Westchester (and national) EMS-fixing the problems

[Guest alsfirefighter]

We've been slowly letting into different types of topics since the inception of these boards. So far I have been impressed with the level of tolerence about other opinions and the thoughtful input we've been seeing. So I feel its time to discuss issues that many of us talk around the table, but apparantly don't get up to let many of our leaders know how we feel about certain issues and problems, as well as how we can bring about change to even out the playing the field as far as different agencies, regions and even states in the delivery of prehospital care. Here are some of the things I feel are wrong and need to be evaluated and simply just plain changed.

First off: Funding. This is a major area that should concern almost every agency in this county regardless of what type of agency you are. You go to one agency and they are using Lifepak 10's, another 12's, some 11's some 5's. There are levels of patient monitoring that are accepted practices that many patients don't receive because of lack of funding and/or resources, even despite tax income, municipal or third party billing. There are so many taxes and such throughout the county and state that I understand a tax increase won't fly, however a surcharge would, Virginia does such a thing by adding a surcharge to all DMV transactions and add on is dedicated to EMS. A large chunk of all cigarette taxes and litigation winnings should go to EMS. FD's get 2% funding from fire insurance, why doesn't EMS get a percentage of motor vehicle and/or accident insurance. And to ensure the money would be fair, the amount received would be on a slide scale basis of funding, that way private EMS companies would still get funding, but it wouldn't go into pockets, instead it would be required to go to equipment each year equalling out the level of service all citizens get.

2. Access: One of the biggest blunders made by this county in recent years was 911. Which was also way to late. There are over 40 PSAP's in Westchester, 7 EMS agencies get dispatched by 60 Control. The day and age of "we like having control" which is a ridiculous arguement is over. Westchester County public access via 911 breaks almost every recommendation made by Nena and congressional bills that started 911 in 1968, we got it county wide around 1995 or so. Whats wrong with this picture? Not allowing a central answering point (like dutchess) limits access, hiders proper resource management (mutual aid and such) and withholds EMD which is proven to increase survival rates for out of hospital cardiac arrest.

3. "Paramedic" shortages: Sounds funny, but it is getting to that point not just in Westchester but other regions nationwide. Whenever meetings are held to discuss the issue and what can be done, it is often relayed prior to politicians and other money givers and "decisionmakers" entering that money should not be brought up at any time, "because its not a money issue." ARE YOU KIDDING ME? Sure we can say its not fully a money issue, but the big issue is money. I'm talking about overall money, salary, benefits and retirement. Sure isn't a shortage of people wanting to be cops or firefighters. Why? Salary, most firefighters and cops top salaries are in the upper 50's, lower 60's on avg. 45k a year in westchester is tough, especially when the avg salary is 62k a year according to census. Add on very few civil service jobs, the job satisfaction drops, and my experience in private companies makes me thank everyday I don't have to deal with some of the ridiculous things and policies that I've seen every day. Now you add in regional squabbles about CME's and call audits and some other really ridiculous actions I've seen done over the past few years in regards to who is or isn't taking CME's and call audits from here and there, or people getting suspended because of paperwork errors on a particular regions part is absolutely intolerable. THESE ARE PEOPLES JOBS THAT ARE BEING SCREWED WITH!! I'm all for suspending those whom don't make the grade, but refusing training of any sort is ridiculous especially those whom work in 2 regions and/or live in one and work in another!!! The REMAC should be there for employees not hindering their income and family survivability.

TRAINING: Its coming along very well I must say, but on the local levels it can be questionable. This is another topic that is too long to address here.

DELIVERY: Not trying to upset anyone here, but there are places where you can get a pizza quicker then an ambulance. A better mutual aid plan needs to be addressed as well as a criteria for when an agency should have to address their response. And I'm talking based on response time, % of calls drop to another agency on initial dispatch. Mutual aid is fine and all agencies will miss a call here and there, but not when it becomes habitual. Once you miss the criteria you should be put on notice, no change in a designated time and you should have to address the possibility you may have to supplement your agency with some sort of compensated personnel.

Add on and discuss....PLEASE!!!

[x635 4,066]

I absolutely couldn't agree more. Great post!

(PS I will throw my thoughts in a little later)

[CG206 29]

Excellent post!!! I could not agree more on the issues addressed here. With the fact that EMS runs seem to be rising in most areas, I feel that funding and manpower are the 2 biggest issues that have to be seriously looked at now and in the future. Unfortunately, volunteerism for ambulance corps seems to be declining and a corps cannot hire personnel without the adequate funding. I also have to add that I think that neighboring EMS agencies should know the capabilites of eachother, so that both can work together more efficiently. Just like the fire ground, if each ambulance corps knows what their neighbors have as far as equipment or other types of techniques, operations together at scenes can become more efficient on top of gaining more insight. Lastly, centralized dispatching can make those mutaul aid calls easier. Example: Mohegan and Yorktown have on occassions used a member from each corps to fill a crew...a driver from one corps and an emt from the other. This beats the need to further call upon mutual aid from a third corps to cover a call. Although this does not occur often, it sure helps when both agencies cannot roster a crew for that one particular call. With centralized dispatching, this can be useful more often, rather than having to monitor the other corps and work it out over the radio or phone to the different dispatching agencies. Does this compensation for a crew occur between other ems agencies?? Any other opinions out there???

[Mofire24 27]

ambulance corps are not giving anyone an incentive to stay or become members. they like to make it difficult to stay a member, and alot of ems agencies take members from other ems agencies instead of saying you live in this jurisdiction you should join with them. thats basically robbing the other vacs or corps of members. and some agencies demand you become an emt within a certain time frame. they are quick to demand ,but what do they do to give you any incentive to do so.

[Guest alsfirefighter]

Mofire, perhaps you could elaborate more on your post in regards to several issues you raised by being more detailed and giving us some of your ideas to solve the problems you raised.

What kind of incentive do you feel that a volunteer agency should give? Other then uniform type stuff, maybe some equipment here or there? The only other real option is a incentive program similiar to what many fire departments have. This isn't intended to upset anyone, but even ems companies lose personnel and their "incentive" is a paycheck. As far as making it difficult to stay a member, this must be a leadership issue you are referring to, in regards to attitude and running things. The only other issue is DOH standards which I will never argue and perhaps would say they are still too laxed. These are people we deal with, with illnesses and conditions that require skill.

Think about this, every 3 years in NY EMS providers have to recertify their certification by either CME based recert or retest. Anytime a new protocol comes up, is changed, or skill introduced or condition comes up, EMS is required to do an update. But to be a firefighter, which can be even more dynamic in nature then EMS in regards to all aspects, YOU BECOME CERTIFIED ONCE AND NEVER HAVE TO DO A CLASS AGAIN!! (the exception is career firefighters whom are required to have 100 hours of training annually, and OSHA requirements that many don't follow requiring hazmat ops refresh, bloodborne pathogens and hazard communication, and certain topics required that even more dept. either have no clue, nor do it the way it should be)