In The Bronx, ‘Fly Cars’ Aim to Speed Up Emergency Care

[EMSLt 27]

From The Wall Street Journal

Quote

By the end of an eight-hour shift in the Bronx, paramedic Barbara Aziz had treated a man who had broken his leg falling from a building, revived another man who stopped breathing after a heroin overdose and cradled a moments-old baby girl born unexpectedly in a public-housing apartment.

Ms. Aziz and her partner had responded to 13 emergency calls—two to three times more than a typical paramedic crew in the Bronx. The reason: She was behind the wheel of a “fly car,” not an ambulance.

Ms. Aziz’s red Ford Explorer is one of 10 specially equipped sport-utility vehicles that rolled out last year in the Bronx as part of a pilot program designed to improved emergency response in the New York City borough with the most medical calls per person in the past year.

The fly cars allow paramedics, the most highly trained first responders in emergency medical services, to respond to priority calls without taking patients to the hospital. That task, which Ms. Aziz estimates can take paramedics away from responding to calls for at least an hour, is handled by ambulances that respond along with the fly cars.

The Fire Department of New York had a record number of medical calls last year. The fly cars are a response to that increase as fire departments nationwide play a bigger role in emergency medical care.

New York City firefighters and emergency medical staff members together responded to 1.44 million medical emergencies last year, up from 1.03 million in 1996, according to department statistics.


The city has added $40 million for more ambulance shifts over the past two years and lowered the average response time for medical calls by 21 seconds since 2015, according to Mayor Bill de Blasio.
The fly car program came out of a steering group that Fire Commissioner Dan Nigro put together to look at innovations in emergency medical services, said Ed Dolan, FDNY’s deputy commissioner for strategy and policy.

Along with the fly cars, the department created a five-ambulance “tactical response group” in the Bronx that can be deployed wherever needed, rather than being assigned to a specific geographic area like other ambulances.

New York is also testing a computerized triage system for 911 dispatchers, to replace a set of flip cards now used to prioritize medical calls. The system, expected to be fully implemented this spring, will allow for better data collection so that the department can determine, for instance, which questions being asked by dispatchers are wasting precious seconds and which are eliciting needed information.

“What we’re finding is that response times have improved more in the Bronx than any other borough,” said Mr. Dolan.

Ms. Aziz, the paramedic who is also a supervisor, said she thinks the tactical response group, more than the fly cars, are responsible for the faster response times. But the fly cars are allowing her and other paramedics to respond to more calls, she said.

During her 13-call shift, she had to help transport patients to the hospital only twice.

“The good thing is, if we’re not needed, we don’t have to hang out there,” she said. “The [ambulance] can take the patient and we can be available for the next call.”

 

https://www.wsj.com/articles/in-bronx-fly-cars-aim-to-speed-up-emergency-care-1486216800

[FireMedic049 597]

8 hours ago, EmsFirePolice said:

Although a fly car may be closer to a call than an ambulance, things really will not change. NYC drivers will not pull over and let ambulances, police cars, or fire trucks through. The roads will still be congested. 

Did you even read the article or at least the portion posted? 

 

Even if "the roads will still be congested", the fact that a fly car is closer to a call than an ambulance means that ALS equipped EMS personnel will likely reach the patient sooner.  It clearly states that response times in that area are down in conjunction with this program.  That certainly seems like a good thing and it's literally change.

 

 

[x635 4,066]

I think it's an interesting tactical move. Hopefully their existence isn't just as a "clock stopper".

 

It states there are two Paramedics to each flycar. Are they able to split up when one goes aboard a BLS bus, or do both have to go?

 

It would be  very interesting if FDNY was to assign a Paramedic to each Engine company. I'd also like to see in the future a Community Medicine Paramedic program instituted.

[FireMedic049 597]

24 minutes ago, EmsFirePolice said:

I understand that the ALS fly car would reach the patient sooner,    If you understand that, then how do you not see that as "change"?

 

but in the grand scheme of things, congestion will still be a problem.   Yes, but if they are putting ALS resources on scene faster than the ambulance can get there, then it would seem that the congestion is less of a problem in terms of getting care to the patient in a timely fashion.  Again, that's "change".

 

Its gonna be interesting what the results of this program are.   I doubt that they'll be much different than what is being seen so far according to the article.

 

[FireMedic049 597]

3 hours ago, x635 said:

It states there are two Paramedics to each flycar. Are they able to split up when one goes aboard a BLS bus, or do both have to go?  I seriously doubt that they would both have to go with the patient.  Right now, the vast majority of patients being transported in the ALS ambulances are likely only being attended to by a single paramedic during transport since their staffing is only 2 paramedics.  If the system required 2 paramedics to be with the patient during transport, then they'd be staffing a third person on those units.  Otherwise, they'd have to send 2 units to every single ALS dispatch.

 

It would be  very interesting if FDNY was to assign a Paramedic to each Engine company.   It certainly would be interesting, but I doubt it would be truly beneficial vs the cost to do so on any sort of large scale.

 

[M' Ave 1,466]

3 hours ago, x635 said:

I think it's an interesting tactical move. Hopefully their existence isn't just as a "clock stopper". 

No, it seems to be helpful.  The fly car often arrives soon after us in an engine and long before a Bus.

 

It states there are two Paramedics to each flycar. Are they able to split up when one goes aboard a BLS bus, or do both have to go? 

If one rides in the bus to help during a tansport, the fly car follows and picks up the other medic before going 10~8

 

3 hours ago, x635 said:

 

It would be  very interesting if FDNY was to assign a Paramedic to each Engine company. 

No thank you!  Engines in the city still respond to far more fire runs than medical runs....and most of the medical runs do not requier our assitance.  A medic would be a waste of money and would lead to more involvment at EMS runs, taking engines away from their primary function.  

 

[Jybehofd 85]

It's doesn't make sense but if it works.  Has NYC changed the ALS protocols that a medic can work alone without a medic partner ? If so I think this is good

[M' Ave 1,466]

6 hours ago, Jybehofd said:

It's doesn't make sense but if it works.  Has NYC changed the ALS protocols that a medic can work alone without a medic partner ? If so I think this is good

They have not changed the protocol.  It would not be good if they did either.  All that would happen is, the city would start looking to cut the number of medics down and save money by using more EMTs. 

[antiquefirelt 994]

13 hours ago, x635 said:

I think it's an interesting tactical move. Hopefully their existence isn't just as a "clock stopper".

 

It states there are two Paramedics to each flycar. Are they able to split up when one goes aboard a BLS bus, or do both have to go?

 

It would be  very interesting if FDNY was to assign a Paramedic to each Engine company. I'd also like to see in the future a Community Medicine Paramedic program instituted.

Don't see a medic helping fire staffing, in fact it would likely be a greater burden on the company and result in poorer fireground staffing and more logistical down time. I say this as on a comparatively microscopic level, we run medics on both EMS and fire apparatus every shift and there is very little continuity day to day, making other tasks very difficult to schedule and complete. I realize other places do this, but the level of success is harder to measure, as in most cases EMS is used to bolster staffing for fire companies who may not have a comparable workload without it.

 

As for Community Paramedicine: until it's paid for, it too is a burden on the system, adding a service that may reduce long term medical costs to the taxpayers as a whole, but the rub is that it costs more upfront to add staff, vehicles and such, with no direct return. Our City wanted to study that model, but again, with no way to defray the upfront costs, the interest waned very quickly. 

Edited February 7, 2017 by antiquefirelt
keyboard caused misspelled words

[FireMedic049 597]

7 hours ago, Jybehofd said:

It's doesn't make sense but if it works.  Has NYC changed the ALS protocols that a medic can work alone without a medic partner ? If so I think this is good

What doesn't make sense? 

[M' Ave 1,466]

1 hour ago, EmsFirePolice said:

 

Did you even read my second line? Change will be minimal. I don't think it would be a colossal change. The ALS unit might still be stuck in traffic, and who knows, the ambulance may even arrive before the ALS fly car. I don't think we can bet on anything yet, you know how NYC traffic is.

 

I work in the city....in the boro where this is being piloted.  The change is tangable and significant.  Bet on that.  The End.

[M' Ave 1,466]

3 minutes ago, EmsFirePolice said:

We'll find out soon

 

YOU'RE finding out now, because experts are telling you.  WE'VE known for some time now, seeing as we work in this system and have been for quite some time.  This flycar thing AINT that new.

[mfc2257 464]

11 hours ago, EmsFirePolice said:

We'll find out soon

Bro you realize that M'Ave is an FDNY jake that turns out of a busy station in The Bronx right?  Sounds like your're trying to argue with someone who has made multiple posts in this thread about experiencing the benefit of the pilot program first hand.

 

What's your end game here?

[x635 4,066]

Does anyone know how they select which calls the Flycar goes on?

[FireMedic049 597]

On 2/7/2017 at 10:16 PM, EmsFirePolice said:

 

Did you even read my second line? Change will be minimal. I don't think it would be a colossal change. The ALS unit might still be stuck in traffic, and who knows, the ambulance may even arrive before the ALS fly car. I don't think we can bet on anything yet, you know how NYC traffic is.

Did you read it?  None of your comments indicated that you thought there would be a noticeable improvement (change).

 

You literally made a statement that the fly car being closer than the ambulance wouldn't make a difference.

[FireMedic049 597]

23 hours ago, M' Ave said:

 

YOU'RE finding out now, because experts are telling you.  WE'VE known for some time now, seeing as we work in this system and have been for quite some time.  This flycar thing AINT that new.

What do you so called "experts" know anyway?

[FireMedic049 597]

4 minutes ago, EmsFirePolice said:

Why did they just announce the news now? 

They didn't just announce this now.  The announcement regarding the creation of this program was done a while ago.  This was essentially a follow up article regarding how the program was working.

 

4 minutes ago, EmsFirePolice said:

 

"Bro" I didn't know that M'Ave is a FDNY member. What are you trying to get at?

It's not that hard to figure out that he is FDNY.  He's literally said it directly or indirectly in a number of posts on here.  What he's likely trying to get at is why after being told by someone with firsthand knowledge of this topic that it is successful, your response was "we'll find out soon".

[FireMedic049 597]

3 minutes ago, EmsFirePolice said:

That was what I was going for.

Then why when I explained that noticeable change was already occurring did you feel the need to emphasize that you said that change would be minimal as if trying to claim your statement was correct on a technicality?

[mfc2257 464]

1 hour ago, EmsFirePolice said:

Why did they just announce the news now? 

 

"Bro" I didn't know that M'Ave is a FDNY member. What are you trying to get at?

I think you're a young enthusiast that doesn't understand some of the respectful tones that should be carried in a conversation with a known member and frequent contributor to this forum who happens to be an FDNY Jake (look up the term if it's escaping you). Take a deep breath. Re-read the posts and you'll see the conclusion that everyone else has come to.  

[Morningjoe 162]

26 minutes ago, mfc2257 said:

I think you're a young enthusiast that doesn't understand some of the respectful tones that should be carried in a conversation with a known member and frequent contributor to this forum who happens to be an FDNY Jake (look up the term if it's escaping you). Take a deep breath. Re-read the posts and you'll see the conclusion that everyone else has come to.  

The term Hobbiest comes to mind 

[S1720G 62]

13 minutes ago, Morningjoe said:

The term Hobbiest comes to mind 

Hobbiest, exterior FF, city hater, HIHFTY comes to mind 

[LayTheLine 108]

This may be a little off topic, but in addition to this article, I saw an article about a watchdog group that wants FDNY to basically re-structure the whole department and put EMT's and Paramedics on engines and/or ladders. The above article talks about EMS Fly Cars with medics. I have an opinion and a question:

 

First I believe it would be very difficult to make the engines in the FDNY paramedic engines. You'd have to outfit all the rigs with the medic supplies and I believe it would lead to crew instability. If it were to happen and a medic from the engine were to go to the hospital they'd be down one person. Also how easy would it be to get that person back to the fire station from the hospital if the ambulance were backed up on calls. And if the medic was a Lieutenant or Captain and had to go to the hospital on a high priority call, who becomes the officer on the engine? If this were to ever be done, a huge amount of rethinking and reshaping the whole FDNY fire and ems service would need to take place. It wouldn't be a "flip the switch" and off you go.

 

My question is about the difference between EMT training and First Responder training in New York State? What is the level of care that an EMT can give as compared to a First Responder without an ambulance to transport? Where I come from, EMT's basically get additional training in packaging and transporting patients with the ambulance. If a First Responder were to show up at a scene with the exact medical kit that an EMT had, they could offer the same level of care (O2, AED, EPI Pen, bleeding control, gather history and medications). The EMT gets additional training in splinting and moving a patient and ambulance transport protocol. Is NY State the same? If the skill level for a First Responder and EMT is the same for initial care and NOT transport, would it be fiscally prudent to have all firefighters (10,000+) trained to the level of EMT when in reality they are just doing First Responder work?  Let me end by saying that if an EMT in NY can do much more than a First Responder, then by all means upgrade them to EMTs. but it would still be a large undertaking with more training requirements, recertifications and money spent.

 

Here's the article about the watchdog group:

http://www.ufanyc.org/cmslist/admin/contents/view/23070

 

Edited February 10, 2017 by LayTheLine

[S1720G 62]

The medic on the fire engine idea was/is something that they've been toying around with for a while. It would probably start off as a pilot program or something. A lot of the logic is that they have a lot of paramedics and emts that came from FDNY Ems and after looking at their last promotion exam recently I'm assuming they anticipate a high number to continue coming over. The logistics of that I can't comment on with much certainty, but from what I was told these medics would not be transporting . Think of a "first response paramedic" . A regular ALS crew would be transporting . (On a side note, why would they pay a FF or in this care FF/medic, to staff an ambulance or do anything with transporting when they can pay a regular paramedic 1/2 the money to do so. Not saying medics don't deserve more , but financially it doesn't make sense). This is like.... at least a 5-10 year plan. They're just throwing around ideas and thinking of ways to utilize the people, a lot of which they trained in THeIR paramedic program, who come over to fire. Also, it would have to be hashed out with the unions (both fire and EMS). 

 

The difference or benefit of having an EMT on an engine VS a CFR ? Response times. I may be wrong, I'm not a "legal issues in the fire service " buff, but I'm almost positive they can't "stop the clock" for having a CFR on scene. If an emt on an engine is on scene , the clock stops when THEY go 10-84, not the ambulance , unless of course the bus is on scene first (10-91, one of the greatest things you can see on the computer ever!). It's all about response times, and their ability to say "we were on scene in 3:10".

 

but medically yes, there isn't much more an emt can do than a CFR kind of. Epi albuterol splitting aspirin etc just a few things but not much more. 

[LayTheLine 108]

Thanks S1720G for an excellent response. It clears up a few issues in my mind. I think the most reassuring thing is that it's just not some random idea. If it's been thought about over the last few years that's a good sign. It doesn't mean it will rollout problem free (how often does that happen), but at least if they try a pilot program that would make sense to work out the kinks before changing everything which may turn into chaos! Thanks!

[M' Ave 1,466]

On 2/9/2017 at 6:36 PM, x635 said:

Does anyone know how they select which calls the Flycar goes on?

 

Good question, one that I don't have a definitive answer to.  However, I can say that EMS runs are coded 1-9.  Engine Co's are dispatched on all 1-3 coded runs.  Those are: Arrests (cardiac and resp.), all cardiac and resp. distress calls, major injury/bleeding and obstetric emergencies.  Grouped in there would be runs related to Seizures, Unresponsive, ect..

 

Eng. Co's should only respond to runs when Medics are assigned, with the exception being car accidents/trauma runs.  So, I'd assume that the Fly Cars are assigned in a similar manner to Engines.  Any run that would normally get two busses (one ALS, one BLS) is eligible to have a fly car replace the ALS bus that would normally be assigned.

 

I did work a few days ago for a cardiac arrest run.  The first unit to arrive after my engine was a fly car.  The medics began working up the patient while we continued CPR, ventilations, ect.  The BLS unit arrived some minutes later with a scoop, ect.  They tranasported.

[16fire5 693]

4 hours ago, M' Ave said:

Engine Co's are dispatched on all 1-3 coded runs.  

 

Eng. Co's should only respond to runs when Medics are assigned.  

 

While these statements were true a few years ago.  Engine Companies are increasingly being dispatched BLS calls.  The Major Injury calls are a good example.  They have added to the CFRD matrix a few years ago.  While the non-FDNY people on here will think yeah they should go on major injury calls, major injury calls are anything but major injuries and that's why they only send BLS.  Engine Companies have been increasingly sent on runs when the BLS unit reports responding with a delay.  In the grand scheme of things, this is nothing new the LAFD has used a matrix based on response times for a while.  The issue is the workload on some FDNY engines is pretty high.  My company has done well over 5K runs for quite a few years.  While it sounds great to work in a busy place and we do enjoy it, a company that is that busy as mine is is out of service over 20% of the time.  When people have real emergencies they have a 1 in 5 chance of the first due engine being unavailable.  

[M' Ave 1,466]

2 minutes ago, 16fire5 said:

While these statements were true a few years ago.  Engine Companies are increasingly being dispatched BLS calls.  The Major Injury calls are a good example.  They have added to the CFRD matrix a few years ago.  While the non-FDNY people on here will think yeah they should go on major injury calls, major injury calls are anything but major injuries and that's why they only send BLS.  Engine Companies have been increasingly sent on runs when the BLS unit reports responding with a delay.  In the grand scheme of things, this is nothing new the LAFD has used a matrix based on response times for a while.  The issue is the workload on some FDNY engines is pretty high.  My company has done well over 5K runs for quite a few years.  While it sounds great to work in a busy place and we do enjoy it, a company that is that busy as mine is is out of service over 20% of the time.  When people have real emergencies they have a 1 in 5 chance of the first due engine being unavailable.  

 

I agree.  I was just giving the, "by-the-book" protocol.  Reality....yes, "Major Injury" has come to mean a nose bleed in some cases....

 

The UCT call takers code things with an insane amount of caution...I assume it's a C.Y.A. move for the city...

 

Also, you're right, the workload is crazy.  In the last 5 years our runs are up 20%.... thats a more dramatic uptick than in years prior to the most recent 5....

[LayTheLine 108]

5 hours ago, M' Ave said:

 

Good question, one that I don't have a definitive answer to.  However, I can say that EMS runs are coded 1-9.  Engine Co's are dispatched on all 1-3 coded runs.  Those are: Arrests (cardiac and resp.), all cardiac and resp. distress calls, major injury/bleeding and obstetric emergencies.  Grouped in there would be runs related to Seizures, Unresponsive, ect..

 

Eng. Co's should only respond to runs when Medics are assigned, with the exception being car accidents/trauma runs.  So, I'd assume that the Fly Cars are assigned in a similar manner to Engines.  Any run that would normally get two busses (one ALS, one BLS) is eligible to have a fly car replace the ALS bus that would normally be assigned.

 

I did work a few days ago for a cardiac arrest run.  The first unit to arrive after my engine was a fly car.  The medics began working up the patient while we continued CPR, ventilations, ect.  The BLS unit arrived some minutes later with a scoop, ect.  They tranasported.

 

Maybe a stupid question, but here goes: Does FDNY only send BLS to major trauma calls? From reading the thread, I get the idea that is the case. I'm not saying it's right or wrong if that is the case. In my neck of the woods, medics are always sent on major trauma calls (hand amputation, car accident, fall from 2+ stories) for two reasons:

 

1) On most trauma patients they do their best to get an IV line into the patient before the veins collapse and once in, they pump fluids into the patient.

 

2) Done less often but still an option, they administer pain medication for example if they have to realign a displaced ankle fracture where no pedal pulses are found.

[FireMedic049 597]

11 hours ago, EmsFirePolice said:

Although one may have experience or knowledge, doesn't mean that something will be successful.... You clearly must believe in everything you read, "FireMedic".

Your comment doesn't make much sense in regards to the context of this discussion.  This wasn't a case of someone directly involved speculating about the success of a new program.  This was a case of someone directly involved telling you that a new program that has been in effect for a while now IS a success.

 

You're response was rather dismissive of that informed explanation. 

 

No, I don't believe everything I read.  However, I've had enough interaction with M'ave on this forum to know that he is FDNY and that he has been reliable when it comes to information related to FDNY matters.

 

11 hours ago, EmsFirePolice said:

 

Thank you for the young compliment, haha. I do feel as if I am getting old day by day. I am trying to have a discussion, but it doesn't seem as if you followers want to (which I understand). That's the whole point of EMTBravo (which you may not completely understand). There is a difference between an argument and a discussion. In this case, it seems as if the argument keeps on flowing due to comments such as those above.

You may be trying to have a discussion and there definitely is a difference between argument and discussion.  However, you don't seem to understand the detail of each.

 

You are the reason why the "argument keeps on flowing".  A discussion was taking place.  You just weren't up to speed on the issue when the discussion started and speculated regarding the potential success of the program.  I offered an educated opinion to counter yours.  You were dismissive of that.

 

You were also provided with reliable information by a person directly involved that the program is successful (because it's been in place longer than you were aware).  However, your response again, was dismissive and some people called you on it and tried to educate you some.

 

You became argumentative in response to that rather than be appreciative of the information provided to you.  Now you are trying to be preachy, apparently unaware that you are the one who took things from discussion to argument. 

[16fire5 693]

10 hours ago, LayTheLine said:

 

Maybe a stupid question, but here goes: Does FDNY only send BLS to major trauma calls? From reading the thread, I get the idea that is the case. I'm not saying it's right or wrong if that is the case. In my neck of the woods, medics are always sent on major trauma calls (hand amputation, car accident, fall from 2+ stories) for two reasons:

 

1) On most trauma patients they do their best to get an IV line into the patient before the veins collapse and once in, they pump fluids into the patient.

 

2) Done less often but still an option, they administer pain medication for example if they have to realign a displaced ankle fracture where no pedal pulses are found.

 

The Major Injury call type is a BLS call in NYC as is Ped Struck and MVAs without more info.  I think this is based on the fact that the vast majority turn out to be BLS and there are limited ALS resources.  There are probably too many call types so and amputation and a long fall would get ALS.  They're moving to a new triaging system and they're attempting to work on the miss-classification.   

 

As to the IV interventions in trauma patients study after study shows this does not help and may actually harm the patient.  It really bugs me when I see transport delayed for it.  Anecdotally I find the experienced medics that I see and who I would like treating me if I was hurt bad never delay transport.  It's the same as the young guy on the roof who's going to cut the hole no matter what compared with the experienced firefighter who knows when it's time to leave or a lost cause.