Overstretched EMS forces hiring of private ambulances

[WAS967 97]

http://www.silive.com/news/index.ssf/2009/..._the_seams.html

Overstretched EMS forces hiring of private ambulances

The city is temporarily adding private ambulance companies like Primary Care (its vehicle pictured above) to handle an increased call volume due to a seasonal increase in emergency medical calls and concerns over swine flu.

A heavy call volume and concerns over swine flu have taxed the city's emergency medical response system so badly that officials have enlisted the help of private ambulance operators to lighten the load.

The FDNY, which runs the city's EMS system, is using a "mutual aid" program to temporarily add about 15 ambulances from several private companies to the city's 911 system, FDNY spokesman Steve Ritea said this week.

The decision doesn't sit well with city EMT unions, however, whose leadership questions whether the private company paramedics have the training and expertise to handle situations such as shootings, crime scenes and sudden cardiac arrests. Typically, the 911 system uses FDNY-staffed ambulances and ambulances from the city's hospitals to respond to emergencies.

The private companies are being used sparingly, Ritea said -- the program was activated to handle extra calls for a few hours on May 20, May 22 and June 2. And from June 4 through today, the private ambulances took 911 calls on weekdays between 11 a.m. and 7 p.m.

"Part of it is probably attributable to an increase in calls related to people concerned about swine flu, but the weather is also warmer," Ritea said.

On Staten Island, that means one additional ambulance, operated by the Sea View-based Primary Care, was responding to 911 calls over the past week.

Ritea wouldn't speculate on how often the mutual aid program might be used in the future.

The city handled an average of 4,200 ambulance runs a day last month, compared to an average 3,900 a day in May 2008, city statistics show.

"Our problem in the New York City Fire Department is that our system does not have capacity," said Patrick Bahnken, the president of the FDNY Uniformed EMTs, Paramedics and Inspectors, adding that 2009 will likely be a record year for EMS calls. "We have a very limited ability to handle a sudden surge in demand."

And with a proposal on the table to cut 30 basic life support tours in the city's next fiscal year budget, the solution is to come up with a dedicated funding stream for EMS, not to use untested private companies, Bahnken said.

"We don't know who these people are. Some of these people have absolutely no experience responding to 911 calls," he said. "It's the difference between an emergency room trauma technician and a family practitioner."

Vincent Variale, president of the Uniformed EMS Officers Union, made similar remarks.

"They're state-certified EMTs, but they're not as well-trained as the person working out on the street," he said.

But officials at Primary Care, which has been responding to 911 calls on Staten Island for the past week, say their company's paramedics are just as well trained, if not better trained, than the FDNY and hospitals' paramedics.

"We do the same type of emergency calls. A cardiac in a nursing home is the same as a cardiac in the street," said Paul Lebowitz, of Willowbrook, the company's president. "We do trauma, too. We get flagged down for car accidents. We get our own share of trauma calls.... The union can't say that we're less trained or less experienced."

Several FDNY EMTs and paramedics got their start in private companies, he added.

"They're saying that because they feel threatened about their jobs," Lebowitz said. "But it's not about taking jobs. It's about taking care of patients."

In all, Primary Care -- which runs 13 ambulances with about 60 emergency medical technicians and 20 paramedics -- handled about 10 calls from 911 each day.

Ritea said FDNY supervisors scrutinize each company's ambulances, equipment and employees to make sure they meet city and state standards.

"If they don't meet all those standards, they're not going to be put in service," Ritea said.

The city doesn't pay the private companies, Ritea said. Rather, the companies bill their patients' insurers.

The union leaders also questioned whether patents might get hit with higher bills if they're treated by a private company, Lebowitz said that simply wouldn't be the case with Primary Care.

[OoO 24]

Sounds like a lot of nonsense to me. The private company's emt's/paramedics should be able to handle a call just as well as an FDNY provider.

[x635 4,066]

In 1996, they decided they wanted to do EMS. You here them crying about closing of Engine companies, and no offense to any FDNY firefighters as you guys have a tough job too, but EMS runs their butts off everyday with the bare minimum of resources, lousy pay and schedule, and a high volume of calls. They make a direct impact daily on peoples lives.

I wonder how people would react if FDNY contracted to private companies to provide engines and trucks because of a higher volume of fires?

My comments don't relfect on the hospital-based EMS systems in the City,as I strongly believe that places like St Vincents, NY Pres, and OLM to name a few greatly add or added to the city's EMS for decades. But, I realize hospitals are cutting costs, and, in admins eyes, they are an easy thing to chop from a budget.

Again, I say it, EMS needs to be differentiated from non emergency TRANSPORT units, which, in most instances, should be and can be handled by a 2 man ambulette with a stretcher and O2.

[helicopper 1,050]

This is the problem with budgeting and planning for the barest minimum coverage. Obviously the City can't afford to put an ALS ambulance on every corner of every borough but they keep cutting and cutting and now it's becoming an issue.

Let's say your average day is 100 calls per hour and you have enough units to cover that. On some days when the volume is only 70-80 calls per day, sure, you have units doing nothing for a little while but if you try to cut to that level you're not even able to cover your average days. The problem arises when you have your above average day - "Swine Flu" scares, extreme temperatures, special events, holidays, and other things drive the volume up - let's say to 120 calls per hour. That leaves you playing catch-up for 20 calls right out of the box.

This is why administrators/politiicans playing with public safety budgets and staffing is such a stupid idea. We don't get paid for what we do everyday, we get paid for what we might have to do (a cliche I know, but it's true).

[Mark Z 18]

This is nothing more than a backdoor attempt by the city to increase the privatization of city responsibilities. They cut and cut public safety budgets and then wonder why the department can't handle the calls and then hire outside companies to cover up the fact that they have cut more than they should and when there aren't enough complaints they use the fact they they already use private companies to justify using them even more until they have cut the EMS to nothing and private companies do it all.

I don't like this and wish the people of FDNY EMS the best of luck because your going to need it!!!!

[Guest Chiefmcfuz]

Isn't this going to cost more in the long run? Just hire more EMS workers Bloomy!

[MGMedic 0]

Isn't this going to cost more in the long run? Just hire more EMS workers Bloomy!

The city isn't paying the private companies, or Volunteer Squads, anything. They are free to bill the pt's insurance companies if it's appropriate. More "EMS workers" cost salary, pension, etc. I still fail to see what the citywide emergency is that has necessitated the implementation of mutal aid...

[Guest Chiefmcfuz]

The city isn't paying the private companies, or Volunteer Squads, anything. They are free to bill the pt's insurance companies if it's appropriate. More "EMS workers" cost salary, pension, etc. I still fail to see what the citywide emergency is that has necessitated the implementation of mutal aid...

I'm talking about the additional lawsuits. At least if they are city employees they use city lawyers, the city indemnifies them etc....

Now being private, they use whatever resources they have and then bill the city more! What does that say about the people the city pays to contract out from the hospitals for 911 buses? Lenox hill and sinai come to mind because those are the non FD buses I am used to seeing where I work.

[moggie6 54]

Hospitals that cut their own ambluance services are making a poor choice. The ambulance provides revenue for the hospital not only by billing the paitent but bringing them too the hospital its self.

[firefighter36 52]

I'm also willing to bet that any loss incurred during transport can be made up by the hospital when billing insurance for treatment rendered in that hospital!

[ny10570 745]

Sounds like a lot of nonsense to me. The private company's emt's/paramedics should be able to handle a call just as well as an FDNY provider.

Sorry, but thats simply just not true. I've done jobs with these added units and seen transport crews lose their poo when flagged or when a job turns south. The voluntary agencies that are recognize for the ability to field good units provide additional in house training to their members before sending them into the street.

Hospitals that cut their own ambluance services are making a poor choice. The ambulance provides revenue for the hospital not only by billing the paitent but bringing them too the hospital its self.

Ambulances are a drain on hospital resources. Their attraction is in bringing the critically sick and injured back to the home hospital. Its reaching the point where the hospital destination of the sickest patients is the closest appropriate and not up to the patient or provider so the benefit of running an ambulance is that much less. Why else when St. Vinny's Midtown closed did they stop running those units? No hospital to bring the patients to means no benefit to running units.

[Guest Loud412]

In my opinion the FDNY refuses to accept ownership of the responsibility to provide the residents of its boarders with high quality emergency medical service. If it had taken ownership of that responsibility, then in the 13 years that the FDNY has been running the EMS system, ALL of the voluntary hospital units would have been replaced by municipal units. That way the FDNY has absolute controle over who is on the ambulances representing the system that they run. People shouldnt have to wory about what agency is providing the ambulance and what hospital the crew is going to try to steer the pt to. In my response area of midtown Manhattan your ambulance could posibly be provided by the following agencies: FDNY, NYU Hospital, Beth Israel Hospital, St. Vincents Hospital, St. Lukes Rosevelt Hospital, Columbia Presbeterian Health System, NY Downtown Hospital, Lenox Hill Hospital, and Mt. Sinai Hospital if they happen to be dropping a PT at a Midtown area hospital. Thats 9 different agencies each with their own uniform, ambulance, paper work, and god only knows what level of training. If it was just the FDNY it would be absolutly known who is on the ambulance what training they have recieved, what equiptment is bein caried, weather the crew is even properly trained in EVOC or not, and having direct controle over disiplin of personel for pt care violations. But such a thing will never happen in NYC so long as the FDNY is in charge of providing EMS to the citizens of its boarders because the people in charge just dont care about the service provided as much as they care about keeping their positions and those of the firefighters safely secured. How else do you justify continuing to cut 30 ambulnace tours, which means 90 emts need to be reassigned, when the fire fighters get to keep thier threatened fire houses (Im not saying that they should have been shut down i think cutting public safety personel or resourses of any kind is grossly negligent).