Croton-on-Hudson opts for full-time EMT

[newsbuff 286]

From Lohud:

CROTON-ON-HUDSON —The village of Croton will contract full time with the Mid-Hudson Ambulance District, allowing for a paid emergency medical technician to handle calls 24/7.

http://www.lohud.com...|text|Frontpage

At least someone realized that the system wasn't working.

Edited December 5, 2011 by jack10562
To comply with source copyright

[miltonfire39 8]

Anybody know who to contact about applying for a paid emt position with them ?

[JJB531 652]

Anybody know who to contact about applying for a paid emt position with them ?

Chief Sam Lubin at Ossining "VAC". 8 Clinton Avenue, Ossining, (914) 942-9204, he is typically there Monday to Friday day tours.

[x635 4,066]

One EMT? That's a "solution"? If getting volunteers is a problem, shouldn't they staff a full ambulance, maybe even an ALS one?

[MoFire390 118]

croton EMS is a BLS agency...they do not have the license to run an ALS rig. that is why they use the 36 medics. 1 emt is what the town sees fit. if they needed more then the town would of asked for more. need to take baby steps before big leaps

[JJB531 652]

One EMT? That's a "solution"? If getting volunteers is a problem, shouldn't they staff a full ambulance, maybe even an ALS one?

Croton had temporarily contracted with OVAC for 1 EMT, Monday to Friday from 7a to 7p, with good results. Calls were getting covered, the rig was making it out the door, and the number of times OVAC went mutual aid into Croton significantly reduced. From a cost saving perspective, as well as being able to keep the Croton volunteers involved in the systm, Croton was looking for a solution to the problem they were having without "breaking the bank", and since the 1 EMT set-up has worked well for them so far, they opted to stick with it and increase the coverage to 24/7. If problems begin to arise, they can always go back to the drawing board and reassess their system, but like I said, for now its working for them.

[Guest alsfirefighter]

Croton had temporarily contracted with OVAC for 1 EMT, Monday to Friday from 7a to 7p, with good results. Calls were getting covered, the rig was making it out the door, and the number of times OVAC went mutual aid into Croton significantly reduced. From a cost saving perspective, as well as being able to keep the Croton volunteers involved in the systm, Croton was looking for a solution to the problem they were having without "breaking the bank", and since the 1 EMT set-up has worked well for them so far, they opted to stick with it and increase the coverage to 24/7. If problems begin to arise, they can always go back to the drawing board and reassess their system, but like I said, for now its working for them.

Kind of reminds me of having to pick up a job at Skyview while a certain medic I know was doing god only knows what. Slacker. lol

[JJB531 652]

Kind of reminds me of having to pick up a job at Skyview while a certain medic I know was doing god only knows what. Slacker. lol

Lol, what can I say, I'm a popular guy!

[x635 4,066]

croton EMS is a BLS agency...they do not have the license to run an ALS rig. that is why they use the 36 medics. 1 emt is what the town sees fit. if they needed more then the town would of asked for more. need to take baby steps before big leaps

Technically, they do. The same company they are contracting for an EMT with runs the 36-Medics, and is owned by Ossining "VAC".

If Briarcliff Manor, which also has a paid EMT, would also just add a Medic, you'd have a full self-sufficient ambulance (except for when backup is needed for cardiac arrests, etc).

Instead of doing things right the first time, why do people drag out the inevitable? It only puts a temporary band aid on the problem.

The Flycar system, in many places, is antiquated. You're putting another vehicle on the road, that adds increased liability, and more costs, such as maintainence and fuel.

How many thousands upon thousands of dollars are wasted, and lives lost, because people don't want to just do things right. EMS is a profession, not just a ride to the hospital nowadays. I don't know the current protocols in Westchester, but Paramedcis can give thrombolytics, induced hypothermia for MI's/Cardiac Arrest and strokes, adminster pain meds, etc. And a lot of these only work with a reasonable response time. We're not going to save everyone, but we can at least give them the best chance possible.

It's time to stop putting band aids on the problems. Communities deserve more. Hiring people to "just get the ambulance out the door" is just not right.

[Remember585 815]

Seth,

Croton did a study earlier this year that showed that most EMS calls in Croton are BLS. Paying for a Full Time Paramedic isn't neccessary.

What I can't understand is why so many members of Croton EMS became MORE ACTIVE now that there is a paid EMT there. If they're getting enough people at certain times or on certain days, then dump the cost of the paid EMT and use the volunteers. That's how other places do it, and that's what I suggested over two years ago when we discussed future plans.

It is fine to have the paid personnel there when nobody is around to commit to the day or certain times, but if you have a day, say Sundays for example, where two or three people will commit to a duty crew, then save that money.

Between how much they're paying someone when they have 3-4 volunteers on the rig showing up (wasted money) to the amount they are getting for recruitment/retention (probably wasted money), it's becoming slightly irritating to taxpayers like me.

Make the members look at a calendar and make commitments. Use the paid personnel for the voids. You save that money and use it for recruitment. If you have a crew doing a shift or two together, they get good at it and learn from it. That's how most of us used to get our training (night crews, etc.).

[x635 4,066]

But, EMS shouldn't be about the money or, in this case, about staffing.

What are the response times for when the ambulance, not anyone else, arrives on scene and makes patient contact? What is the average duration of a call, from dispatch to back in quarters?

As mentioned, most Croton calls are BLS, how many are ALS? What is the response time for ALS? What is the response time if 36-M-1 is committed on another call?

Also, what is the experience level and competencies of the EMT's if recruitment and retention are an issue? Is there a QA/QI process for Croton VAC, including any patient that was assesed by ALS and may have been "BLS's"?

[MoFire390 118]

seth u have great views. i dont think that the Village would want to drop over a million dollars plus for an ALS fly car. there was talk a few years ago about dropping ossining and going with cortlandt regional. dont know what ever happened with that. they might have an OVAC emt but they still need to get the lincense from NYSDOH. which is alot of money u need to prove that u have the personel trained in either EMT-I, Or EMT-P (or EMT-CC which isnt recgonized in westchester). i dont know if they do. i know at one time peekskill VAC was (might still be) an ALS agency. they had a ton of EMT-I's and a few EMT-P's. i know at one time they were talking about dropping the ALS license to keep costs down. if someone from Peekskill VAC could chime in and answer my question if they still are an ALS agency i would like that. and if someone from CEMS can fill us in if they have any members who are EMT-I certs.

Thanks

Ken

Edited December 5, 2011 by MoFire390

[Guest alsfirefighter]

John...good points and I always find it funny how the hive stirs up for a bit just because someone is getting paid to do something. Be careful around there...the hive will go back to normal in about 3 months when things will return to normal.

I'm wondering...how many flycar systems are in Westchester? And which ones are "antiquated?" I can't see where having an ALS ambulance in Briarcliff or Croton would make any sense nor be cost effective. The response times are pretty decent, at least they were when I was working in Ossining. The system I'm currently in our standard is 8 minutes or less which is the national standard and I believe we are in the mid 5's to 6 minute area. The area I'm in was built for a flycar system, allowing flexibility being a medic isn't driving when its a BLS call effectively taking them out of the mix. As far as adding a vehicle...its one vehicle, there's another emergency service that has a lot more additional vehicles that often have multiple going to non priority calls with a lot more liability and wasted resources we can discuss.

It was very easy for years to say public safety of any kind isn't about money or staffing. But the tide has shifted and unfortunately is all about money and how to do the most with less as the assault on paying taxes and public safety continues. Bottom line is this..if its not broke don't fix it..and the current ALSFR programs in north west westchester are not broken. The BLS systems however I will venture to say has some serious fractures and is close to be broken.

[x635 4,066]

And which ones are "antiquated?"

The area I'm in was built for a flycar system

No disresepect, just questions- I'm growing more and more out of touch with changes since 2007.

Do you still have to take an Engine company out of service to provide ALS to another community? Or do you currently run an ALS Engine company (I know that was a goal at one point)?

If the Engine does go out of service for ALS, is another Engine moved up to cover that station? And, if the Station/Engine could afford to go out of service for ALS calls, is that Engine even needed if the flycar is the priority?

[Guest alsfirefighter]

No disresepect, just questions- I'm growing more and more out of touch with changes since 2007.

Do you still have to take an Engine company out of service to provide ALS to another community? Or do you currently run an ALS Engine company (I know that was a goal at one point)?

If the Engine does go out of service for ALS, is another Engine moved up to cover that station? And, if the Station/Engine could afford to go out of service for ALS calls, is that Engine even needed if the flycar is the priority?

No disrespect taken or even perceived...I know you and you me better then that.

1. Yes an engine still goes out of service.

2. No we haven't upgraded to ALSFR engines.

3. No units move up nor really need to. It doesn't effect response times in any extreme way.

4. Yes the engine is needed as we guarantee 1 firefighter/paramedic to the system but 85-90% of the time give 2. Minimum staffing is ladder, rescue, 3 engines. The engine level flux's with ALS calls and the rescue is the BLSFR unit. Dual role..and you know I feel fire based EMS is the best way, best bang for your buck way to go.

[x635 4,066]

So, then, Engine 130 really isn't needed, and can be replaced by a Squad type of unit like this that can respond to fire or EMS calls?

http://x635photos.com/displayimage-2531.html

Wouldn't just an across the board standard to work torwards be all staffed ALS ambulances in Westchester? Port Chester, Yonkers (tiered), Scarsdale, New Rochelle, Mount Vernon, White Plains, Grasslands, Ossining, and Harrison are some of the systems that have first out or more ambulances that are ALS staffed by an EMT and Paramedic.

Most of our neighboring systems in CT.....Stamford, Norwalk, and Greenwich have all ALS ambulances.

Can we learn from these agencies and how their systems came to be?

In reality, all Croton is paying for is a driver to get the ambulance to the scene. But, how long until a proper crew arrives on scene and can transport, especially in trauma cases?

[newsbuff 286]

In reality, all Croton is paying for is a driver to get the ambulance to the scene. But, how long until a proper crew arrives on scene and can transport, especially in trauma cases?

I may be mistaken, but I don't think they roll with just one person, unless it is a confirmed ALS call in which they can guarantee that the medic will be riding it in.

[FF398 45]

I may be mistaken, but I don't think they roll with just one person, unless it is a confirmed ALS call in which they can guarantee that the medic will be riding it in.

The only time Croton will roll "driver only," is when an EMT notifies the driver that they'll meet them on scene or as newsbuff said, a medic can confirm that they'll ride in the call.

Edited December 5, 2011 by FF398

[JJB531 652]

Wouldn't just an across the board standard to work torwards be all staffed ALS ambulances in Westchester? Port Chester, Yonkers (tiered), Scarsdale, New Rochelle, Mount Vernon, White Plains, Grasslands, Ossining, and Harrison are some of the systems that have first out or more ambulances that are ALS staffed by an EMT and Paramedic.

Most of our neighboring systems in CT.....Stamford, Norwalk, and Greenwich have all ALS ambulances.

Can we learn from these agencies and how their systems came to be?

I think the concept of all ALS ambulances across the board in Westchester County is an excellent one, but...

When we look at systems like Port Chester, Yonkers, New Rochelle, Mount Vernon, White Plains, Ossining, and Harrison... we are talking about systems who have call volumes that are in the thousands. The call volumes are there to support the concept of staying away from the Fly Car methodology of delivering Advanced Life Support and instead utilize dedicated ALS ambulances staffed with Paramedics. The majority of these busier systems utilize the Fly Car methodology for field supervisors who are available to stop the clock should the systems units be tied up on active calls. Smaller systems like Croton, who are responding to 700 calls for service (roughly 2 calls per day), and out of those 700 annual calls, 200 actually require ALS level interventions, it may be more financially feasible to utilize the concept of a regional approach to ALS coverage through the use of Fly Cars, rather then a staffed ALS ambulance. When more then half of your annual call volume are BLS level calls, is it feasible to tie up a Paramedic for an hour for a BLS level call, rather then having your medic go back into service when not needed for a BLS level call and remain available for the next job where ALS level interventions may desperately be needed?

The other issue at hand is although it may seem like there is an abundance of actively employed Paramedics in Westchester County because of all the systems prevalent, when you really think about it, the number of medics currently working in Westchester is not as great as it seems. This is because if there are 20 ALS agencies in Westchester (a ficticious number), you have the same 8 Paramedics going from Agency "A", to Agency "B", to Agency "C". The point I'm getting at is that the same 100 or so (once again, a ficticous number since I don't have the time to go to the WREMSCO website and count all the MAC'ed Paramedics) Paramedics REMAC'ed and working in Westchester County are all working for multiple agencies. To add another ALS system where you have to tap into the already overworked pool of Paramedics is going to lead to more difficulty covering shifts and the ever so prevalent threat of Paramedics who are working 16, 24, 32, even 48 hours straight going from one agency to the next.

If smaller systems like Croton, and I keep mentioning Croton only because they are the agency being discussed in this thread since there are numerous smaller systems here in Westchester County, were to look at the idea of having a 24/7 staffed ALS ambulance, I think it would be more feasible to take on a regional approach with the surrounding communities of Cortlandt, Ossining/New Castle, Yorktown to establish a system with fully staffed ALS ambulances (note I said ambulanceS, plural), where response times can meet the national standards and taxpayers can get the service they expect and deserve. Of course, and no surprise to anyone here since it's been pointed out numerous times, this concept will depend on surrounding agencies to pool resources, work together, and get past the boundaries of the "my town" syndrome that has crippled the Westchester "EMS system" (if we can even call it that).

[Guest alsfirefighter]

So, then, Engine 130 really isn't needed, and can be replaced by a Squad type of unit like this that can respond to fire or EMS calls?

http://x635photos.com/displayimage-2531.html

Wouldn't just an across the board standard to work torwards be all staffed ALS ambulances in Westchester? Port Chester, Yonkers (tiered), Scarsdale, New Rochelle, Mount Vernon, White Plains, Grasslands, Ossining, and Harrison are some of the systems that have first out or more ambulances that are ALS staffed by an EMT and Paramedic.

Most of our neighboring systems in CT.....Stamford, Norwalk, and Greenwich have all ALS ambulances.

Can we learn from these agencies and how their systems came to be?

In reality, all Croton is paying for is a driver to get the ambulance to the scene. But, how long until a proper crew arrives on scene and can transport, especially in trauma cases?

How do you figure any engine in that system isn't needed? And to then suggest it can be replaced by a squad type of unit? The system is staffed to handle the appropriate amount of calls both fire and ems and to maintain the appropriate coverage for ISO reasons. The system works the way it does fine and has for 14 years. Sure there are things we'd like to button up a little tighter, like more staffing. If we had more staffing we might be able to look at a system like that, but then again EMS transport is handled by a 3rd party service in that system and isn't just that easy, even though they have their problems at times.

Edited December 5, 2011 by alsfirefighter

[x635 4,066]

Alright, I'm dropping the Peekskill thing so we don't go off topic after this comment. I'm not current on the operations, but I trust the people who say the system works. I'm also not going to mention other systems for the same reasons.

Getting back to Croton again, I still believe one EMT on an ambulance is half the equation, and that shouldn't settle the issue.

As I said earlier, I live in a county, like many in the area, that runs a countywide career ambulance system operated and funded by the same county. Response times are excellent. FD remains fully staffed at 3-4 firefighters.

And I pay 1/4 the taxes I did in Westchester. I admit I am looking at the situation not being involved it anymore and from a different persepective, but I still think that every ambulance that rolls out the door should be ALS, especially in one of the wealthiest county's in the nation.

Everybody in Westchester is facing the same issues with EMS, yet handling it in their own way. It still seems to me that getting out the door is more important than a rapid response and excellent patient care.

[Bnechis 3,961]

So, then, Engine 130 really isn't needed, and can be replaced by a Squad type of unit like this that can respond to fire or EMS calls?

Functionally it could be but under ISO it can not be replaced by a squad. The ISO increase would not cover the savings.

ISO requires in most communities a pump capacity that matches the 3 highest required fire flow in that district. The vast majority require 3,500gpm minimum. If you own 1,500gpm pumpers, then you need 3. Even without that, you need a minimum of 2 plus a spare.

Now back to our regularly scheduled Croton EMS debate.

[stvrap79 8]

I have lots of opinions on this matter, but I'll keep it brief. When all the media attention and the spotlight came down on Croton EMS, Croton was having serious issues covering calls. However, 6 months prior Croton was one of the top VACs in call coverage. There was a drop in membership and participation. However since then, Croton has obtained numerous new volunteers and quite a few current members becoming EMTS and/or drivers. I can't say without the paid EMT CEMS would be back to covering 98% of its calls, but membership has stepped it up. I personally think a 7am-7pm EMT is sufficient. One thing that I like seeing, is when a full crew can not be filled, the 36 medic will ride the call in BLS with the paid EMT. I just wish that happened more frequently when Croton was 100% volunteer. I hope that croton can continue to boost its volunteer membership. Nothing would be greater than to see its return to a 100% volunteer agency.

[ny10570 745]

Alright, I'm dropping the Peekskill thing so we don't go off topic after this comment. I'm not current on the operations, but I trust the people who say the system works. I'm also not going to mention other systems for the same reasons.

Getting back to Croton again, I still believe one EMT on an ambulance is half the equation, and that shouldn't settle the issue.

As I said earlier, I live in a county, like many in the area, that runs a countywide career ambulance system operated and funded by the same county. Response times are excellent. FD remains fully staffed at 3-4 firefighters.

And I pay 1/4 the taxes I did in Westchester. I admit I am looking at the situation not being involved it anymore and from a different persepective, but I still think that every ambulance that rolls out the door should be ALS, especially in one of the wealthiest county's in the nation.

Everybody in Westchester is facing the same issues with EMS, yet handling it in their own way. It still seems to me that getting out the door is more important than a rapid response and excellent patient care.

There are several hurdles that you're not addressing. First, we're still stuck with local everything. A county wide FD, EMS, and PD would be great but for the purposes of this thread they are not a reality at this time. Croton, Peekskill and everyone else cannot fix this and for the immediate future have to find a way to work with the fragmented system.

Austin and Texas in general are growing. Relatively speaking a growing community is cheaper. More development and more people genertae more income to fund the new services they require. Most of the state taxes paid by residents of LI, NYC, and the Hudson Valley never come back. We're sustaining the dying decaying industrial cities of the rest of the state. Decaying communities become poor communities and require more resources than prosperous ones due to increases in crime, fires, and decreases in healthcare. An extreme example is Detroit.

We have massive infrastructure repairs that we're way behind on. Across the country politicians did little to prepare for the long term upkeep and upgrade of highways, rails, power distribution, water and sewage systems. These now urgent costs are most heavily centered on areas the grew the most in the 50's and 60's.

At a certain point population density tips the scale from being a cost benefit to being an expense. As the population begins to exceed the area's ability to supply it more expensive alternatives have to be found. These are not always offset by the added population. For example Los Angeles pays more than anyone else in the country for water. Pumping in more and more water just keeps adding to the price per gallon. Here transportation is a problem. Efficient mass transit cannot work on fares alone. We are pretty close to capacity for highway construction. We can expand here or there, but the days of constructing entirely new highways are probably over. That means more congested roads and more mass transit solutions. These both cost more money.

Cost of living is yet another hit to the taxpayer's wallet. As the community grows and sprawls from the urban centers people begin paying a premium for convenience. This drives up everyone's property values. So now your workers need to be paid more, your business need to charge a little more, and your services begin to cost more. This one is great because its self perpetuating.

If you stick it out a few decades you'll see Austin become just as dysfunctional and messed up as dear old Westchester. Hell, you guys already had a waste and corruption scandal in your transit system. Its only a matter of time.

[JJB531 652]

I have lots of opinions on this matter, but I'll keep it brief. When all the media attention and the spotlight came down on Croton EMS, Croton was having serious issues covering calls. However, 6 months prior Croton was one of the top VACs in call coverage. There was a drop in membership and participation. However since then, Croton has obtained numerous new volunteers and quite a few current members becoming EMTS and/or drivers. I can't say without the paid EMT CEMS would be back to covering 98% of its calls, but membership has stepped it up. I personally think a 7am-7pm EMT is sufficient. One thing that I like seeing, is when a full crew can not be filled, the 36 medic will ride the call in BLS with the paid EMT. I just wish that happened more frequently when Croton was 100% volunteer. I hope that croton can continue to boost its volunteer membership. Nothing would be greater than to see its return to a 100% volunteer agency.

I really not trying to put you on the spot, but I have to respectfully disagree. Working the Croton system for 13 years now, I know first hand that Croton at one time was superb at covering calls, and the "abuse" of mutual aid was absolutely never an issue. but in the past year, there have been serious, serious issues with Croton being able to staff an ambulance, and I commend the Village and the agency for recognizing this and stepping up to the plate to address and correct this issue.

If 7a to 7p coverage is sufficient, then why did Ossining have to take their one and only ALS ambulance out of service at 3am this morning to cover an MVA in Croton because they couldn't muster a crew? This now means that not only is Croton uncovered in terms of EMS since there clearly is no crew available, but now you leave Ossining uncovered as well because their one ambulance is being utilized to cover someone elses work. Ossining ended up receiving another call in their district, and fortunately the crew was able to do a quick turn-around and handle that job as well. I'm not trying to bash Croton for not getting an ambulance on the road, I'm trying to use a real life example from 10 hours ago that 7a tp 7p coverage is not the answer, and that the decision they made to go to 24/7 coverage is the right answer for their needs.

You may like seeing when the 36 medic rides in a BLS call, but you know who doesn't like it? The unconscious diabetic, the active MI patient, the witnessed cardiac arrest patient, the exacerbation of CHF patient who would benefit from early, timely ALS intervention, and doesn't get it because their paramedic is tied up driving someone with a twisted ankle to the emergency department. It's an unjustifiable misallocation of resources in a system where BLS ambulances should be staffed by BLS providers to keep ALS level providers in-service to handle calls that required ALS level interventions.

I can undersand you think nothing would be greater for CEMS to go back to a 100% volunteer agency, and I honestly do hope that they can boost their membership and get some new blood in there to increase their volunteer numbers. Personally, I think nothing IS greater then CEMS realizing that they had a problem, identified it, addressed it, and are now taking steps to correct it... and for that I applaud them.

[x635 4,066]

One thing that I like seeing, is when a full crew can not be filled, the 36 medic will ride the call in BLS with the paid EMT.

So, basically, you are taking a Paramedic out of service to ride in a BLS call?

Austin and Texas in general are growing. Relatively speaking a growing community is cheaper. More development and more people genertae more income to fund the new services they require.

I agree with you completly about infastructure issues. However, public safety must trump everything.

Actually, much of the growth down here is planned for, and paid for, ahead of time. The government is extemly supportive of emergency services, and they usually take top priority. Also, the citizens actually care, and customer service is a huge part of operations. They have 5 year plans, 10 year plans, etc. They have fiscal foresight.

There are also towns that thrived in the past from agriculture, industry and the railroad. Many of these towns have done a great job in reinventing themselves. There is tons of small business.

There's also many reasons why our economy is thriving comparitively, and therefore growing.

As far as the transit scandal, it was sensionalized. It basically was straightened out quickly and involved private contractors. They are already planning more light and heavy rail systems.

I don't EVER believe it will be like Westchester, especially if you compare the history between the two communities.

[stvrap79 8]

So, basically, you are taking a Paramedic out of service to ride in a BLS call?

It's not ideal. However it's better than 20+ minutes of toning out for a mutual aid bus when the patient could have been at the hospital already. Either way the Medic is tied up.

Edited December 5, 2011 by stvrap79

[JJB531 652]

It's not ideal. However it's better than 20+ minutes of of toning out for a mutual aid bus when the patient could have been at the hospital already. Either way the Medic is tied up.

If it's a BLS level call and the paid EMT is on scene, the medic is not tied up. They can triage care to the EMT on scene and go back in-service and/or handle another call. Now the only one tied up is the EMT who has to wait.

[stvrap79 8]

If it's a BLS level call and the paid EMT is on scene, the medic is not tied up. They can triage care to the EMT on scene and go back in-service and/or handle another call. Now the only one tied up is the EMT who has to wait.

The Medic is not going to transfer care unless there is a crew to transfer to. Before the paid EMT, it only a driver was present the ambulance would not respond unless an EMT filled out the crew. So if OVAC was unavailable, sometimes it could take an absurdly long time to find mutual aid. Today if such situation arises, the paid EMT will respond to scene and the medic will fill out the crew if mutual aid is unavailable in a timely fashion.

[MoFire390 118]

So why not take the berden off ur neighbors and speak with a paid service to supply 1 M/A BLS ambulance. I can think of one where there is always a unit 5min from the village