depending on their availability at the time. A few people on here work for WEMS as medics and could probably answer better then me though.

[PFDRes47cue 653]

All I know is that the WEMS 45-Medics do an incredible job covering the large area that they are responsible for. I do not work with them 45-Medics often, but when I do, they are professional, competent and a pleasure to deal with. Keep up the great work!

[x635 4,066]

In a word, no. And that's more a function of sheer geographical area then anything else.

Westchester EMS has no affiliation with the County Of Westchester. They are owned by Stellaris Health, a cooperative owned by Northern Westchester Hospital, Phelps, White Plains, and Lawrence Hospitals. (which is why the lettering is on the side of their ambulances.)

45-M-1: Mount Kisco (HQ) opposite Holiday Inn

45-M-2: Somers Lincolndale Firehouse

45-M-3: Lewisboro VAC

WEMS runs a transport ambulance, or if a supervisor is on duty, they can run as 45-M-4.

When one medic goes out, the other two are mobile and repostioned. As long as 60 Control EMD's each call, the first responders get there with an AED and solid CPR, that makes a HUGE difference.

The call volume isn't there, and the municipality's don't even want to pay for ALS in the first place. Often,the Medics arrive before or with the first responders.

Plus, with solid BLS and competent EMT's, they can do a proper patient assesment and cancel ALS.

Also, as a rule of thumb, Norwalk is sometimes closer and will send an ambulance to Vista IF available (Vista actually used to be in CT)

[SRS131EMTFF 471]

In 6 years I have never had to wait longer than a minute or two for a 45-Medic and more than half the time they beat me there.

Not once have I had a Mutual Aid medic called to a single call I have been on nor have I heard of many calls requiring mutual aid medics unless the call is in a far out part of their district or involving multiple serious injuries.

Unless I am missing something, 9 days out of 10 it seems that 3 medics can handle the volume, especially when patient care can transfered to competent BLS staff when no ALS is required, as it usually is not.

Edited November 1, 2011 by SRS131EMTFF

[INIT915 1,119]

Westchester EMS has no affiliation with the County Of Westchester. They are owned by Stellaris Health, a cooperative owned by Northern Westchester Hospital, Phelps, White Plains, and Lawrence Hospitals. (which is why the lettering is on the side of their ambulances.)

45-M-1: Mount Kisco (HQ) opposite Holiday Inn

45-M-2: Somers Lincolndale Firehouse

45-M-3: Lewisboro VAC

WEMS runs a transport ambulance, or if a supervisor is on duty, they can run as 45-M-4.

When one medic goes out, the other two are mobile and repostioned. As long as 60 Control EMD's each call, the first responders get there with an AED and solid CPR, that makes a HUGE difference.

The call volume isn't there, and the municipality's don't even want to pay for ALS in the first place. Often,the Medics arrive before or with the first responders.

Plus, with solid BLS and competent EMT's, they can do a proper patient assesment and cancel ALS.

Also, as a rule of thumb, Norwalk is sometimes closer and will send an ambulance to Vista IF available (Vista actually used to be in CT)

No, I'm aware of who operates WEMS. As I mentioned, call volume is not the issue as much as geographic accessibility to some of the outlying areas of Northeast Westchester. It has nothing to do with the dedication or work ethic of the Medics, it's just a product of the vast area covered. Many areas without straight-shot response routes. The coverage area is in the neighborhood of 200 square miles, and again, many areas accessible by travel on local roads for a considerable period of time. Splitting it up into four or five sectors would be fantastic if resources allowed.

Edited November 1, 2011 by INIT915

[mikeinet 37]

Maybe my geography is off... but isn't Norwalk a bit of a distance from Vista?

I would think that maybe something like a medic from wilton would be closer (which is actually still a norwalk medic..)

[Jybehofd 85]

we need another medic out there during the day. it gets busy and with the fly car being left at the scene it really hurts the system alot.. it can take a medic out for up to 3 hours until they are back in the system again. yes there are days when its slow and nothing is going on. Usually medic 4 is one of the ALS transport ambulances that isn't busy running down to the city with a patient.

[Bnechis 3,961]

Also, as a rule of thumb, Norwalk is sometimes closer and will send an ambulance to Vista IF available (Vista actually used to be in CT)

The line between Westchester (NYS) & Conn was established by the King of England. Vista, being in Westchester never "used to be in CT". However, Vista fire district may have or still have areas in CT that it covers (similar to Banksville).

[mikeinet 37]

we need another medic out there during the day. it gets busy and with the fly car being left at the scene it really hurts the system alot.. it can take a medic out for up to 3 hours until they are back in the system again. yes there are days when its slow and nothing is going on. Usually medic 4 is one of the ALS transport ambulances that isn't busy running down to the city with a patient.

One option would be to NOT leave the flycar on scene... I've riden with a handful of depts that require the EMT to take the fly car while the medic is in the ambulance to allow a faster return to service, especially if it's a shared medic.

[Stench60 29]

"The line between Westchester (NYS) & Conn was established by the King of England. Vista, being in Westchester never "used to be in CT". "

Actually Barry until 1700 The Towns of Rye (Port Chester, Rye Brook, Rye Neck, and all of Modern Harrison) and Bedford were Towns in the County of Fairfeild CT. Modern day Harrison was stripped from Rye and the "purchase" of Mr. Harrison, a man conected to the royal governor, was a way of repaying the "rebellious" efforts of the people of Rye to remain in Connecticut including their appeal to William III.

Edited November 1, 2011 by Stench60

[Ga-Lin 86]

As I understand it, the original proposal included 4 medic units. Mt. Pleasant pulled out & the remainding muncipalities did not want to pony-up for the lost $ opting instead for allowing a longer response time. What should be discussed is Ambu availability. Most of the time, mainly during the daytime Hrs., the medic units arrive well before any local resources & then must sometimes wait while a crew is found from somewhere. Usually this is not a problem for the "HOT" jobs like confirmed rollovers & severe trauma or cardiac arrests, but its incrediblly hard to get people to respond for the average "sick" call, or injury secondary to a fall. This is & will continue to be a universal problem in all communities that are served by volunteer agencies.(no I am not bashing the volunteers)

Edited November 1, 2011 by Ga-Lin

[medic929 0]

As a former WEMS medic I remember times that I would be dispatched to calls in Vista and Pound rRdge and when I arrive at the seen they would of left the scene and forget to cancell the medic or it was a BLS call and they just wanted additional help or an evaluation. Good BLS is the first line. 3 medics is enough in the area

[ny10570 745]

Three medics is not enough. If it were, the ALS transport or supervisors wouldn't be a a regular supplement to the system.

A few years ago there was a push to add a 4th medic. I don't remember if WEMS or the municipalities initiated it, but when it came time to cough up the dough the communities didn't want to pay.

[Jybehofd 85]

instead they bought new equipment for the flycars

Three medics is not enough. If it were, the ALS transport or supervisors wouldn't be a a regular supplement to the system.

A few years ago there was a push to add a 4th medic. I don't remember if WEMS or the municipalities initiated it, but when it came time to cough up the dough the communities didn't want to pay.

[Ga-Lin 86]

As a former WEMS medic I remember times that I would be dispatched to calls in Vista and Pound rRdge and when I arrive at the seen they would of left the scene and forget to cancell the medic or it was a BLS call and they just wanted additional help or an evaluation. Good BLS is the first line. 3 medics is enough in the area

3 medics might be good on paper except for other traffic on the road esp. during the morning & eve. commutes. And lets face it we all know that there are some really stupid people out there. The real issue is when one unit goes out. Then, you are really dividing the area into North & South. Thats a alot of area to cover effectively. I would think that Supervisors or transport units would not be put into the system until 2 or all of the regular units are engaged, which again,still, leaves a large area to cover. There will always be a time when exsisting schudled resources are not enough & are over extended, when it becomes an everyday occurance its time to reevaluate the system.

[ny10570 745]

3 medics might be good on paper except for other traffic on the road esp. during the morning & eve. commutes. And lets face it we all know that there are some really stupid people out there. The real issue is when one unit goes out. Then, you are really dividing the area into North & South. Thats a alot of area to cover effectively. I would think that Supervisors or transport units would not be put into the system until 2 or all of the regular units are engaged, which again,still, leaves a large area to cover. There will always be a time when exsisting schudled resources are not enough & are over extended, when it becomes an everyday occurance its time to reevaluate the system.

They have reevaluated the system, but the towns didn't want to pay. It was something about disproportionate use of service or some garbage. If the downs don't want to pay then WEMS has little recourse.

[ONEEYEDMIC 68]

BITD, I had the great pleasure of doing the first ALS call in the Northern West area when it was Metro/Transcare's contract. I can't remember how long it was before 45-M2 was in service, but I can tell you how crazy the response times were, especially from NWHMC. Most of the time it was an intercept & the fly car stayed on scene. Alot has changed since then. Glad to see 3 fly cars up there.

Someone made the point of getting the fly car to the ER. It's nice when the VAC's have enough personal to take the fly car, but I have heard on numerous occasions either 60 control or the VAC's directly ask if the call was gonna be ALS or BLS to the medic on scene or even ask if the medic could transport the call regardless. That totally defeats the purpose.

I personally like the RPS system with two medics and 2 sets of equipment!

[SRS131EMTFF 471]

One option would be to NOT leave the flycar on scene... I've riden with a handful of depts that require the EMT to take the fly car while the medic is in the ambulance to allow a faster return to service, especially if it's a shared medic.

If you have good BLS, then 9/10 you don't need ALS, thats a given...however for the 1/10 call that requires a medic, the medic, at least in my experience, has a dozen other things they need to do at the ALS level, therefore they usually require a BLS attendant to get vitals, bag the patient, assist in a head to toe etc.

Unless its a boring day or a particularly high risk/need patient, whenever the 45-Medic rides, we both are sweating by the end of the call with the amount of work we had to do in the back of the rig. Very rarely if ever do we leave the fly car at the scene, if anything an attendant or chief will drive the fly car to the ER so that both the medic and the EMT can continue patient care and the medic can go back into service as soon as their PCR is written or a call for the 45-Medics drops.

This does work a lot better however when the 45-medic-3 car actually starts once you park it at the ED, (long story).

Edited November 1, 2011 by SRS131EMTFF

[Ga-Lin 86]

They have reevaluated the system, but the towns didn't want to pay. It was something about disproportionate use of service or some garbage. If the downs don't want to pay then WEMS has little recourse.

It always seems to come down to that, doesn't it? But I bet that doesn't stop the towns from B*** about response times.

[Goose 188]

If you have good BLS, then 9/10 you don't need ALS, thats a given...however for the 1/10 call that requires a medic, the medic, at least in my experience, has a dozen other things they need to do at the ALS level, therefore they usually require a BLS attendant to get vitals, bag the patient, assist in a head to toe etc.

Unless its a boring day or a particularly high risk/need patient, whenever the 45-Medic rides, we both are sweating by the end of the call with the amount of work we had to do in the back of the rig. Very rarely if ever do we leave the fly car at the scene, if anything an attendant or chief will drive the fly car to the ER so that both the medic and the EMT can continue patient care and the medic can go back into service as soon as their PCR is written or a call for the 45-Medics drops.

This does work a lot better however when the 45-medic-3 car actually starts once you park it at the ED, (long story).

Good BLS is great, but the real problem is that the we are often the only reliable part of the EMS system in many of the areas. Given that, we tend to show up before a BLS truck gets on the road...thus the we get stuck holding BLS jobs down until a bus arrives, obtaining BLS RMAs, etc. You want to free up the medics, start getting those ambulances on the road in a timely fashion (before anyone has a stroke, I'm speaking generally!).

I guess my point is, we are really required on 100% of the calls 99% of the time because otherwise there would be no one else....

Edited November 1, 2011 by Goose

[PFDRes47cue 653]

I can understand both sides of the argument. 3 Medics may or may not be enough. I do not run jobs in the area enough to know exactly how well he system is working. However, one thing that relates to all areas is the type of calls that are going ALS? are these jobs actually in need of ALS or are the BLS providers not capable of handling certain BLS calls? If there was a reduction in BLS calls that were going ALS and tying up a Medic, then 3 might very well be enough, but on the flip side, if Medics are constantly stuck with BLS calls then no way is having 3 Medics sufficient. It is important for BLS providers to be competent, confident and not reliant on ALS. (No offense Medics...I'm sure you agree)

[PEMO3 523]

Looking at it from the outside it appears that the system has become it's own worst enemy not just with the 45 medic area but in Westchester in general. Allow me to explain. Every job gets a medic and a BLS transport unit, be it a stubbed toe or a cardiac arrest. This type of response has allowed the BLS units to comfortably slow their response, lets call it the "already a medic enroute syndrome". The clock stops on response when that medic arrives on scene, so a medic in 3 minutes and a transport bus in 20 still shows help arrived in 3 minutes regardless of how long the "help" sat on scene waiting for a transport unit. True EMD that labels and dispatches calls as ALS or BLS would push these issues to light and force a true change. Additionally, medics would be available for ALS calls and not tied up babysitting a true BLS job while waiting for transport. The argument that there is no response time issues will quickly evaporate once the true BLS call sits waiting 20 to 30 minutes for a bus with no backlog to justify the delay, e.g. multiple calls active at the same time, MCI, etc.

Just my personal opinion.

Edited November 1, 2011 by PEMO3

[joetnymedic 43]

i worked WEMS from when they first started until Feb. 12, 2002. This was when Doug and Billy Dawson were road supervisors. Now some of the other medics I worked with are supervisors themselves and some went the supervisor route and went back to being road medics (probably not worth the aggravation- who knows) Anyway there were 3 medics back then just as there are now and the supervisor had an extra flycar (was a dodge ram pick up back then which was actually painted to the WEMS colors after being bought in "baywatch yellow" WAS967 will remember that, as well as the champagne toast)When resources would run low or if a unit needed a hand, the supervisor would respond to that particular scene. While it's been awhile and I'm sure the call volumes have risen, I still think the 3 flycar system with that 4th unit being able to get out there can work. WEMS used to use system status management and they did it pretty effectively back then. I'm not sure who else on the board may work up here in CT in "The Valley" or if Will Pendleton is even on this board, but he's be able to tell you guys. Here in CT we have a service called VEMS (Valley EMS) which is a flycar system that is independent, but run through Griffin Hospital in Derby. They have 3 flycars out there covering jobs all day long and two supervisors that can be called into service as an ALS unit at any given moment. That system works and it works very well. Hardly ever do they have to go to mutual aid now. Back in the old days, before the "new VEMS" at night, units from AMR Bridgeport would constantly get called in for coverage, but the system was gone over and changes were made. Maybe that's what needs to be done here if there is a constant need for mutual aid medics. But from what I'm reading, that's not the story. The other thing is, and the Villages and Towns need to realize this, if you need and want another unit out there, it's going to cost money, so if you want it or even if you need it, you have to be prepared to pay for it. As for the medics being professional, etc. They were back then, they most likely are now and will be in the future. WEMS handpicked their medics when they started. They were the best of the best, They hired people from all over just to provide the best that money could buy. Being a WEMS medic wasn't just a job, it was an honor. I'm sure that the guys working the road now feel that way now, just as we felt back then.

Joe

[medic929 0]

RPS system is a great system double medic really helps, I us to work in northern westchester when it was covered by A-1. They have made great strides in improve the system but money does make the difference and when towns are not willing to spend the money what can you do

[firedude 985]

So what I'm getting is that as long as ALS is not abused, it will work?

Edited November 1, 2011 by firedude

[INIT915 1,119]

So what I'm getting is that as long as ALS is not abused, it will work?

Not entirely, the fact remains, even an ALS unit not tied up on BLS-ride-ins will still have long response times to outlying areas of the district. It's just a fact.

[grushkjs 2]

It's not bad for Norwalk to get to Vista, as all they have to do is shoot up Route 123 to get into Vista. As long as a Vista ambulance has already rolled, the Vista ambulance can usually intercept with a Norwalk medic along route 123 in New Canaan. Now, if you're using Norwalk's medic as a transport unit, requiring them to actually get on scene, that may take a bit more time. However, Norwalk's response times are great and they tend to get into or near Vista within a few minutes. As for Wilton's medic, they wouldn't likely be called, as they have to cover Wilton, Weston, and parts of Georgetown and Redding. New Canaan's medic has been called before to respond into Vista, and Norwalk will then bring an ambulance to the New Canaan line or into New Canaan to backup their town. Wilton and Weston Medics are Norwalk Hospital Paramedics operating in town-owned flycars. At the end of the day, if Vista needs help and New Canaan and/or Norwalk are available, they are guaranteed to be merely minutes away. Norwalk has 24/7 ALS units and New Canaan has a 24/7 medic and at least one BLS ambulance (often more) fully staffed by volunteers in-house at all times.

[27east 19]

Who covers the other half of New Castle?

Edited November 1, 2011 by 27east