Starting a new VAC

[Arbrow06 5]

Hey Guys,

I wanted to know the process in creating and supplying a new VAC. I also wanted to know a estimated time frame. I also would like to know if any of you guys have taken on such a task.

Do you guys think starting a new VAC in Westchester is plausible?

Thanks for your input guys. Also if anyone has ever started a VAC before please let me know.

[JM15 386]

Where?

[Arbrow06 5]

Lower Westchester like servicing the areas of mt vernon yonkers pelham manor new rochelle maybe even larchmount and mamaroneck since they are small towns along 95. Also where can I get info about call statistics ? as in how many calls a year wait times between call taken and ambulance arrival

[foreman1923 22]

You would need a really good core of about 60 members with nothing to do and about 8 or 9 ambulances to cover those districts. Plus who would cover Als? Empress has been a fixture in Yonkers for a long time as well. If you were going to start a vac to supplement them like throggs neck vac does in the Bronx that may work otherwise it's too big to handle

[Arbrow06 5]

Do you know who covers that area currently of Pelham Manor, New Rochelle, Larchmount and Mamaroneck. Like in simple words its a VAC but I want to ultimately take it a step further to be utilized for research in EMS etc. etc. and ALS would be as most VAC do by a paid medic or we could be strictly BLS and call in for ALS so we can start pt. care and head towards the hospital in a serious case and have a rendezvous en route or hopefully in most cases they meet us on scene and we transfer care to them. Thats what we do up in Syracuse, NY with the university ambulance.

[MoFire390 118]

Empress covers Pelham/Pelham Manor both ALS and BLS. New Rochelle is covered by Transcare, I believe Mamaroneck has their own ambulance corp. not 100% sure though.

[dmc2007 17]

Do you know who covers that area currently of Pelham Manor, New Rochelle, Larchmount and Mamaroneck.

Pelham Manor is covered by Empress Ambulance (with an ALS fly car and transporting ambulances sent in as needed). New Rochelle is covered by Transcare with 2.5 ALS Trucks (2 24 hour and 1 12 hour). The Village of Larchmont and the Town of Mamaroneck are covered by Larchmont VAC, while the Village of Mamaroneck is covered by Mamaroneck EMS. The last two have 24/7 ALS staffing through the Town of Mamaroneck Ambulance District.

Like in simple words its a VAC but I want to ultimately take it a step further to be utilized for research in EMS etc. etc. and ALS would be as most VAC do by a paid medic or we could be strictly BLS and call in for ALS so we can start pt. care and head towards the hospital in a serious case and have a rendezvous en route or hopefully in most cases they meet us on scene and we transfer care to them. Thats what we do up in Syracuse, NY with the university ambulance.

An ALS intercept system would be a downgrade from the current system, as all of the areas you mentioned except Pelham presently have dedicated ALS transporting ambulances. You're talking about transport times here of 10-15 minutes max, often less.

[Bnechis 3,961]

NYS Health Law Article 30 requires all ambulance services to recieve a CON (certificate of need) from the Department of Heath. To get that you have to prove that there is a need for an ambulance service in an area and that an additional ambulance service would not (financially or membership drain) hurt the existing services. To prove need, you would have to show that calls are either not being covered or are being delayed. Since the area is fully covered by ALS services with average 4 minute response times you will not be able to prove need. An additional service will financially hurt the 2 existing services in (MV, NR, & Pelham). You could also hurt the membership rolls of Eastchester, Scarsdale and Larchmont/Mamaroneck VAC since many of there members come from NR.

Since each of the communities already have established services and are dispatched by the local police (most via a service contract) you will no be able to recieve calls.

Finally, Most VAC's are having major problems with staffing, instead of watering down the pool, why don't you join one of the existing VAC that could use the help.

[helicopper 1,050]

NYS Health Law Article 30 requires all ambulance services to recieve a CON (certificate of need) from the Department of Heath. To get that you have to prove that there is a need for an ambulance service in an area and that an additional ambulance service would not (financially or membership drain) hurt the existing services. To prove need, you would have to show that calls are either not being covered or are being delayed. Since the area is fully covered by ALS services with average 4 minute response times you will not be able to prove need. An additional service will financially hurt the 2 existing services in (MV, NR, & Pelham). You could also hurt the membership rolls of Eastchester, Scarsdale and Larchmont/Mamaroneck VAC since many of there members come from NR.

Since each of the communities already have established services and are dispatched by the local police (most via a service contract) you will no be able to recieve calls.

Finally, Most VAC's are having major problems with staffing, instead of watering down the pool, why don't you join one of the existing VAC that could use the help.

Barry summed it up very nicely. You can't just "start" an ambulance service (volunteer or commercial) without demonstrating the need for it, having the financial, human resources, and logistical capital to do so, and establishing these facts to the satisfaction of the applicable regional EMS council and NYS Bureau of EMS. Since some of the most well established EMS coverage in the county exists in the area you describe, I doubt very much you'd be able to demonstrate that need and I don't know who would support such a venture with the money necessary to start-up.

If you want to do research on the efficacy of the existing systems, contact them and ask for data. Work with the region and BEMS to obtain information. You don't start a new agency to do research.

Advocating a step backward in our already troubled EMS system won't be very well received by most and the system you describe may be advantageous for a university based volunteer system but even in Syracuse, Rural Metro provides the EMS service to the city. Not a VAC.

It would make no sense from any standpoint to try and duplicate them.

[Arbrow06 5]

Thanks guys! I appreciate the input it was very helpful. Do you think the VAC in the area would be succeptive to a young guy trying to do EMS research with their vac and pt. As the subjects

[helicopper 1,050]

Thanks guys! I appreciate the input it was very helpful. Do you think the VAC in the area would be succeptive to a young guy trying to do EMS research with their vac and pt. As the subjects

You'd have to approach them and ask. Really the only agencies with a volume that lends itself to research is Empress and TransCare. The others have much lower call volumes and fewer patient contacts so your sample may leave something to be desired.

You can also approach some of the NYC 911 providers if you're looking for data but patient information is obviously going to be protected.

Good luck.

[craigs71 5]

Maybe you should just stick to beer pong

[ny10570 745]

What are you trying to research? How far along are you into this? Are you receiving any support for this study? There's a lot of data out there, but to get access you've got a few hurdles. If you want, pm me the details and I'll see if I can help you get access.

[Medicone 14]

Not to be a downer, but your chances of getting a CON for an area already covered by adequate EMS is like 1 in 1,000,000; not exactly that ratio, but it would be near impossible.

First you have to show a need, most likely you will have to get the data from one of the commercial agencies who provides coverage who probably would not want to part with it.

Second, assuming you get the data, you put in an application to REMSCO. You will probably not be surprised to see all the commercials/potential competitors of yours sitting on the REMSCO as members; don't expect them to do the right thing, assuming there is a right thing. They will not turn on their interests.

Third, even in the slim chance that you get enough REMSCO members to agree that there is a public need, and that your CON should be approved, all the commercials have a chance to appeal it.

Fourth, assuming they appeal it, it goes to SEMSCO which also is littered with commercial ambulance lobby grounds that control who gets a license. Plan on them not wanted to give you a share.

So, the whole process is supposed to be 60 days, that is up to the REMSCO determination. Plan on it taking anywhere between 1-3 years or until you run out of money on legal fees fighting the man.

It's sad, but it is a very difficult process to get a new license due to the conflict in the REMSCO's and SEMSCO's.

I am speaking from experience. But with that said, there is always that chance, so best of luck!!

-M1

[Jybehofd 85]

Do you know who covers that area currently of Pelham Manor, New Rochelle, Larchmount and Mamaroneck. Like in simple words its a VAC but I want to ultimately take it a step further to be utilized for research in EMS etc. etc. and ALS would be as most VAC do by a paid medic or we could be strictly BLS and call in for ALS so we can start pt. care and head towards the hospital in a serious case and have a rendezvous en route or hopefully in most cases they meet us on scene and we transfer care to them. Thats what we do up in Syracuse, NY with the university ambulance.

EMS Research is intresting but very very hard to do with a VAC because you have to man the ambulance and stuff 1st. maybe you can do an intership or something with Empress, Transcare or somebody. they might let you if your doing it on your dime and stuff... but its hard to tell.

[sympathomedic 383]

In terms of call volume: Empress Yonkers about 17,000/year. Empress total= about 70,000/year, NOT including the VAC's they provide EMT's for: Hawthorne, Peekskill, Mohegan. As I recall, Mt Vernon is good for about 6000 calls/year. Larchmont and Mamaroneck are about 1200/year EACH. EVAC about 3500/year. Empress does have an observer program, or at least I think we still may. HIPPA changed the landscape a tad. That may also cloud up your chances of gathering research data.

Side note: I saw an article about the mis-application of HIPPA. It said the office that receives HIPPA complaints had gotten 26,000 complaints. only NINE were complaints about violations, the other 26,000 were complaints about people mis-applying the law to wrongfully block access to info.

Anyhow, if you can give me a little info about what you want, maybe I can speak to a boss at Empress for you.

[Bnechis 3,961]

Not to be a downer, but your chances of getting a CON for an area already covered by adequate EMS is like 1 in 1,000,000; not exactly that ratio, but it would be near impossible.

First you have to show a need, most likely you will have to get the data from one of the commercial agencies who provides coverage who probably would not want to part with it.

You are correct in his chances, but not for the reasons you stated. There are 2 commercial, 1 vac and 1 ambulance district in the communities listed (L/M, MV, NR & P). All are dispatched by the municipalities (either directly or via 60 control). The data is public information and does not belong to the commercial services. The info needed is not how many calls are done, be it 1 or 1,000,000 what difference does it make, since the data you need is how many calls are not being covered or not being covered in a timely manor (as you are trying to prove need). Since 99% of the calls are being covered by ALS services within the national response time standards, you will not be able to prove need for another service (particularly one that is at a lower training level).

Second, assuming you get the data, you put in an application to REMSCO. You will probably not be surprised to see all the commercials/potential competitors of yours sitting on the REMSCO as members; don't expect them to do the right thing, assuming there is a right thing. They will not turn on their interests.

It's sad, but it is a very difficult process to get a new license due to the conflict in the REMSCO's and SEMSCO's.

I am speaking from experience. But with that said, there is always that chance, so best of luck!!

While much of what you have said about REMSCO's are true in many regions, the Westchester REMSCO has a specific number of seats dedicated to each type of organization (Commercial, VAC, Vol Fire, Career Fire, PD, Hospitals, Health Dept., etc.) and only 2 of the 30 voting members are allowed to represent commercial services. The Transportation Committee (who investigate CON requests) is chaired by a Sr. Law Enforcement Official (who does not work for any EMS agency). By NYS regulations, the committee has to investigate if their is need and if an additional service will hurt the existing services. Removing $2 million+ in billables and additional competition for volunteers in the region will hurt existing services. The Westchester REMSCO does not allow any members to vote if they have a financial incentive and we have seen member abstain in a number of CON issues based on this.

So unless your experience is with the Westchester REMSCO, you do not know what you are talking about.

[helicopper 1,050]

Not to be a downer, but your chances of getting a CON for an area already covered by adequate EMS is like 1 in 1,000,000; not exactly that ratio, but it would be near impossible.

First you have to show a need, most likely you will have to get the data from one of the commercial agencies who provides coverage who probably would not want to part with it.

Second, assuming you get the data, you put in an application to REMSCO. You will probably not be surprised to see all the commercials/potential competitors of yours sitting on the REMSCO as members; don't expect them to do the right thing, assuming there is a right thing. They will not turn on their interests.

Third, even in the slim chance that you get enough REMSCO members to agree that there is a public need, and that your CON should be approved, all the commercials have a chance to appeal it.

Fourth, assuming they appeal it, it goes to SEMSCO which also is littered with commercial ambulance lobby grounds that control who gets a license. Plan on them not wanted to give you a share.

So, the whole process is supposed to be 60 days, that is up to the REMSCO determination. Plan on it taking anywhere between 1-3 years or until you run out of money on legal fees fighting the man.

It's sad, but it is a very difficult process to get a new license due to the conflict in the REMSCO's and SEMSCO's.

You're right that the odds of getting a new CON anywhere in Westchester County are slim to none but your characterization that the commercial agencies are the reason why not is off base. Commercials are represented on REMSCO's but, as Barry pointed out in very small numbers, and their members are not permitted to vote on matters where there is a conflict of interest or they have a fiduciary interest. An executive from XYZ ambulance can't vote against 123 Ambulance if they're competitors. Conflicts of interest arise in these matters often and are the basis for many spirited debates.

The volunteer agencies have as much right to contest a CON if they are going to be affected by it. Eastchester, Larchmont and Mamaroneck could all object to another agency being started in their back yard. It's not strictly commercial opposition.

The process by statute only takes 60 days but appeals and other things could add time to that.

The arbiter of an appeal is an Administrative Law Judge in an Article 78 hearing. They are objective and hear only facts in evidence not speculation or rhetoric. They don't base their decision on commercial entities desires or competition.