Eastern Dutchess EMS issues

[RNMedic08 0]

I can't tell if you're kidding or not. Hopefully you are.

Most commercials are for profit - they pay sucks, the bennies suck, the rigs suck, the equipment sucks and the staffing will suck.

County EMS will give you a more robust budget to attract the best and brightest and pay them well (on par with FD and PD), county bennies & retirement, cutting edge education, cutting edge equipment, modern vehicles that are well maintained, vast expanses in resources - hazmat, USAR, PD support for SWAT entry teams, etc.

It won't even cost a whole lot - granted you eliminate all the useless duplication of resources. No one ever wants to cut FD, but you look at some of these departments in Westchester, Putnam and Dutchess and sometimes (most of the time) you just have to scratch your head. Probably could save a few million in needless apparatus expenditures. Consolidate smaller PDs into a larger regional/county system, do the same for school systems and add a dollar or two surcharge onto parking violations or other county/regional forms to benefit EMS. You can really fund it 1000 ways.

Check out Wake County EMS in North Carolina - see how it hails in comparison to the the NY Metro Area. It's a joke, we are living 20 - 30 years behind the times.

So Goose,

Are you saying that Commercial agencies have sub par EMT's and Paramedic"s because I highly doubt that!!!!! Granted the equipment might not be cutting edge or the ambulances bright and shiny right out of the dealership but that doesn't make them any less competent then their counterparts in other counties in this area. Personally, I think the commercial agencies here in Dutchess County do a damn good job providing care to the residents in their call area. I, as a commercial agency Paramedic do the BEST I can providing pre hospital care to my patients and I do believe I am a Bright individual.

[Guest]

Until the AHJ wakes up and see the issues, nothing will change. We recogonized the problem several years ago and took corrective action. Even thou it meant bringing in an "outside" agency to assist during daytime hours. Since that time, we have not "missed" a call with the volunteer squad, even during daytime hours as 2nd due. Yes, it does cost us money, but as Chief, I am comfortable that I am providing the service that the public deserves. It has also allowed my own EMT's that work in town, to respond to calls during the day...do what they were trained to do, then turn patient care over to the duty rig. They in turn return to work without loosing money. The AHJ has to except responsibility for the public....till they do....not going to change.

[x129K 1,393]

So Goose,

Are you saying that Commercial agencies have sub par EMT's and Paramedic"s because I highly doubt that!!!!! Granted the equipment might not be cutting edge or the ambulances bright and shiny right out of the dealership but that doesn't make them any less competent then their counterparts in other counties in this area. Personally, I think the commercial agencies here in Dutchess County do a damn good job providing care to the residents in their call area. I, as a commercial agency Paramedic do the BEST I can providing pre hospital care to my patients and I do believe I am a Bright individual.

I think he meant the commercial environment has medics and techs that are working in an unstable environment, with sub par equipment...let's face it. commercial EMS is usually considered a stepping stone, with no real possibility of advancement or retirement...(yes, advancement - UP AND OUT! I have 12 years commercial under my belt. I KNOW the truth!)....

Commerical agencies have proven themselves (agencies - not the medics - QTIP) to be UNRELIABLE. Risking coverage of an emergency contrat to squeeze out one more transport....extended response times.....

Commerical EMS is rampant with empty promises....and again..I KNOW that from experience.

If Goose meant otherwise....oops.

[helicopper 1,050]

How about a countywide system administered by a professional EMS manager and medical director with measurable response time standards, ALS coverage, staffed BLS units, and EMD. I agree that establishing it as a government entity with civil service protections is desirable as low-bid contract awards get you just that. This is not to say that commercial providers are substandard but they have a different mandate and bottom-line when compared to a municipal system. But (being infinitely optimistic) I do believe that the system could have paid elements, volunteer elements and still be a cutting edge EMS system.

Managing a county level system and not a patchwork of individual towns, villages, or districts would be far more efficient and cost-effective - that's probably why it will never happen.

[RNMedic08 0]

I think he meant the commercial environment has medics and techs that are working in an unstable environment, with sub par equipment...let's face it. commercial EMS is usually considered a stepping stone, with no real possibility of advancement or retirement...(yes, advancement - UP AND OUT! I have 12 years commercial under my belt. I KNOW the truth!)....

Commerical agencies have proven themselves (agencies - not the medics - QTIP) to be UNRELIABLE. Risking coverage of an emergency contrat to squeeze out one more transport....extended response times.....

Commerical EMS is rampant with empty promises....and again..I KNOW that from experience.

If Goose meant otherwise....oops.

Thanks for clarifying that Dan. Initailly I took it differently than the way you just presented it. Working for a commercial agency I strive to give you accurate info when you are sending me all over the great City of Poughkeepsie on the Friday and Saturday overnights....LOL...and let me tell you these past few weekends have been quite busy and filled with interesting calls.

[Goose 188]

So Goose,

Are you saying that Commercial agencies have sub par EMT's and Paramedic"s because I highly doubt that!!!!! Granted the equipment might not be cutting edge or the ambulances bright and shiny right out of the dealership but that doesn't make them any less competent then their counterparts in other counties in this area. Personally, I think the commercial agencies here in Dutchess County do a damn good job providing care to the residents in their call area. I, as a commercial agency Paramedic do the BEST I can providing pre hospital care to my patients and I do believe I am a Bright individual.

Relax. I worked for the same commercial company you do. I never said commercials employed sub-par employees, i worked with some amazing people in Dutchess and i loved about 99% of my time there. But the fact's remain that commercials, generally speaking, are part of the problem for more reasons than i feel like outlining here.

This notion that subcontracting EMS is going save dollars and cents is asinine, if you ask me. Would you subcontract a police department? Point is, make it a budget line item and you will not only eliminate the waste county wide (duplication of services - Wake County has 15 ambulances for an entire COUNTY which includes a busy city, how many trucks are in duthcess? Probably more than their are staff to complete crews). You won't have to deal with the Ambulance Wars that occur all the time in dutchess or the inability to properly cover contracts - those are just two of the most frequent issues that arrive from subcontracting out a vital service.

You can shut your eyes, stuff your ears and whistle dixie. If other counties around the country can do it, there is no reason why we can't. Eventually, call volume is going to increase so much that you will have no choice but address the issue with a REAL solution. Maybe not right now, given the economic climate but its, in my opinion, the only solution. You simply can't ignore the type of system places like Wake County are - they are what ems should be country wide.

I suppose it's difficult if you've never worked commericial EMS and have never looked at places like Wake county. They are about 25 - 30 years ahead of us in every single way. Honestly, you compare the two and you want to throw up.

Edited April 30, 2009 by Goose

[gamewell45 258]

I suppose it's difficult if you've never worked commericial EMS and have never looked at places like Wake county. They are about 25 - 30 years ahead of us in every single way. Honestly, you compare the two and you want to throw up.

In fairness, most of us have most likely never heard of Wake County so how would we know what kind of places to look for?

[SRS131EMTFF 471]

In fairness, most of us have most likely never heard of Wake County so how would we know what kind of places to look for?

http://www.wakeems.com

http://www.wakegov.com/ems/default.htm

[citystation1848 15]

Look at the setup Putnam County has. More or less it's "countywide", even though its a commercial service (TransCare) that runs the whole show. That could work in Dutchess, but the thing that would cause a problem is all these fire departments with their own medics & emt's would be up in arms because they cant lose their jobs. The solution to that is fine, you keep your medics/emt's but your district still has to pay into the pool for the county ambulances. That could, and i say that loosely, could work.

[Goose 188]

Look at the setup Putnam County has. More or less it's "countywide", even though its a commercial service (TransCare) that runs the whole show. That could work in Dutchess, but the thing that would cause a problem is all these fire departments with their own medics & emt's would be up in arms because they cant lose their jobs. The solution to that is fine, you keep your medics/emt's but your district still has to pay into the pool for the county ambulances. That could, and i say that loosely, could work.

Putnam is not the best example - Sloper, Alamo, Empire, Transcare. Constantly changing shirts in Putnam, ask any medic and they will tell you it becomes downright unfair. Besides they have been saying they are going to go to a county run municipal ALS system for at least 10 years - biggest problem there is the County has no money (we all remember when they wanted to get rid of ALS altogether, don't we?). Besides, its hard to compare a system where the entire county only does ~4,000 EMS calls. I don't know the duthcess numbers but i am sure they are WELL above that.

[citystation1848 15]

Putnam is not the best example - Sloper, Alamo, Empire, Transcare. Constantly changing shirts in Putnam, ask any medic and they will tell you it becomes downright unfair. Besides they have been saying they are going to go to a county run municipal ALS system for at least 10 years - biggest problem there is the County has no money (we all remember when they wanted to get rid of ALS altogether, don't we?). Besides, its hard to compare a system where the entire county only does ~4,000 EMS calls. I don't know the duthcess numbers but i am sure they are WELL above that.

Yes Goose, your right, but bear in mind Sloper is out of the picture now, so is Alamo (in putnam). Empire could grab it or Hudson Valley Paramedics/Regional EMS could get it. But as of know everyone seems to think that TransCare is providing a fine service down there. In Dutchess County, Alamo could handle it i think with ease, TransCare would have to quadruple the amount of crew bases and ambulances/medics it has on, and provide ample backfil for the towns. Also remember Poughkeepsie would need probably 5 units dedicated I'd imagine, City of Beacon maybe 3

[Danger 160]

Besides, its hard to compare a system where the entire county only does ~4,000 EMS calls. I don't know the duthcess numbers but i am sure they are WELL above that.

To put it in perspective; Just the Arlington Fire District in Dutchess County runs 4 medics during the day time hours and 2/3 at night. Running nearly 4,000 EMS calls.

[Goose 188]

Yes Goose, your right, but bear in mind Sloper is out of the picture now, so is Alamo (in putnam). Empire could grab it or Hudson Valley Paramedics/Regional EMS could get it. But as of know everyone seems to think that TransCare is providing a fine service down there. In Dutchess County, Alamo could handle it i think with ease, TransCare would have to quadruple the amount of crew bases and ambulances/medics it has on, and provide ample backfil for the towns. Also remember Poughkeepsie would need probably 5 units dedicated I'd imagine, City of Beacon maybe 3

I mentioned the commercial agencies (sloper, alamo, empire, transcare) to highlight the lack of stability in the system due in large part to the fact that the system is put out to bid or contracts were assumed during buyouts. It's hard on the employees and their families and not fair, sadly it drove some solid paramedics away from the county. Likewise, i am not debating the quality of service, i left before the current system was put in place but i do know some of the medics personally and know that putnam is well served.

As far as positioning units and stuff like that. Bro, you got me. I'm not an analyst, just a provider. The only way to figure out how to do it right is have a survey and research company like Fitch & Associates (leader in EMS studies) come in and do their thing and report back. I like your enthusiasm though!

[helicopper 1,050]

Look at the setup Putnam County has. More or less it's "countywide", even though its a commercial service (TransCare) that runs the whole show. That could work in Dutchess, but the thing that would cause a problem is all these fire departments with their own medics & emt's would be up in arms because they cant lose their jobs. The solution to that is fine, you keep your medics/emt's but your district still has to pay into the pool for the county ambulances. That could, and i say that loosely, could work.

I agree with Goose that Putnam is not the best example though it does have some good points. First, the county is primarily providing ALS service countywide. It also provides BLS coverage because the local agencies have been unwilling or unable to step up and do it properly. This creates a political issue because now residents of at least three towns are paying for a service they don't receive - there is only one BLS unit and it only covers a portion of the county.

Because the county provides the ALS but has little control over the BLS, there are instances where the medic has to take BLS calls to the hospital when the volunteer BLS crews don't get out.

Finally, the system is a low-bid contract system (at least it was, hopefully now it is a little bit better). This almost cost Putnam County its ALS service when a low bidder said "sorry, we can't afford to do this anymore" and left the county with two options - pay more or hire someone else. Not a good political situation.

I applaud Putnam for getting the ALS system established on a countywide level - it's the only way to work in a county such as Putnam. But the BLS "system" is still a nightmare!

[moggie6 54]

I think there are a couple of problems with EMS in Dutchess and the biggest seems to be who is going to pay for it. Towns, Fire Districts, and other forms of goverment need to stop dividing up the cost of the EMS service by the number of alarms in each district.

When it comes to Eastern Dutchess and those fire districts\departments involved with this has anyone looked at back to back calls in the towns?

[Beekman 5]

I'm guessing Wake can bill the insurance companies? The Fire Districts cannot so you lose all that money by letting the insurance companies off the hook. I don't believe the laws would allow the County to bill either. Sitting in the "4 Town" meetings for the past few years, you are talking about a significant amount of money that you would not be able to recoup if you had a County run EMS system vs a Commercial Service based system that could bill.

[moggie6 54]

There is a legal way for fire districts to bill.

[JTF429 37]

This has been a problem for years. How many PTs suffred because of delayed response. You hire commercial services to be dispatched at the sametime or provide a rig at insane costs across the board. They talk about money and spending, the state of the economy etc. County wide EMS. Cost effective, jobs, PT care. I worked in Northern VA for 9 years and most of the counties are combo departments. Voulnteers were allowed to ride 3rd on county rigs anytime or if they had a crew could put there own rig in service and run calls. Every 4 years we get a new president and a different commercial service has the majority of the county. Commercial agencies are there to make a profit period. Most provide good care, have good employees, and try to do the right thing. This topic has come up and will countine to come up for ever. Until pepole realize its not about power or a red light or white hat its about Patients and doing the right thing.

[Guest ab2se]

As I said before it's all about money not red lights, white hats or power. We could design a system that has an ALS unit on every block and response times of a minute but who's going to pay for it? The system is the way it is because of money. A lot of agencies providing EMS in this county are still being funded (at least partially) by pancake breakfasts and ham dinners and sharing those funds with the fire side of things. There are limits from the State on how much a Fire District can tax. The Eastern Dutchess towns are rural and their tax base is limited. The Towns themselves need to be involved with sharing the cost but its hard to get them on board when their residents aren't complaining about the service they recieve.