More NYC EMS changes

[ny10570 745]

Monty North, formerly Our Lady of Mercy has began informing employees that in 90 days they will cease ambulance operations. This is reportedly in response to the new fee the city plans to collect from hospitals for each 911 ambulance they run.

Where it gets interesting is the well publicized financial problems affecting Medisys in Queens have prompted similar rumors about Jamaica Hospital. They are a major component of the EMS system and their closure would be a tremendous strain on the nearest FDNY*EMS facilities.

[sympathomedic 383]

Any idea what the fee is? Is it a $$ per unit, more for ALS etc? Does the city figure there is sooo much money in the ambulance biz they want a piece?

[INIT915 1,119]

Any idea what the fee is? Is it a $$ per unit, more for ALS etc? Does the city figure there is sooo much money in the ambulance biz they want a piece?

I'm guessing it's a considerable fee if the preferred course of action is closing up shop. What are the long term costs to the city now that they have to potentially fully fund the bus that will assume these tours?

[Goose 188]

So you're looking at taking out 3 - 5 BLS units from the system, right? 15V got yanked a few years back...and i know Jamaica runs a few ALS units as well. Sure seems like a lot of resources. I feel for the employees that are looking at pink slips (hopefully those still part of the union can pick up jobs at other shops). That said, seems like the fire department is strong arming their way to get what they always wanted.

[nycemt326 6]

I hate to hear this. I know a couple guys still at Monty north and Mike M. is a great guy.

[ny10570 745]

I don't remember the actual number, but it was a flat fee per unit around $30,000/year. The dept thinks they found a number that will allow most of the hospitals to stay in the game, but helps to fill a looming budget deficit. The argument is the fee pays for medical control and dispatching services.

The added costs with absorbing these units are not as severe as they appear. First the dept is saddled with most of the poorest areas and until recently most of the ALS was provided by voluntaries. The numbers are a bit old, but our union commissioned a review that estimated taking all of the 911 ALS resulted in more insurance reimbursements that actually decreased our operating budget. Now I don't know how adding BLS to the mix works, but I'm assuming it was less than favorable to their argument. The research also didn't account for the added cost of new facilities. So while it will probably cost more money the expense is relatively small.

There is a greater benefit to any hospital who's EMS division is costing them money. Thanks to the proliferation of specialty referral and the restrictions on patient steering there should be no significant decrease in the hospital's patient census. There is absolutely a bias towards facilities closer to a unit's home station. Hospitals can easily take advantage by simply providing a place for the dept to build a facility.

[sympathomedic 383]

$30G a year does not sound huge when compared to other costs to run an ambulance-like salaries for 10 crew members, fuel insurance etc. Could the hospital be bluffing to get the fee reduces/cancelled? If not, I wonder if the city has a plan set in case a provider chose to close instead of paying?

[Guest ME4]

And now we see the flaw in The Giuliani Admin Cutting NYC EMS Ambulances to turn over the service to private companies and hospitals as a political payback to the private ambulance company CEOs that gave him campaign donations.

We also see the flaw in the misguided policy of trying to replace ambulances with fire trucks responding to EMS Calls in NYC.

This Giuliani Admin Policy set NYC EMS back 20 yrs with response times that were finally after decades of improvement at an acceptable time.

Under Giuliani and still today fire trucks respond to EMS Calls and then have to wait out of service for an ambulance to respond that has taken longer and longer to arrive because there are less ambulances on the street..

EMS is just as important a public service as police and fire, and especially in NYC it should have been left alone to continue to improve, instead we have an agency that was merged into FDNY and has been a win win for FD and a lose lose for EMS.

In NYC EMS should be a stand alone uniformed service charged with providing emergency medical service to residents and visitors.

Just my opinion.

[PEMO3 523]

The voluntary EMS system in NYC has always been flawed. Voluntary units were know to perform wallet biopsies prior to transport. If the patient test positive for insurance they returned to base like homing pigeons, if the patient test negative then it was off the an HHC receiving facility. I can not speak for how it is today but I suspect things have not changed that much. While the crews are great the administrations see these units as cash flow systems. So they have to pony up to join the city's 911 system and play by the rules. I see nothing wrong with a pay to play policy. Only question I have is does OLM, St Barnies, etc have their own certificate of need or do they operate under the NYC EMS/FDNY certificate of need? If they have their own then it seems the charge would be similar to a fee for dispatching them, allowing for use of their radio freqs, and record keeping. These voluntary hospitals operate in the black and cry poverty with a loaf of bread under each arm. Seems interesting that they pull these things every year around the holidays. Ebenezer is alive and well!!

[comical115 32]

Voluntary units were know to perform wallet biopsies prior to transport. If the patient test positive for insurance they returned to base like homing pigeons, if the patient test negative then it was off the an HHC receiving facility. I can not speak for how it is today but I suspect things have not changed that much.

I can assure that on my rig, quality patient care is paramount. I offer the services of my hospital but always with the disclaimer that they are my employeer. I always try and do what is best for my patient. The attitude that voluntary units are only interested in insurance information and brining "home" paying patients is a slap in the face of hard working medics and EMT's who are doing their job. It has always driven a wedge between services in the NYC EMS community, and we wonder why they don't take us seriously.

Edited December 7, 2011 by comical115

[ny10570 745]

$30G a year does not sound huge when compared to other costs to run an ambulance-like salaries for 10 crew members, fuel insurance etc. Could the hospital be bluffing to get the fee reduces/cancelled? If not, I wonder if the city has a plan set in case a provider chose to close instead of paying?

Its not huge, but I've yet to see an EMS dept that was running in the black without an inter-facility transport arm to prop it up. It may only be 30k per unit but some hospitals are looking at nearly $1,000,000 a year in additional debt.

We also see the flaw in the misguided policy of trying to replace ambulances with fire trucks responding to EMS Calls in NYC.

This Giuliani Admin Policy set NYC EMS back 20 yrs with response times that were finally after decades of improvement at an acceptable time.

Under Giuliani and still today fire trucks respond to EMS Calls and then have to wait out of service for an ambulance to respond that has taken longer and longer to arrive because there are less ambulances on the street..

EMS is just as important a public service as police and fire, and especially in NYC it should have been left alone to continue to improve, instead we have an agency that was merged into FDNY and has been a win win for FD and a lose lose for EMS.

In NYC EMS should be a stand alone uniformed service charged with providing emergency medical service to residents and visitors.

Just my opinion, unless someone will now say I have no business commenting on EMS or a moderator decides to censor my post.

You need to double check who you're getting your information about present day EMS from. When was NYC*EMS ever even close to the response times we have today? I have not been able to get my hands on real statistics, but every break down I've seen has shown response times then were nowhere near what they are now. Anecdotal the picture is even worse. Absolutely, the MVAs, shootings, stabbings, and every other hot job were getting great responses. But the vast majority of EMS calls were often left waiting.

HHC was doing nothing to grow and improve EMS. For all of the problems, false promises, and lies as part of the merger/takeover/whatever you want to call it the service has improved. Yeah, the pay sucks and management is half a step shy of evil but those are both problems straight from the days of green and white.

The voluntary EMS system in NYC has always been flawed. Voluntary units were know to perform wallet biopsies prior to transport. If the patient test positive for insurance they returned to base like homing pigeons, if the patient test negative then it was off the an HHC receiving facility. I can not speak for how it is today but I suspect things have not changed that much. While the crews are great the administrations see these units as cash flow systems. So they have to pony up to join the city's 911 system and play by the rules. I see nothing wrong with a pay to play policy. Only question I have is does OLM, St Barnies, etc have their own certificate of need or do they operate under the NYC EMS/FDNY certificate of need? If they have their own then it seems the charge would be similar to a fee for dispatching them, allowing for use of their radio freqs, and record keeping. These voluntary hospitals operate in the black and cry poverty with a loaf of bread under each arm. Seems interesting that they pull these things every year around the holidays. Ebenezer is alive and well!!

The patient steering of the old days is greatly curbed. The real issue is voluntary units work in high insurance areas and crews tend to return to the hospital they're most comfortable with. Jacobi units txp overwhelmingly to Jacobi, Lincoln to Lincoln, and Presby to Presby. After the voluntaries were busted for actively encouraging the steering they're continually watched.

[x635 4,066]

A lot of municipal EMS systems that once had problems similar to NYC*EMS pre-1996 and stuck it out have found leadership to turn themselves around to become some of the top EMS agencies in the Country. I guess it's all about leadership, funding, and priorities.

FDNY*EMS is a division, but everyone who isn't familiar always asks if they respond from a firehouse, and that they have the impression that they are firefighters. And the EMS people find it unbelievable that it is a 5 day 8 hour day workweek. Personally, regardless of who operates the system, I think the whole "FDNY*EMS" name gives more credit to the FD and firefighters in the public's eye then the "NYC*EMS" name and what that would portray. And EMS should be a career, and not a pathway into becoming a firefighter.

Thank you for posting the logic, ny10570, I find it very interesting as to you setting the story straight and giving some pre and post merger comparisons, as well as current models. I just want to note that I am not in any way disagreeing with you, just adding my small take on just a part of the issue.

[PEMO3 523]

Seth I can tell you that the rotating 5-2-5-3 schedule with 8 hour tours was much needed. The call volume in the 80's and 90's, it was not unreasonable for a unit to bang out 8 to 10 jobs in a tour, 12 if the coffee sensor next to the radio was working. Based on the call volume there was no way a crew could pull a 24 hour tour and be effective at the end of their shift never mind safe enough to drive home.

[Guest ME4]

You need to double check who you're getting your information about present day EMS from. When was NYC*EMS ever even close to the response times we have today? I have not been able to get my hands on real statistics, but every break down I've seen has shown response times then were nowhere near what they are now. Anecdotal the picture is even worse. Absolutely, the MVAs, shootings, stabbings, and every other hot job were getting great responses. But the vast majority of EMS calls were often left waiting.

I do not understand the reply above at all. You seem to be taking 2 sides of a point.

Are you saying EMS Response times today are the best they have ever been?

Are you saying the vast majority of calls do not get a good response time?

In the 70s/80s EMS Response times in NYC were atrocious as the norm. And that included shootings,stabbings, heart attacks.

EMS's Problem then was they simply did not have enough money, crews, ambulances.

During the Koch Admin EMS Started to get additional funding and correspondingly improved in all areas. EMS always strived to reduce their response times and prior to the merge with FDNY had the best response times EMS ever had in NYC to date.

Today some 15 yrs post merger its not uncommon to have response times to low priority and some high priority calls bring back memories of the 80s. That is not a success in any way in my book.

Edited December 8, 2011 by ME4

[Guest ME4]

FDNY*EMS is a division, but everyone who isn't familiar always asks if they respond from a firehouse, and that they have the impression that they are firefighters. And the EMS people find it unbelievable that it is a 5 day 8 hour day workweek. Personally, regardless of who operates the system, I think the whole "FDNY*EMS" name gives more credit to the FD and firefighters in the public's eye then the "NYC*EMS" name and what that would portray. And EMS should be a career, and not a pathway into becoming a firefighter.

The above could not be more correct.

You can rest assured it was designed that way by FDNY.

Getting EMS meged into FDNY was a God Send for FDNY, it became their justification for just about anything they wanted.

NYC EMS has never been given the recognition they deserve for the work they do.

Edited December 8, 2011 by ME4

[ny10570 745]

A lot of municipal EMS systems that once had problems similar to NYC*EMS pre-1996 and stuck it out have found leadership to turn themselves around to become some of the top EMS agencies in the Country. I guess it's all about leadership, funding, and priorities.

FDNY*EMS is a division, but everyone who isn't familiar always asks if they respond from a firehouse, and that they have the impression that they are firefighters. And the EMS people find it unbelievable that it is a 5 day 8 hour day workweek. Personally, regardless of who operates the system, I think the whole "FDNY*EMS" name gives more credit to the FD and firefighters in the public's eye then the "NYC*EMS" name and what that would portray. And EMS should be a career, and not a pathway into becoming a firefighter.

Maybe things could have improved, but in 1995 EMS was just a division of HHC. With the right leadership staying in HHC would have worked. With the right leadership a third service would have been phenomenal. With the wrong leadership staying with HHC could have made NYC*EMS the next EMS dept to be shuttered and handed over to transcare. With the wrong leadership who knows what could have happened with EMS as a third service. What I know is what we had. A lot of initial ambivalence from within the Fire Depts administration, a very weak union, and a very eager workforce. That's the recipe for exploitation and we floundered. Today we have a Commissioner and COD that both appreciate EMS and what it means to the FD, we have a very vocal union, and we still have that eager workforce. On side perk to being an FD division that is rarely mentioned is Federal Grant money. Can anyone find any regular EMS dedicated grants? As a division of the FD we are eligible and have exploited many additional funding opportunities that would not be available to a third service.

It is absolutely annoying explaining to everyone from my family and friends, down to the patients, and passers by on the street that no I am not a firefighter. I am a paramedic employed by the fire department. I would love for it to be different, but it is not. That is my single biggest gripe with working for the fire department. I can deal with that. Every other problem(and there are plenty) I have is not because we work for the FDNY.

Seth I can tell you that the rotating 5-2-5-3 schedule with 8 hour tours was much needed. The call volume in the 80's and 90's, it was not unreasonable for a unit to bang out 8 to 10 jobs in a tour, 12 if the coffee sensor next to the radio was working. Based on the call volume there was no way a crew could pull a 24 hour tour and be effective at the end of their shift never mind safe enough to drive home.

Come on, with all the back to back to back 16 hour days you guys were doing back then you couldn't have maybe gotten a 12 hour schedule worked out?? Hell, you guys got us these polo shirts. Why not a better work schedule?

I do not understand the reply above at all. You seem to be taking 2 sides of a point.

Are you saying EMS Response times today are the best they have ever been?

Are you saying the vast majority of calls do not get a good response time?

In the 70s/80s EMS Response times in NYC were atrocious as the norm. And that included shootings,stabbings, heart attacks.

EMS's Problem then was they simply did not have enough money, crews, ambulances.

During the Koch Admin EMS Started to get additional funding and correspondingly improved in all areas. EMS always strived to reduce their response times and prior to the merge with FDNY had the best response times EMS ever had in NYC to date.

Today some 15 yrs post merger its not uncommon to have response times to low priority and some high priority calls bring back memories of the 80s. That is not a success in any way in my book.

I was saying that the response times to the hot jobs were bad and the other jobs were even worse. Yes, before the merger the times were the best yet, but still do not compare to the times we are achieving today.

Absolutely there are occasional jobs that fall through the cracks, Mistakes happen and they are addressed. Two summers ago when the high priority BLS job in Manhattan waited for a crew from SI, the system was changed to prevent that from reoccurring. The blizzard was an absolute failure on many levels and changes have been implemented and we'll see what happens. Occasionally those non-emergent jobs do wait for for a very very long time, but even on those busiest days during the peak of the H1N1 outbreak when we were still catching up to the queens hospital closings we maintained an EMS response of under 7 minutes for all of our life threatening call types. When was HHC coming close to that?

[Guest alsfirefighter]

And now we see the flaw in The Giuliani Admin Cutting NYC EMS Ambulances to turn over the service to private companies and hospitals as a political payback to the private ambulance company CEOs that gave him campaign donations.

We also see the flaw in the misguided policy of trying to replace ambulances with fire trucks responding to EMS Calls in NYC.

This Giuliani Admin Policy set NYC EMS back 20 yrs with response times that were finally after decades of improvement at an acceptable time.

Under Giuliani and still today fire trucks respond to EMS Calls and then have to wait out of service for an ambulance to respond that has taken longer and longer to arrive because there are less ambulances on the street..

EMS is just as important a public service as police and fire, and especially in NYC it should have been left alone to continue to improve, instead we have an agency that was merged into FDNY and has been a win win for FD and a lose lose for EMS.

In NYC EMS should be a stand alone uniformed service charged with providing emergency medical service to residents and visitors.

Just my opinion.

With all the respect of your opinions and the validity of them....utilizing a tiered response for EMS is a national standard and one used in just about every major city in the U.S. and also statistically offers some of the best out of hospital resuscitation rates out there. I can't speak on ambulance wait times...but that is also why BLSFR is also important for those times that there is a wait from a minute to a few minutes to several minutes, that the patient has someone in their face and beginning care. I think there's enough fire apparatus to go around as well.

[PEMO3 523]

Come on, with all the back to back to back 16 hour days you guys were doing back then you couldn't have maybe gotten a 12 hour schedule worked out?? Hell, you guys got us these polo shirts. Why not a better work schedule?

You forget one thing. The mandatory O/T was only for 4 hours, 8 if you wanted to stay. Once you got you number pulled you went to the bottom of the list to be forced. A lot of guys, myself included jumped at the doubles when they were there, who wouldn't. You just made a deal with the boss - I'll do it voluntarily for 8 but you put me in for a force that way you didn't get screwed the next day. If you were lucky they needed 2 people and you and your partner would double the shift together. By the time you got back and switched rigs you blew off the first hour of the shift and then you could blow the last 30 or so minutes going in "O/T personnel". If you had gotten 12 hour shifts you would be working 16 hour shifts on a regular basis. Thank god they left it as 8 hour shift. As they always say, be careful what you wish for because you just might get it and it may not be the green grass you thought it was.

[Goose 188]

http://fdnyemswebsite.com/

I always find this and interesting website with interesting opinions on some of this very stuff...worth a read if you've got the time

[ny10570 745]

He's not worth the read. He's a bitter and angry individual that divested himself from the system some time ago and continues to rant under some perceived slight from the FDNY. He chases any valid points an factual info with half truths and exaggerations to prove his points. As I've said before there are plenty of flaws with FDNY*EMS but its not the mess some former members would have you believe.

[Guest pneumono]

Voluntary units were know to perform wallet biopsies prior to transport. If the patient test positive for insurance they returned to base like homing pigeons, if the patient test negative then it was off the an HHC receiving facility.

Complete garbage...in all my years working at a voluntary hospital EMS dept in NYC, I never ONCE heard of someone doing this or even suggest doing this. Nor have I EVER had a manager suggest where to take a patient. We were never involved in any aspect of billing, didn't document their insurance or check if they had it. The only time I have ever heard of this crap is when it is coming from FDNY EMS.

What we did do, was treat our job like someone's life depended on it. We always had SOD radio up and were already responding when EMS was dispatched, buff, whatever. If a job in our area was mis-dispatched to another unit, we took it. If we were closer to someone elses job, we took it. If we got relocated, we did it without complaint. If the patient wanted to go to manhattan, they went there. If the patient wanted QGH, they went there. If the patient didn't care, they went to the closest appropriate, end of story.

[ny10570 745]

Complete garbage...in all my years working at a voluntary hospital EMS dept in NYC, I never ONCE heard of someone doing this or even suggest doing this. Nor have I EVER had a manager suggest where to take a patient. We were never involved in any aspect of billing, didn't document their insurance or check if they had it. The only time I have ever heard of this crap is when it is coming from FDNY EMS.

What we did do, was treat our job like someone's life depended on it. We always had SOD radio up and were already responding when EMS was dispatched, buff, whatever. If a job in our area was mis-dispatched to another unit, we took it. If we were closer to someone elses job, we took it. If we got relocated, we did it without complaint. If the patient wanted to go to manhattan, they went there. If the patient wanted QGH, they went there. If the patient didn't care, they went to the closest appropriate, end of story.

That's great that you did your job and did it the right way. However too many of your peers did not. In 1994 the city council held an investigation at the behest of HHC into the issue. All of their evidence was weak at best and their research was conducted by HHC hospital staffers with a vested interest in the outcome. That investigation while raising some interesting stats resulted in a warning to follow the established rules. Then in 2001 the city comptroller published a report showing clear evidence of substantial disparities in patient destinations between municipal and voluntary units.

If you'd like when I get to my computer I'll email you the report. Patient steering was absolutely a problem.

[joetnymedic 43]

He's not worth the read. He's a bitter and angry individual that divested himself from the system some time ago and continues to rant under some perceived slight from the FDNY. He chases any valid points an factual info with half truths and exaggerations to prove his points. As I've said before there are plenty of flaws with FDNY*EMS but its not the mess some former members would have you believe.

isn't that the old FDNY sucks website? I thought the guy took the site doewn after 9/11?

[ny10570 745]

Not sure. Could be, they have similar opinions of FDNY

[masterofmetal85 10]

Never worked FDNY love the voluntaries but I knew ppl in nslij that the higher ups were hell bent on pt steering that no pt goes to another hospital...this is all what I heard.

[masterofmetal85 10]

Never worked FDNY love the voluntaries but I knew ppl in nslij that the higher ups were hell bent on pt steering that no pt goes to another hospital...this is all what I heard.