Westchester VAC's With Paid EMT Coverage?

[efdcapt115 1,511]

It's no secret Eastchester EMS (VAC) whatever, has been employing per-diem EMT's and Paramedics for years. Have to say, they do a great job working with the FD/PD.

How come Seth can't get a damn answer to his question?

[x129K 1,393]

maybe we should call them SPAC's?

(Sometimes Paid Ambulance Corp?)

[efdcapt115 1,511]

maybe we should call them SPAC's?

(Sometimes Paid Ambulance Corp?)

Spac/Spock?

[newsbuff 286]

How come Seth can't get a damn answer to his question?

Because to answer his question, you first have to admit there is a problem. Getting people to do that....You may having better luck finding a pot of gold.

[helicopper 1,050]

Dobbs Ferry VAC does 6am-6pm and then any nights not covered by volunteers which is a 9pm-6am shift and there independently hired

What happens between 6 PM and 9PM?

Who's the vendor for the daytime coverage or are they hired independently by the VAC?

[INIT915 1,119]

Because to answer his question, you first have to admit there is a problem. Getting people to do that....You may having better luck finding a pot of gold.

That's not true. There's actually quite a few members of this Board who believe there is a problem.

[INIT915 1,119]

Correct...it's a goal, but I would assume if an agency doesn't start taking steps to mitigate their issues within a reasonable time frame there could be consequences. This is the most progress on this issue I've seen since i moved back to Westchester.

Regards to the Fitch study....pretty disgraceful if you ask me.

There should be consequences, but there's really no currently available avenue of enforcement, so that Policy Statement isn't worth the paper it's printed on. I'd hesitate to call that "progress." Now, a change in state law giving DOH some teeth, that would be progress.

[OoO 24]

What happens between 6 PM and 9PM?

Who's the vendor for the daytime coverage or are they hired independently by the VAC?

Hired directly by DFVAC.

[miltonfire39 8]

Some of these agencies if you look on their websites still have that they're 100% volunteer. It would be nice to know who to talk to about getting hired at some of these places but I guess it's all about who you know.

[WAS967 97]

Regardless of whether the REMSCO has the "power" to enforce policy statements, it SHOULD send out a big message to agencies who would fall under it's auspices. First time a patient dies and the family decides to accuse the EMS response times as being causative, medical malpractice lawyers could take that policy statement and run with it having a field day.

[Bnechis 3,961]

There should be consequences, but there's really no currently available avenue of enforcement, so that Policy Statement isn't worth the paper it's printed on. I'd hesitate to call that "progress." Now, a change in state law giving DOH some teeth, that would be progress.

DOH has a full set of teeth. They could revoke the CON (certificate of need) if they wanted to. The problem is they dont. We do not need another state law, we need enforcement.

I wonder if DOH could be included in a wrongful death lawsuit, where the agency has a well documented history of failure to cover its CON? What obligation does DOH have to protect a patient in this case?

Could the documentation in WREMSCO's QI/QA policy become the reason in the future for a CON investigation?

If nothing else, as was said before, admitting you have a problem is the 1st step. This policy requires the agencies to document areas (like response) that need improvement. That might help agencies admit what they are writing down.

[INIT915 1,119]

Regardless of whether the REMSCO has the "power" to enforce policy statements, it SHOULD send out a big message to agencies who would fall under it's auspices. First time a patient dies and the family decides to accuse the EMS response times as being causative, medical malpractice lawyers could take that policy statement and run with it having a field day.

Actually, as having been discussed here in the past, in New York, as in most states, it is very, very difficult (but not completely impossible) to successfully file a civil suit due to a delayed response.

See (for New York only):

Laratro v. City of New York, 8 N.Y.3d 79 (2006)

Cuffy v City of New York, 69 N.Y.2d 255 (1987)

Kircher v City of Jamestown, 74 N.Y.2d 251 (1989)

[Bnechis 3,961]

Actually, as having been discussed here in the past, in New York, as in most states, it is very, very difficult (but not completely impossible) to successfully file a civil suit due to a delayed response.

See (for New York only):

Laratro v. City of New York, 8 N.Y.3d 79 (2006)

Cuffy v City of New York, 69 N.Y.2d 255 (1987)

Kircher v City of Jamestown, 74 N.Y.2d 251 (1989)

How much of that difficulty is because these cases are against governments, vs. not for profits?

[PFDRes47cue 653]

http://www.wremsco.o...-8-Feb-2011.pdf

Enforcement is up for debate. I don't know all the particulars, but i'm not sure if the REMSCO has enforcement powers, i know REMAC does...but their scope may only be limited to ALS (again, i don't know how the law is interpreted). That said, the REMSCO is tasked with managing EMS in it's respective area of oversight as per the public health law, the REMSCO here requires agencies to have QA & QI...and it looks like they are looking at the response time in terms of a QI issue.

However it unfolds down the road, this is a good step for the community.

[INIT915 1,119]

How much of that difficulty is because these cases are against governments, vs. not for profits?

First, there doesn't seem to be much in terms of record related to non-governmental agencies. That being said, the initial calls for assistance are traditionally made to 911, a governmental instrumentality, therefore, that is who would be actionable. Due to the sovereign immunity traditionally granted government representatives, it seems unlikely the action would be transferable to a third party, i.e. a VAC or a private ambulance company. The immunity claim would be ineffective if the call was made direct to a non-governmental agency, then the protections afforded to municipalities could be eliminated. There, a "special relationship" as outlined in Sorichetti v City of New York (65 NY2d461), would not exist. Of course that is a hypothetical, pending the disposition of such a claim.

[x635 4,066]

How come Seth can't get a damn answer to his question?

I'd like to know the same! It was a pretty simple one, too.

[PFDRes47cue 653]

Dobbs Ferry, Croton, Hawthorne, Somers...answers were given. In addition, Valhalla VAC uses paid EMT's I believe through Transcare, but I am not sure. I also am not positive of coverage hours.

There are also a lot of agencies who use other VAC's for coverage...

[NWFDMedic 58]

The Region does not have enforcement authority here and the state really doesn't either. This all boils down to the individual municipality (just as the lawsuits did). The municipality is primarily responsible for the safety of its citizens. If the municipality doesn't believe that the emergency services are providing proper coverage, then it's their responsibility to either help them or change them. There have been at least 2 VACs here in the Hudson Valley that have been shut down by the powers-that-be in their municipality (not arguing that it was the right thing to do, just that it happened).

While the DOH sets the standard for level of care, I think response times and level of response should be handled on the local level. The local politicians, as representatives of their citizens, have to make a determination of what level of care is appropriate and sufficient. In some rural communities, the population may be happy with "whenever those fine young volunteers get there. They do such a great job for us." However, another municipalities citizens may demand that the ambulance be there "before I hang up the damn phone, duh." It is the job of locally elected officials to balance the cost versus risk and benefit to appropriately match their community.

[firedude 985]

Both Village of Mamaroneck EMS (MEMS) and Town of Mamaroneck/Larchmont VAC (TMLVAC) have paid medics on the bus 24/7 provided by the Town of Mamaroneck Ambulance District (TMAD). All EMTs are voluteers, and both agencies consider themselves 100% volunteer.

Edited December 1, 2011 by firedude

[Goose 188]

Both Village of Mamaroneck EMS (MEMS) and Town of Mamaroneck/Larchmont VAC (TMLVAC) have paid medics on the bus 24/7 provided by the Town of Mamaroneck Ambulance District (TMAD). All EMTs are voluteers, and both agencies consider themselves 100% volunteer.

There are paid EMTs that cover when their are no rostered volunteers.

[firedude 985]

There are paid EMTs that cover when their are no rostered volunteers.

Correct. And those paid EMTs are usually TMAD empoyed.

[EMSer 15]

Dobbs Ferry, Croton, Hawthorne, Somers...answers were given. In addition, Valhalla VAC uses paid EMT's I believe through Transcare, but I am not sure. I also am not positive of coverage hours.

There are also a lot of agencies who use other VAC's for coverage...

valhalla "vac" runs per diem 6a-6p.

btw "valhalla volunteer ambulance corps" does not exist. the agency is just called V.A.C as in "valhalla ambulance corps"

the word "volunteer" was taken out of the charter around 2001 when they initially started paying techs.

sorry, just a pet peeve...

[PFDRes47cue 653]

valhalla "vac" runs per diem 6a-6p.

btw "valhalla volunteer ambulance corps" does not exist. the agency is just called V.A.C as in "valhalla ambulance corps"

the word "volunteer" was taken out of the charter around 2001 when they initially started paying techs.

sorry, just a pet peeve...

I have heard this before. I have also heard them referred to as Valhalla EMS. I also know that their website is www.ValhallaVAC.com and that their badge still says Valhalla Volunteer Ambulance. You can see where he confusion comes from. Either way, this is a growing trend around the country. Wasn't trying to play the name game, just answering the threads questions. Also, no apology needed lol.

[efdcapt115 1,511]

Bottom Line: VAC's in Westchester (many of them) have not been able to provide 24/7 BLS for a very long time. Answer: Many came up with a billing scheme (I say this word in the English fashion, it's not defamatory) if insurance pays for the transport and ALS service many of the VAC's responsibly set up the per diem system years ago; they collect the revenue for the ALS and the BLS systems.

Most of the Medics I've known through my career, made ends meet by working their A job, which wasn't enough to pay the bills, and then a B job at a VAC, call it EMS now, fine.

The Medics in particular (from my FD BLS provider background) have been a welcome addition in a system I worked where we often had a PD stand-by, a late FD response because of no BLS VAC bus (so we looked like dopes showing up 25 minutes later).

Because EVAC years ago was able to obtain primary medical responder status for the entire EFD district, including the villages, we as an FD could not have upgraded to ALS if we wanted to.

I credit one or two guys Paul and Fazz for setting up the EVAC/EMS system. As far as I know it's been able to function with additional help from the TOE for equipment, like a bus purchase would come from the Community Fund.

[RushTheBus 10]

Bottom Line: VAC's in Westchester (many of them) have not been able to provide 24/7 BLS for a very long time. Answer: Many came up with a billing scheme (I say this word in the English fashion, it's not defamatory) if insurance pays for the transport and ALS service many of the VAC's responsibly set up the per diem system years ago; they collect the revenue for the ALS and the BLS systems.

Most of the Medics I've known through my career, made ends meet by working their A job, which wasn't enough to pay the bills, and then a B job at a VAC, call it EMS now, fine.

The Medics in particular (from my FD BLS provider background) have been a welcome addition in a system I worked where we often had a PD stand-by, a late FD response because of no BLS VAC bus (so we looked like dopes showing up 25 minutes later).

Because EVAC years ago was able to obtain primary medical responder status for the entire EFD district, including the villages, we as an FD could not have upgraded to ALS if we wanted to.

I credit one or two guys Paul and Fazz for setting up the EVAC/EMS system. As far as I know it's been able to function with additional help from the TOE for equipment, like a bus purchase would come from the Community Fund.

George, in reference to your last sentence, were you trying to say "able to function withOUT additional help from the TOE?" Our funds from the Town and Villages, while still extremely important to us, have dropped to about $20,000 per year. And because we are not a tax district, we really survive completely off of soft third party billing and donations from the community. We have been extremely lucky for the last 10 years to have partnered with the Community Fund who donates funds for us to be use towards our ambulance replacement program.

In terms of our operations, Eastchester VAC, as I've said before, offers numerous services to the community we serve, one of which being Eastchester EMS, primary EMS service to the Town of Eastchester and Villages of Bronxville and Tuckahoe. We have a paid Paramedic staffed 24 hours a day, 7 days a week (sometimes double medics during storms, big incidents, etc.) who operates an ALS fly car. We also pay an EMT Monday thru Saturday, from 7am to 7pm, who is only to go on the ambulance if no volunteers are in house. Most days, this EMT has a pretty good gig and gets to sit around while the volunteers handle the system, other days, he or she becomes a vital aspect of our operations (if a volunteer is late for their shift, for the inevitable 2nd and 3rd call back-to-back in district that Eastchester is known for, etc.)

Again, as I've said before, our system isn't perfect by any means, but it's pretty effective. The volunteers don't have the luxury of relying on the paid staff to cover the calls like some other agencies. Eastchester's volunteers are still the primary force, and we're quite proud of that. What hurts our system is when we get called to Lockwood Avenue for the "sick", around the corner from Sound Shore, because TransCare was busy. I'm not saying that we never call mutual aid, because we do, but a paid service shouldn't be relying on ScarVac, or Eastchester, or TMAD. In my 10 years at EVAC, we've been called ONCE to Yonkers, and Empress threatened to fire the dispatcher for doing it, even though he knew it was the right call to make. (That's me ranting, and shouldn't be taken personally by anybody.)

I don't post often, but I read often, and I truly feel that the only way to making EMS in Westchester (and fire/PD) is to be open and talk about it, so please feel free to PM me if you want to continue the discussion.

Thanks,

Kevin

[Jybehofd 85]

You're going to see a whole lot more when the REMAC & REMSCO mandate that a bus roll within 3 minute of dispatch takes effect ( see policy statement 11-02 on the remsco website).

I have heard that the REMAC and or REMSCO is going around and putting some heat on departments and VACs that can't get an ambulance out the door from the 1st tones and calling enroute.. i heard the numbers they were looking at were over 9 minutes for the VACs

[Jybehofd 85]

I'm sure the REMSCO police aren't going to come arresst you, but wouldnt this be valuable in court as it would be an accepted industry standard?

I am sure if it got really really bad and alot of issues and paper trail was done that the VAC or department would lose there cert

[efdcapt115 1,511]

George, in reference to your last sentence, were you trying to say "able to function withOUT additional help from the TOE?" Our funds from the Town and Villages, while still extremely important to us, have dropped to about $20,000 per year. And because we are not a tax district, we really survive completely off of soft third party billing and donations from the community. We have been extremely lucky for the last 10 years to have partnered with the Community Fund who donates funds for us to be use towards our ambulance replacement program.

In terms of our operations, Eastchester VAC, as I've said before, offers numerous services to the community we serve, one of which being Eastchester EMS, primary EMS service to the Town of Eastchester and Villages of Bronxville and Tuckahoe. We have a paid Paramedic staffed 24 hours a day, 7 days a week (sometimes double medics during storms, big incidents, etc.) who operates an ALS fly car. We also pay an EMT Monday thru Saturday, from 7am to 7pm, who is only to go on the ambulance if no volunteers are in house. Most days, this EMT has a pretty good gig and gets to sit around while the volunteers handle the system, other days, he or she becomes a vital aspect of our operations (if a volunteer is late for their shift, for the inevitable 2nd and 3rd call back-to-back in district that Eastchester is known for, etc.)

Again, as I've said before, our system isn't perfect by any means, but it's pretty effective. The volunteers don't have the luxury of relying on the paid staff to cover the calls like some other agencies. Eastchester's volunteers are still the primary force, and we're quite proud of that. What hurts our system is when we get called to Lockwood Avenue for the "sick", around the corner from Sound Shore, because TransCare was busy. I'm not saying that we never call mutual aid, because we do, but a paid service shouldn't be relying on ScarVac, or Eastchester, or TMAD. In my 10 years at EVAC, we've been called ONCE to Yonkers, and Empress threatened to fire the dispatcher for doing it, even though he knew it was the right call to make. (That's me ranting, and shouldn't be taken personally by anybody.)

I don't post often, but I read often, and I truly feel that the only way to making EMS in Westchester (and fire/PD) is to be open and talk about it, so please feel free to PM me if you want to continue the discussion.

Thanks,

Kevin

Hey,

Nice post, explains the system very well, better certainly than I did. Stay well Kev.

Edit: for shaved head comment; different Kevin lol

Edited December 1, 2011 by efdcapt115

[axman 5]

I would venture to say that most "vacs" have paid personnell to some degree. It seems some call themselves "EMS" and stray away from "vac". The only time it seems they are "vacs" is during there fundraising. Also, how can they be "vacs" when they receive insurance payments for the transport, hell I know some "vacs" that bill out more than for profit services. Makes you wonder what would happen if the VFD did the same.

[PFDRes47cue 653]

I would venture to say that most "vacs" have paid personnell to some degree. It seems some call themselves "EMS" and stray away from "vac". The only time it seems they are "vacs" is during there fundraising. Also, how can they be "vacs" when they receive insurance payments for the transport, hell I know some "vacs" that bill out more than for profit services. Makes you wonder what would happen if the VFD did the same.

It all boils down to labels being using to loosely. VAC should be reserved for agency that are 100% volunteer 24/7 and do not bill or collect insurance money for transports. These are places that are Volunteer AC's Tradition plays a huge role in emergency services so changing names is not a popular switch.