Wappinger looks at ambulance guidelines

[JetPhoto 626]

http://www.poughkeepsiejournal.com/apps/pb...EWS01/705180334

Friday, May 18, 2007

Wappinger looks at ambulance guidelines

Non-contracted services would be prohibited from responding

By Michael Woyton

Poughkeepsie Journal

WAPPINGERS FALLS - The Town of Wappinger wants to make sure its residents get what they are paying for with ambulance service.

"Our residents are paying close to $400,000 a year for ambulance service," Supervisor Joseph Ruggiero said. "It demands an orderly system."

The town has drafted a law that will prevent ambulance services not contracted by the municipality from attending to patients unless they are dispatched through the county 911 system.

Contract signed in 2005

In 2005, the town signed a five-year, $395,000 contract with TransCare Hudson Valley to provide two ambulances and crews for advanced life support and one ambulance for basic life support.

The Brooklyn-based company serves communities in New York City, the Hudson Valley and Long Island.

The proposed legislation grew out of an incident when a town restaurant employee directly contacted an ambulance service for an injured party instead of dialing 911.

At the same time, 911 was called by another person, and an ambulance from TransCare was dispatched to the scene.

The TransCare ambulance arrived first, but the ambulance from Mobile Life Support Services that had been called directly disputed who was responsible for taking care of the patient.

Councilman William Beale, an emergency medical technician, said Mobile Life should have relayed the direct call to 911.

"When I receive calls on our seven-digit phone number, I immediately turn it over to the proper 911 center," he said.

Ruggiero said the proposed law will assure the patient receives the proper level of care and provide data about the call, including response times.

There also could be a financial consideration in using the town's ambulance, he said. Not everybody has insurance for ambulance service.

The town created an ambulance district and covers any shortfall after TransCare bills the patient's insurance.

"We want people to not have to make a decision to call an ambulance," Ruggiero said. "When our people go to sleep at night, they know that an ambulance will be there if they need it."

The board will continue discussing the law at future meetings.

Reach Michael Woyton at mwoyton@poughkeepsiejournal.com or 845-451-4518.

[Danger 160]

Interesting. I wonder how would this effect nursing homes, who often call direct for "emergencies".

[Guest alsfirefighter]

Directly disputed whom was responsible? LOL. You want the patient...you got it. Medic XX in service.

Better be careful what you ask for. Many of us try to get nursing homes to do what that person in the restaurant did...call a commercial provider instead of wasting 911 resources.

[Guest]

Seems a bit silly that one incident sparks a law and politicians saying "oh we want our people to know we have ambulances!" I think most people know or at least expect that and the majority of residents are far more prone to dialing 911 than running to the yellow pages. I suppose it comes down to who gets to bill the patient :\

[nycemt728 49]

This situation is ridiculous!

1. We all need to do whats best for the pt; put the money and the egos aside. Whoever is O/S first treats and transports unless the secondary unit is higher lever of care. In terms of continuity and good standard of care, how could we as EMS do any different??? (and yes I realize this is idealistic and is not quite how it happens)

2. ALS is right, whatever the pts wants, pt gets. If someone called a bus other than the municipality, so be it. If he wants to go w/ them, so be it. Unless there is a medical need, neither the pt or first crew o/s should be challenged.

I have worked for a volly squad that handles direct calls from the public and is not the municipal response. If we get a call and we're the first ones o/s then fine, no one takes the pt but us unless they're higher level; if we're second o/s, we assist but don't challenge, even if we rec'd a direct call from the public.

This situation is baffling to me, to legislate that an ambulance , private or otherwise, cannot respond if called seems irresponsible and bordering on infringement of rights. As a citizen, I have a right to call 911 or call a private ambulance. Second, if it saves lives, no way I'm gonna make it law that only certain ambulances can respond. That's like saying x school can't use the ZOLL PAD it bought b/c the city purchased Lifepaks... I would be interested in seeing follow-up/debates and further reasoning behind this b/c right now I'm at a loss for a good explanation.

Edited May 18, 2007 by nycemt728

[IzzyEng4 427]

Three or Four years ago we had a nasty dispute in CT, mainly in the South West (Fairfield) and South Central (New Haven) areas between two commercial ambulance services responding to "Priority 1" (aka medical emergencies that should go through 911).

For example in my town we have our own municipal ambulance service and the local rehabilitation center would call either 911 or their contracting transporting service depending on the call. Unfortunately 9 out of 10 calls to the commercial services they contracted (these two commercial services in question) would get to the scene and find out its a priority call, contact the dispatch center over the MED radio and then we would have to send the local ambulance and paramedic intercept. We'll this turned into a fight with the commercial services sneaking around the system going lights and siren to the call and then telling us after they were en route to the hospital with a priority patient. Now this happened else where through out the areas and these two services bickering with each other and going to court.

NOW comes the the cities, towns and agencies that have the local PSARs who provide first responder service in the municipalities through both regions who were fed up from the start of of the commercial agencies and nursing facilities circumventing the 911 system as it was in tended (needless to say yes patients suffered from this) and wanted to put a stop to it, not for trying to make money but provide the service that the municipalities invested in to provide proper care for all those people with in the towns they resided, worked or were facilitated in.

The PSAR holders do not mind the commercial service doing their inter-faciltiy transportation of patients to doctors appointments, ect but when the commercial service got the call for a MI and they were coming from 15 miles away to get the patient and transfer them to a hospital, who is suffering here???? AND who looks bad for not providing service, so to speak despite 911 not being called for immediate service.

Well, needless to say this is only part of the story and I cannot get into the whole thing, especially because I work at a CMED and witnessed this first hand. In the end, any nursing home or re-hab facility has to call 911 for true medical emergencies and if the private service is contacted, that service has to contact that specific agency who dispatches the local ambulance and medic service to respond for the medical emergency.

This was a mess, trust me but now it works a lot better not with the new regulations in place.

[20y2 43]

Nassau and I believe Suffolk County have had this rule in effect for years.

[Danger 160]

When towns stop letting nursing homes call commercial agencies direct, they're going to find that Sally Taxpayer isn't going to have an ambulance anymore because it's going to be on it's 10th "minor bleeding from a stent site" call of the day. Another rumor bouncing around the firehouse gossip world is that the person who requested MLSS direct works for MLSS. IMHO it should be your choice to call who you like, especially in this instance, as typically commercial services provide a free transport for employees and besides, who wouldn't want to be taken care of by their brothers.

[JTF429 37]

In response to the post about citizen and PT rights. The PT did not call the ambulance service a person who worked for that commercial service did. Another good samaritian called 911. In Wappingers the 3 fire departments work very hard at providing a 1st responder service. If a person calls a private commercial service for a 911 call it circumvents the system.

[WAS967 97]

Allow me to play devil's advocate for a second.

What about areas where the 911 bus may be coming from 30 minutes away, such as is the case many a time with Alamo?

Or if you are in a town with a volly squad that you know takes forever to get out?

If I worked for a private that I knew could get there quicker, I'd call them.

I understand the goal of this law is to prevent the exact converse of the situation, but still, a person should have the right to call whomever they want for ambulance service. Perfect example is the case of a sick patient that wants to go to X hospital but knows that the local ambulance will only take them to Y.

Edited May 21, 2007 by WAS967

[Guest]

In response to the post about citizen and PT rights. The PT did not call the ambulance service a person who worked for that commercial service did. Another good samaritian called 911. In Wappingers the 3 fire departments work very hard at providing a 1st responder service. If a person calls a private commercial service for a 911 call it circumvents the system.

←

And what do the fire departments have to do with the patient going on one company's ambulance or another? Their only concern should be providing first responder care and then transferring to whomever is to take the patient to the hospital, be it the 911 ambulance or an ambulance of the patients choosing.

[emt301 4]

And what do the fire departments have to do with the patient going on one company's ambulance or another? Their only concern should be providing first responder care and then transferring to whomever is to take the patient to the hospital, be it the 911 ambulance or an ambulance of the patients choosing.

←

They don't necessarily have anything to do with which ambulance the patient goes on (unless the FD operates the local ambulance)...I believe the point was that for an FD to provide that first responder care, they need to be made aware of the call...a.k.a. 911. When 911 is circumvented, the FD first response is also circumvented. The FD is not going to be toned out if a commercial agency gets the call, and then keeps the information to themselves & doesn't pass it along to 911. Depending on the situation, the commercial provider that got the call direct could be responding from a considerable distance away, and that FD first response could be important in rendering initial & possibly lifesaving care.

In the event that the local FD operates the ambulance...by skipping 911, there's a chance that the commercial agency is sending a unit from a considerable distance away, when the local 911-dispatched ambulance would actually be closer...i.e. especially when talking about career or combo FD's that run their own ambulances and have good response times, such as Lagrange, Arlington, and Fairview up here in Dutchess.

Bottom line, from a dispatching & patient care standpoint...commercial services have an obligation to notify 911 (except in the cases where the service already has a pre-established contract with a facility, such a prison or nursing home, where there is already nurse or physician care available by which to stabilize the patient until the ambulance arrives). The commercial agency can continue in if they want & work the details of the transport out with the other responders on scene, but don't deny the patient the possibility of a quicker FD first response or FD ambulance. Like everything else, this comes down to corporate greed....patient care should be coming first, not money.

Edited May 21, 2007 by emt301

[emt301 4]

Seems a bit silly that one incident sparks a law and politicians saying "oh we want our people to know we have ambulances!" I think most people know or at least expect that and the majority of residents are far more prone to dialing 911 than running to the yellow pages. I suppose it comes down to who gets to bill the patient :\

←

You're right....it does come down to money. I heard of a call recently (and I won't go into exactly where it was) where a hospital took an emergency call from an elderly person unfamiliar with the ems system...yes, these people DO exist, and unfortunately are easily taken advantage of. Instead of refering the caller directly to 911, the hospital told the patient to call that hospital's affiliated commercial ambulance service. 911 only became aware of the situation when the patient, in frustration over the response time, finally dialed 911, asking "where's my ambulance?" 911 then dispatched out the local paid FD ALS ambulance, and also contacted the commercial service to inquire about what was going on (the frustrated patient told 911 what had happened). This was a case of money first, patient care second on the part of the ambulance service...a principal that many of these commercial services sadly seem to live by these days. If the local FD ALS ambulance (for which the patient pays taxes) hadn't responded & transported, this patient would have been slapped with a nice big bill from the commercial service. I believe that the legislation being proposed is to help keep the 911 system working properly, not to say something stupid like "hey, we have ambulances". Unfortunately, these incidents occur more often than many people would think...there are lots of people, especially the elderly, who are taken advantage of all too easily.

Edited May 21, 2007 by emt301