Penalties For Not Being Able To Get Out

[x635 4,066]

EMS-wise, I'm wondering if their are any penalties that could be imposed on agencies that can't get a crew and respond, or have significant delays in getting out on a frequent basis?

In Westchester, for example, how many chances are agencies given to get a crew before the next agency is called for mutual aid?

Do VAC's have a CON?

Could NYS*DOH or REMAC take their agency out of service, and replace them with a commercial service or another agency that has the capacity to handle their calls until such time the agency figures out how to resolve their issues?

[10512 214]

The issues are simple.

There are not enough volunteers.

The answer is what is going to be difficult.

Throwing penalties at the problem is not going to get more volunteers.

I do not have the answer. Paid services and/or merges might be an answer, but for many reasons, may not be feasible.

Edited October 28, 2013 by 10512

[Bnechis 3,961]

1) Do VAC's have a CON?

2) Could NYS*DOH or REMAC take their agency out of service, and replace them with a commercial service or another agency that has the capacity to handle their calls until such time the agency figures out how to resolve their issues?

1) Yes all agencies in the state are required to have them and about 1 year ago they were reviewed and updated. There were a number of issues for some because the coverage areas in the CON (certificate of need) did not match what was being covered, the best example was Tarrytown & Nyack. They each cover the TZ Bridge, TVAC going north & Nyack south. but the CON's say they cover the eastern 1/2 and western 1/2 (to the county line). Was corrected, while minor it is a legal issue. Was critical to prevent medicaid/medicare fraud for operating out of area.

2) yes & no. DOH has the legal ability to suspend a CON and they have done so but not for failure to get out. If they did there would be far fewer vacs in the state. REMAC has the ability to suspend ALS coverage, technically failure to cover 24hr/day is a reason, but they rarely (if ever) have used it for that.

Neither can order someone to cover, thats left to the community to get coverage after their regular agency has been suspended.

[EMT111 149]

EMS-wise, I'm wondering if their are any penalties that could be imposed on agencies that can't get a crew and respond, or have significant delays in getting out on a frequent basis?

In Westchester, for example, how many chances are agencies given to get a crew before the next agency is called for mutual aid?

Do VAC's have a CON?

Could NYS*DOH or REMAC take their agency out of service, and replace them with a commercial service or another agency that has the capacity to handle their calls until such time the agency figures out how to resolve their issues?

The issues are simple.

There are not enough volunteers.

The answer is what is going to be difficult.

Throwing penalties at the problem is not going to get more volunteers.

I do not have the answer. Paid services and/or merges might be an answer, but for many reasons, may not be feasible.

In orange county, county policy is three pages and then it turned over to your mutual aid, and that includes resounding for a driver or emt. Now, I don't know about westchester, but not enough volunteers is not always the problem in Orange County. I have one neighboring VAC that has a very young membership, and if it's not a hot call, they don't go. You will literally hear them page three times for an elderly fall victim, tot it to the mutual aid, and then ten minutes later page out for a rollover on the highway and they get a fly car and at least one rig out with one page, that is definitely a situation where a penalty would help. As for commercial services, in my opinion, you need to contract with them for a permanent in house rig and if you're going to do that and at that point you might as well go paid, otherwise, they may be around or not be around. Another neighboring VAC had made a deal to use Emstar/ Care 1 (whoever they are this week) as their backup since they only had a couple EMTs and their mutual aid agencies were tired of always going over there. However even though the VAC has a number of new EMTs and personnel in EMT class, they have come to rely on the commercial service to take the calls they don't want. The problem is that Emstar has a significant decrease in the number of units they put out over night, sometimes only two or three for an area covering from fishkill to the NYC line in Westchester, meaning that frequently they don't have a rig available to respond. The area is also generally covered by a fly car, which for obvious reasons can't transport, so they mutual aid rig has to go too, which kinda defeats the purpose of the Emstar agreement. I think part of something that needs to be looked at is how to get volunteers out to these calls that aren't glory filled picture on the front page of the newspaper type calls.

[Westchester 49]

You know I was going to jump into this thread ! Several months ago I started this same type of topic involving Irvington Volunteer Ambulance Corps. To this date I still don't know what the solution to this ongoing problem within Volunteer Services. IVAC still uses mutual aide to cover blank spots in there schedule. I know they had there yearly elections and they have a new Captain and 1st Lieut. but no 2nd Lieut. Knowbody wanted the position! I think there getting a little better, but not what they used to be. IVAC was threatend with a fine and suspension if they use mutual aide cause they can't get members on shift assingments. Same problem, same result, NOTHING!!!!!!!!!!!

[Bnechis 3,961]

IVAC was threatend with a fine and suspension if they use mutual aide cause they can't get members on shift assingments. Same problem, same result, NOTHING!!!!!!!!!!!

Who threatened them?

[firemoose827 324]

Volunteer EMS agencies are quickly fading away. We have an ambulance sitting in our station with no one to run it. All of the EMT's are gone and we only have about 5 active members, drivers and attendants only. It has been out of service for a few months now and we go automatic MA for all calls. When we get a structure fire we tone out our neighboring department for both fire and ems assistance.

One of the largest departments in our county that averages 500-600 calls annually with 2 rigs even has trouble getting out. If not for the very dedicated captain/paramedic they have responding to all their calls they would turn-over more calls.

EMT Training is also difficult to go through for someone with a FT job and family obligations, it's not just firefighter 1 training thats hard to take. They could be away from their families for months, 2 nights a week, some saturdays spent in ER's and OR's or riding second on ambulances, and then afterwords having to keep up with CME's (depending on what level you are) every 6 months, meetings, drills, fundraisers...

I was a member of 2 separate organizations in my previous department where the EMS agency was a private organization separate from the fire department. I was an 18 year old EMT taking my EMT-CC class, Lieutenant in the EMS agency, taking fire classes left and right, going to two meetings a month and 2 drill nights a week, working bingo at 2 organizations on a weekly schedule for fund raising on top of responding to calls. That was rough too, when there was an MVA or fire I would respond with the FD and I told the EMS agency that the FD came first for me, if it was a straight EMS call I would respond with them, otherwise I was a firefighter.

Its tough to be a volunteer anything today...there is just no time in the day for someone with a FT job, maybe a PT side job, spouse, kids, dogs, cats, house to take care of, gold fish to feed...its not like it used to be where there was one bread winner in the house working only M-F 9-5 and had enough spare time to volunteer. You need to work 2-3 jobs just to barely scrape by in today's world and its killing the volunteer sectors. But once the community has to pay for a monthly career EMS agency to run calls maybe the tune will change but that will never happen...no one can afford career EMS, not around me anyway, they can barely run a decent highway department that plows with trucks held together with bondo and a prayer, with an old piece of metal roofing welded on as a plow blade and using a leaf blower as a snow blower...imagine having to pay a FT EMS crew 24/7 365????????

I honestly dont have an answer, but know for a fact that volunteer EMS is in danger if something is not done soon.

[NJMedic 96]

Here in New Jersey........

Same issues as Westchester or any where else that has bee staffed by volunteers. The NJ Department of Health, Office of EMS had a company (major player but can't remember the name) and do a study of EMS in NJ. One in a long list of "studies" on EMS in New Jersey. Municipalities have no mandate to provide EMS unlike law enforcement or fire services. One recommendation coming out of the study was giving municipalities the responsibity for proving EMS, 24 hours a day. The State and Assembly drafted legislation which passed both house at the state capital but vetoed by Chris Christie. Apparenlty he realized that assuring EMS delivery across New Jersey was going to cost money. So the budget prevailed and human suffering prevailed. And the volunteers got there way once again.

[Westchester 49]

Who threatened them?

60 Control

[v85 212]

Here in New Jersey........

Same issues as Westchester or any where else that has bee staffed by volunteers. The NJ Department of Health, Office of EMS had a company (major player but can't remember the name) and do a study of EMS in NJ. One in a long list of "studies" on EMS in New Jersey. Municipalities have no mandate to provide EMS unlike law enforcement or fire services. One recommendation coming out of the study was giving municipalities the responsibity for proving EMS, 24 hours a day. The State and Assembly drafted legislation which passed both house at the state capital but vetoed by Chris Christie. Apparenlty he realized that assuring EMS delivery across New Jersey was going to cost money. So the budget prevailed and human suffering prevailed. And the volunteers got there way once again.

So what should happen in a boro that gets about 200 calls a year. If you put paid EMS in there, or paid fire, the taxpayers will soon be screaming about them "doing nothing" or "sitting around"

[Bnechis 3,961]

60 Control

They do not have the legal authority to fine or suspend them.

[velcroMedic1987 330]

You know I was going to jump into this thread ! Several months ago I started this same type of topic involving Irvington Volunteer Ambulance Corps. To this date I still don't know what the solution to this ongoing problem within Volunteer Services. IVAC still uses mutual aide to cover blank spots in there schedule. I know they had there yearly elections and they have a new Captain and 1st Lieut. but no 2nd Lieut. Knowbody wanted the position! I think there getting a little better, but not what they used to be. IVAC was threatend with a fine and suspension if they use mutual aide cause they can't get members on shift assingments. Same problem, same result, NOTHING!!!!!!!!!!!

Who threatened them?

60 Control

"60-Control"? The dispatch center threatened them? You're going to have to do better than that. As bnechis said, 60 control has no authority to do anything to an EMS agency, except maybe stop dispatching them and I'm not even sure they can stop that if there's an inter-municipal agreement for it.

What would they be "fined" for exactly? A violation of what law or regulation?

Sounds like you're getting information late in the game of telephone and the story has changed a lot! I don't even know if NYS DOH could "fine" them for not making calls.

[NJMedic 96]

So what should happen in a boro that gets about 200 calls a year. If you put paid EMS in there, or paid fire, the taxpayers will soon be screaming about them "doing nothing" or "sitting around"

Do you think that someone would b**** if their $2 million McMansion burns down or grandpa dies because no ambulance shows up. Regionalize the response. Five towns of that generate 200 calls a year can be combined into 1 department that handles 1000 calls a year.

[Westchester 49]

"60-Control"? The dispatch center threatened them? You're going to have to do better than that. As bnechis said, 60 control has no authority to do anything to an EMS agency, except maybe stop dispatching them and I'm not even sure they can stop that if there's an inter-municipal agreement for it.

What would they be "fined" for exactly? A violation of what law or regulation?

Sounds like you're getting information late in the game of telephone and the story has changed a lot! I don't even know if NYS DOH could "fine" them for not making calls.

Your right I beleieve it was DOH or REMSCO, I getting old and forgetful I'm sorry.

I remember that Department of Emergency Sevices warned them of a possible fine or suspension cause they were not notified that IVAC Captain asked help from Dobbs Captain to cover shifts where IVAC had no one on the shift.

My days of this threading are over, it's a young persons game. Sorry for making mistakes. Good Luck and Be careful out there. God knows I wasn't.

[Dinosaur 844]

The time has come for municipalities to be held responsible for EMS, not a club like the Lions, Elks, or Masons. Sorry folks, but a VAC is really no different than those organizations. Despite all the best intentions, the volunteer era is on life support and it must really be people elected to positions of responsibility to address the issue on a long-term basis. This may mean contracts with successful volunteer organizations, contracts with commercial services, or hiring and staffing their own service.

But the days of nobody being responsible have to end.

[INIT915 1,119]

Your right I beleieve it was DOH or REMSCO, I getting old and forgetful I'm sorry.

I remember that Department of Emergency Sevices warned them of a possible fine or suspension cause they were not notified that IVAC Captain asked help from Dobbs Captain to cover shifts where IVAC had no one on the shift.

My days of this threading are over, it's a young persons game. Sorry for making mistakes. Good Luck and Be careful out there. God knows I wasn't.

I don't know where your getting your information, but it makes no sense whatsoever.

[paulie3jobs 4]

So what should happen in a boro that gets about 200 calls a year. If you put paid EMS in there, or paid fire, the taxpayers will soon be screaming about them "doing nothing" or "sitting around"

You do what is happening now, at least in north jersey (MICCOM service area). You call MICCOM and ask for an ambulance and they will send the closest (proprietary or hospital based) ambulance that is available.

The patient will be billed, but at least they won't be waiting forever for an ambulance. No contracts involved, just ask (and for the most part) receive.

[sympathomedic 383]

A related topic for this discussion is this: Many squads (Somers and Mohegan come to mind) that have hired paid folks refuse to send them out mutual aid. The arguments I have heard are, "they are too valuable to our community to send out" and "we paid for them, we won't share them with agencies that didn't".

So here is squad A that was having day-long coverage gaps, and now suddenly they hire a crew and they won't let them help someone in squad B land for an hour, a decision that could be truly life- threatening. Also, squad A in theory may have a volunteer crew for their own town- they are a Volunteer service after all.

And you can bet the FD in Town A will happily send the Towns only ladder truck, at about $800,000, to another town- with NO backfill!! $800,000 buys a LOT of $15/hour EMT's. Oh, and I bet the Town A PD sends cars to Town B when they ask. Suddenly the service that no one seems to care about is too valuable to share!

A suggestion: MANY squads get little gifts of my tax money to buy stuff- Larchmont got an bay exhaust system, other squads get CPR machines, building expansions, ambulances etc. How about this: before our government officials borrow money from China to buy the support of local service members, they do some freaking research to see if those agencies are performing, or failing to perform their moral responsibilities, versus protecting turf. And have the balls to say, "NO". Just sayin', but for the record: "As If!"

[Remember585 815]

Our local EMS agency won't send the paid EMT to only one Mutual Aid agency, but will send it to others. I am told this was because the agency in question was pulling our Paid EMT too often and refuses to resolve their own issues.

If they get two volunteers to cover the call, they will respond.

Not sure how I feel about it, but it does make sense, even if it's partial sense.

[velcroMedic1987 330]

All these stories point to the same thing = we have NO SYSTEM!!!!

[velcroMedic1987 330]

A related topic for this discussion is this: Many squads (Somers and Mohegan come to mind) that have hired paid folks refuse to send them out mutual aid. The arguments I have heard are, "they are too valuable to our community to send out" and "we paid for them, we won't share them with agencies that didn't".

So here is squad A that was having day-long coverage gaps, and now suddenly they hire a crew and they won't let them help someone in squad B land for an hour, a decision that could be truly life- threatening. Also, squad A in theory may have a volunteer crew for their own town- they are a Volunteer service after all.

And you can bet the FD in Town A will happily send the Towns only ladder truck, at about $800,000, to another town- with NO backfill!! $800,000 buys a LOT of $15/hour EMT's. Oh, and I bet the Town A PD sends cars to Town B when they ask. Suddenly the service that no one seems to care about is too valuable to share!

A suggestion: MANY squads get little gifts of my tax money to buy stuff- Larchmont got an bay exhaust system, other squads get CPR machines, building expansions, ambulances etc. How about this: before our government officials borrow money from China to buy the support of local service members, they do some freaking research to see if those agencies are performing, or failing to perform their moral responsibilities, versus protecting turf. And have the balls to say, "NO". Just sayin', but for the record: "As If!"

Bill, I don't disagree with you but there are some differences in what you're comparing.

The ladder TRUCK cost $800 K. The personnel are the issue here. It's not like someone is calling to borrow a vehicle. And let's face it, there are many more calls for ambulances requiring mutual aid these days than mutual aid fires requiring the ladder.

The PD is not a valid comparison because the PD's are all staffed to start with and each chief gets to say what he/her will send on mutual aid. The PD mutual aid plan is actually pretty impressive if you look at it. I learned about it in an ICS class at the training center. If the PD calls for mutual aid, you know how many cops to expect. Not so with FD or EMS.

The problem is there are EMS agencies RELYING on mutual aid to cover calls on a daily basis. We're not talking about 2nd, 3rd, or 4th jobs in their area.

[sympathomedic 383]

I totally hear you. Many of us detest the system player patients we come across and we always proudly tout "Patient care FIRST" as a motto. If I hear "seconds count in an emergency" again, I may vomit.

But here we are with some squads being system players, and other squads putting pt care SECOND. I like to think (fantasize) that EMS is better than to let that kind of thing happen. Do the job and ask questions later. I have planted my flag in this system, and I prefer to hold my head high and not hang it in shame.

It is complex. Some agencies are organized in a way that their towns have ZERO to say in how they operate. In others the local gov't does have control but is afraid to excersize it or they have no money to fix the problem. It kinda sucks. You call 911 and you have no choice to accept who the system designates as your responding agency, yet you have no control of the management of that agency. At least in the case of the PD and most but not all of the FD's there is some level of elected official somewhere.

I cannot accept that we, the EMT's medics and others that have the responsibility for this system are either unable (not smart enough) or unwilling (not brave enough) to solve these issues. Makes want to tear off my patches, but there are so many dedicated, proud, hard-working folks of all skill levels and agencies that make the system function as well as it still does.

But getting back to my first post; STOP giving free-bees and taking photo-ops with squads that are not getting it done. Reward the ones that are.