"Volunteers vs. Paid? Nope. It's Volunteers vs. Patients."

[Goose 188]

The below link was sent to me in an email. It's well written and thought out and while its soley about Sufflok County, it seems awfully similar to what goes on in Westchester.

http://resqrev.blogspot.com/2013/06/volunteers-vs-patients.html

[antiquefirelt 994]

Good article. Interestingly, while that was specific to Suffolk CO. NY, as noted the facts ring true in far more distant areas. In our Co. up here in Mid-coast Maine the same pains are being felt. The oldest and largest "volunteer" EMS agency just lost out it's coverage area to the State's largest "for profit" private company. The issue was the minuscule amount of money the incumbent agency charged the communities no longer covered the rising costs and loss of volunteer help. Some bad business decisions that forces some poor care decisions didn't help either.They sought the funds to "right the ship", but alas, change happened and the 77 year old non-profit company was handily voted out by each town it served. All around us the vol. ambulances are having a far harder time staffing crews, and they certainly aren't turning out in the rapid fashion that EMS has come to expect to maintain a standard of care. At least half now have per diem crews which is driving their costs up and still ignoring the issue that starts at about 3:00 am (lull between vol. turnout and per diem shift).

Edited June 19, 2013 by antiquefirelt

[50-65 205]

A lot of this could very well be applied to the volunteer fire service as well.

[firemoose827 324]

_{We have the same issues in my county, but a lot of it here boils down to pride and ego. I have argued countless times with the EMS in my department because its the same EMT and same Driver that show up to every call, and they both take over 10 minutes to get to the rig and the rig takes 15-20 minutes to roll out the door; this includes Delta and Echo calls. I have brought up automatic mutual aid with 2 of our nearest agencies to be simultaneously toned out with us and the first rig to roll gets the call, and it can be a mix-matched crew if needed, like our driver with our rig but with an EMT from the other agency. The answer I got? "Well, we should be allowed to answer our own calls, its our town and we should get the chance to roll to the call before anyone else does"...................}

_{I have timed our EMS several times for Charlie, Delta and Echo calls and the best time I have seen is a 6 minute time (for the rig to roll after initial tone out time) and that was because they were at station for a meeting. The best time otherwise is 15 minutes...UNACCEPTABLE for any call you respond to. As mentioned and well known already, it only takes 4 minutes for brain death with lack of O2. It may take 4 minutes for the family to call EMS, talk to the dispatcher and get the tones out...then you make them wait another 15-20 minutes for a rig to show up? And then its only staffed with an EMT fresh out of school with minimal experience and no ALS support????? Yes, this system is flawed beyond repair and its being ruined by volunteers with extremely large egos and personal pride. People are putting their pride before the needs of the patient and it needs to stop.}

_{Very well written article and i am from Suffolk County originally, I was raised in Northport NY. Its hard when you are a volunteer that started in a larger, well run agency with a large call volume and more volunteers than you know what to do with ending up in a small town agency, with a handfull of volunteers and a small call volume. You try to offer advice and they instantly get defensive and insulted because "The big city man is trying to push his way in and run our squad thinks he knows it all, trying to boss us around..." yadda yadda yadda.}

_{Pride. Ego. Need to put those things asside and put patients first. I dont care if its an ambulance from 10 miles away that just so happens to be driving through our town returning from hospital; if they are staffed they should be able to call the dispatcher and say they will go to the scene and assess the patient and give an update. If the other squad still has not answered tones then they SHOULD be able to transport; no arguments or petty attitudes, turf wars, "this is my call what are you doing here" BS that most volunteers display. (And to end the pettiness right now, I have been in volunteer EMS for 18 years now as well as career EMS for 11 years, I have been a volunteer EMS lieutenant, Captain and training officer. I have specced out a new rig, and applied for our squad to become ALS certified all at the age of 19) I too am not a volunteer basher, I am a proponent for the patient. I have been a patient and did not want to wait 20 minutes for a rig. My child was a patient and I almost grabbed her and ran in my car instead of wait for the rig to finally decide to arrive. I too used to have that disgusting attitude of "Its our call, dont let XYZ agency take it, lets get a crew and respond even if it takes 20 minutes and 4 tones of our pagers"......That was wrong and I know it now. We need to get the proper care to the patient within minutes. Period.}

_{End of rant...sorry! lol}

[JM15 386]

It took 6 minutes for an in-house crew to respond? I think I am confused on this part.

_{I have timed our EMS several times for Charlie, Delta and Echo calls and the best time I have seen is a 6 minute time (for the rig to roll after initial tone out time) and that was because they were at station for a meeting.}

[SageVigiles 1,194]

Second, utilize volunteers more effectively. Gone should be the days when volunteers respond from home to the station. Put them in quarters: When you're on duty, you're at the station, in uniform, and ready to roll. Period. No pagers. No green lights. Rather, a ten step walk to the ambulance and out the door in less than a minute.

Yes.

Volunteer departments should be making every effort to encourage their members to staff stations. I actually beat the career guys in our department first-due to a job the other night because we were doing a shift night. We have dinner as a group, run a couple quick drills, make sure the rigs are in order, maintain some tools, etc. Not only are you providing a more timely service to your first due area, you're building camaraderie and helping keep the station in order.

Not everyone can come in for cleanup night due to work schedules, etc. But maybe they can hang around the station for 4 hours to respond to whatever alarms come in. If your department uses a points system, X number of points every 4 hours for a staffed crew at the station. Helps the guys with odd schedules stay active in the department and keeps the rigs on the road. Obviously not everyone can do this due to work, family commitments, etc. But if we get 15% of the department to start staffing the trucks, are we not improving service?

I don't think we should be doing away with pagers, etc. But if we can encourage our membership to be in quarters to at least get a first ambulance/engine/rescue out the door within a few minutes, it only helps us. The guys at home can come get the next call or the second-out piece.

Edited June 19, 2013 by SageVigiles

[antiquefirelt 994]

_{have timed our EMS several times for Charlie, Delta and Echo calls and the best time I have seen is a 6 minute time (for the rig to roll after initial tone out time) and that was because they were at station for a meeting. The best time otherwise is 15 minutes...UNACCEPTABLE for any call you respond to.}

Well maybe those in our area are not so bad off... our dispatch center just started using the dispatch codes this past week, but had been using EMD for years (just not telling us the determinant codes). The local EMS agencies are all excited (in a bad way) but the arguments are over requiring M/A on C, D or E calls within 3 or 6 minutes of the initial tone (not a lot of volunteer medics in our area). Of course things are hard to compare when you don't look at the population density, travel times and receiving facility options.

[firemoose827 324]

It took 6 minutes for an in-house crew to respond? I think I am confused on this part.

Yes so am I. When I heard the call come out I was home and knew there was a meeting at that time and expected to hear them call out immediately yet it took over 5 minutes. Apparently they had the tables set up in the garage in front of the rig and had to move them (Nice weather and they wanted to have meeting outside)

Then there was confusion on whether EMT was taking call or not...typical backwoods junior high BS...

[50-65 205]

We have a "volunteer" agency in a nearby town that I belonged to for a short time. They have 24hr paid paramedic staffing and daytime paid EMT/EMT-I. The volunteer crews are required to be in station, in uniform when on duty. If you are not on the duty roster, you are not to be at the station after 11pm (I think it's 11. It's been a while). This agency has an average time from dispatch to on scene of 6 minutes or less depending on where their call is. I believe that most of the time, they are on scene in 4 minutes or less.

It is not unusual for them to staff an ambulance for 2nd and 3rd calls, even in the daytime.

Unfortunately, I think they are an exception rather than the rule.

On the other side of the coin, is the ems in my town that is paid 6a-6p x 7 days. The chances of a second rig getting out during the day is all but 0. From 6p to about midnight you have a fair chance of an ambulance showing up. Midnight - 6a you're waiting for the commercial service to get to you.

[Jybehofd 85]

its a great article and hits the problems right on the head. I sent a minor head lacerations BLS to the medical center because it was the weekend and i know that the plastic surgeon wasn't going to come in on a weekend to see a 10 year old girl so the scar could be small... and they went to the local level 4 hospital anyway because it was a closer transport time.... and the family wanted her to see a surgeon at least.

[firemoose827 324]

Well maybe those in our area are not so bad off... our dispatch center just started using the dispatch codes this past week, but had been using EMD for years (just not telling us the determinant codes). The local EMS agencies are all excited (in a bad way) but the arguments are over requiring M/A on C, D or E calls within 3 or 6 minutes of the initial tone (not a lot of volunteer medics in our area). Of course things are hard to compare when you don't look at the population density, travel times and receiving facility options.

Good points you bring up that I forgot to mention to give a better perspective for our times.

Our town, according to the last census taken in 2009, is 9.2 square miles with roughly 2500 people. Our department; 32 members (Including life, exempt, auxilliary, and administrative as well as fire and ems), 9 of which are interior qualified (Firefighter I or equivilant training) and 2 EMT's, Engine, Engine/Tanker, brush truck, Rescue, UTV Brush/rescue, and Ambulance. (I am in the process of making some GIS type maps of distances to other mutual aid departments, travel times to each others districts, and travel to hospitals)

Our county runs paid EMS coordinators, three, all paramedics with flycars, and they take shifts in different parts of the county for a quicker response.

We have a local hospital (more like first aid station) in the town to the south of us with a small ER, and a 50 bed wing, small OR that does basic operations (Like my shoulder repair), they have clinics, lab and xray unit but nothing special and they cant offer much to the PT. They are a 15 minute ride for us depending on what part of our district we are in.

The nearest trauma center is a Level II trauma at Bassett Hospital in Cooperstown NY, which is a 30 minute ride for us.

There is Albany Med, a Level I Trauma center and cardiac/burn units as well, where Life Net is based out of, they are a 45 minute ride for us.

Ellis Hospital is a decent medical hospital with cardiac cath lab, OB unit and a good ER. They are 40 minutes out.

AO Fox Memorial is a decent hospital with a newly rennovated ER, OB, Psych, and orthopedic services and they are an hour for us.

Nearest Burn Units for us.....Westchester or Syracuse. (Albany is only basic treatment until they can be flown out by Life Net.)

[Jybehofd 85]

We have a local hospital (more like first aid station) in the town to the south of us with a small ER, and a 50 bed wing, small OR that does basic operations (Like my shoulder repair), they have clinics, lab and xray unit but nothing special and they cant offer much to the PT. They are a 15 minute ride for us depending on what part of our district we are in.

The nearest trauma center is a Level II trauma at Bassett Hospital in Cooperstown NY, which is a 30 minute ride for us.

There is Albany Med, a Level I Trauma center and cardiac/burn units as well, where Life Net is based out of, they are a 45 minute ride for us.

Ellis Hospital is a decent medical hospital with cardiac cath lab, OB unit and a good ER. They are 40 minutes out.

AO Fox Memorial is a decent hospital with a newly rennovated ER, OB, Psych, and orthopedic services and they are an hour for us.

Nearest Burn Units for us.....Westchester or Syracuse. (Albany is only basic treatment until they can be flown out by Life Net.)

why would the transport time matter if its going to bring the patient to the correct facility, when that said patient is stable. Yes when the patient is unstable and with out a good airway go to the closet place you can. And life net is also a good resource to close that time when available.

Be the patient, think if they were your mother or father or close loved one where would you want them to go when they are stable and able to make the trip... majority of our patients are stable enough to endure a 30 to 45 min transport time if it means they go to a cath lab or OR in minutes on arrival to said higher care facility.

[firemoose827 324]

why would the transport time matter if its going to bring the patient to the correct facility, when that said patient is stable. Yes when the patient is unstable and with out a good airway go to the closet place you can. And life net is also a good resource to close that time when available.

Be the patient, think if they were your mother or father or close loved one where would you want them to go when they are stable and able to make the trip... majority of our patients are stable enough to endure a 30 to 45 min transport time if it means they go to a cath lab or OR in minutes on arrival to said higher care facility.

Thank you, but I was mainly concerned with posting the square miles and population as a time factor in our response, I just got ambitious and posted the rest of the information as well for further discussion. I am aware that PT's condition affects what hospital you transport to. I just wanted to paint the picture for all that are not from my area to see what we face outside of the Westchester area with large travel distances to the scene and to the hospitals taking our crews hours for just one call. The average time spent on EMS call here is about 2 1/2 hours from tone out time to leaving the station to go home. (Factors that affect our membership and high turn-over rate)

[EdAngiolillo 61]

FireMoose started this and I see a quote about putting the volunteers IN THE STATION. 100% absolutely true! Last year, Chester County (my home turf) enacted a dispatch change stipulating: Ambulance XX gets dispatched, if no response (I mean ON THE ROAD, not re-dispatch for driver, EMT, IV bag holder, etc), the next due gets dispatched. PERIOD. End of argument. There was a LOT of pushback in the rural western half of the county because, you guessed it, it takes at least 5 minutes to hop out of bed and drive to the station! I was at that meeting and I can tell you, those fire companies were told, in so many words "well, tear down your bar and/or your social hall and start building bunk rooms like the rest of us, or you'll be out of business in a year."

While my squad is now mostly paid staff, we have a strong and active volunteer contingent that MUST be in-house for their 6 or 12 hours and in uniform (identical to the paid staff since we're all there to do the same thing, save lives). The only time we page out for additional help is when we need to roll our bariatric truck or certain occasions when the duty crews will be committed to an incident for an extended period of time.