WREMSCO EMD Deadline

[firedude 985]

What are EMS agencies (those not already dispatched through EMD) doing to adhere to WREMSCO's new EMD policy, effective Janurary 1st, 2013.

Due to critical importance of pre-arrival instructions and resource prioritization associated with emergency medical calls, the Westchester REMSCO urges all dispatch centers to institute the use of Priority Emergency Medical Dispatch (EMD) with a quality improvement procedure. EMS agencies authorized by the REMAC to provide ALS services will be required to be dispatched by EMD Centers effective January 1, 2013

From: WREMSCO Policy Statement EMS System Resource Utilization

[Stealthmedic1 5]

I seriously hope 60 control has a mass hiring, because it's going to be interesting!

[wiscems 23]

Are most agencies scheduled switch over on December 31st or something? My understanding was those that were going to switch have essentially done so.

[Goose 188]

Switching over to what? 60 Control? Those poor guys can barely handle the call volume they have now - this county (including the DES comissioner) doesn't seem to have any plans to face the reality and expand staffing. However, despite the exponential increase in call volume over the years w/o appropriate expansion i really do tip my hat to them - they do as best of a job as they can given what they have to work with.

That said, the REMAC (and i watched the webcasts) pushed out this policy statement without effectivly researching dispatching in this County. I think there was one indavidual who actually had a grasp on the reality in the webcast i watched. The expectation to have everyone EMD capeable by 1/1/13 (if that is even still the go live date) is rediculous. These are the issues as i see them:

EMS System issues:

- The point of EMD is to prioritize resources - send medics and other resources only on calls that they are truly required for. Unfrotunately, the reality is many of the volunteer ambulances (which make up the majoirty of the transport capeabilities county wide) are unreliable. Average wait time in excess of 20 minutes are the norm - some days/time of day are better, some days/time of day are worse. That said, sending a medic is the only way to get a reliable and timely EMS resource to your front door - thus defeating the purpose of EMD alltogether.

60 Control

- They simply dont have the staffing to answer, EMD, dispatch, and do all the other tasks that are required (imput CAD data, see the calls through to the end, request and or arange for more resources to scenes, etc)

- It seems a lot of time the PSAP (often a PD) who gets the initial call is not transfering the caller to 60 control for proper EMD. Rather, the caller is being hung up on, and the PD will call 60 and tell them "hey, dispatch XYZ VAC/Medic for chest pain IFO 123 Avenue." Again, whats the point?

Local PDs

- Most don't have exisiting EMD capabiliuty - that means buying a dedicated computer system and training all those who dispatch radio runs and EMS runs (often it seems like desk Sgts) in EMD.

- Bugetary constraints are creating atmospheres where most agencies are having to consider layoffs or vacating positions through attritiion, where are they supposed to come up with the money (infrastructure and OT training) to pay for the above?

- Honestly, i wonder how many PDs even care to be involved in this (i can't personally blame them)...they are busy taking care of what goes on in the law enforcement world.

I would much rather the REMAC work together with the County and Law Enforcement, take it's time, and establish a better thoughout system - preferably one that is a regional approach. I just think thats a much better path than spending a whole lot of money in a knee jerk reaction to an ill thought out policy and an arbitrary go live date.

Edited October 13, 2012 by Goose

[x635 4,066]

EMD saves lives. With some of the response times in this county, pre-arrival instructions can make a critical difference in the outcome of a call.

It's nice to see a progressive move like this.

[Goose 188]

There is no question that EMD is the standard of care and it can save lives. I don't disagree that it's good for the region to be behind the use of EMD. The problem, as I see it, is that they developed a binding policy statement without properly researching the realities that exist in this county's EMS system or exploring ways to employ EMD effectively.

[Bnechis 3,961]

There is no question that EMD is the standard of care and it can save lives. I don't disagree that it's good for the region to be behind the use of EMD. The problem, as I see it, is that they developed a binding policy statement without properly researching the realities that exist in this county's EMS system or exploring ways to employ EMD effectively.

They spent over 2 years researching it and in working with the police chiefs they extended the deadline from 1/1/2012 to 1/1/2013. A number of police depts. are in the process of implimenting EMD who would have never done it without a deadline.

[Goose 188]

They spent over 2 years researching it and in working with the police chiefs they extended the deadline from 1/1/2012 to 1/1/2013. A number of police depts. are in the process of implimenting EMD who would have never done it without a deadline.

I'll take your word for it. But, none of the agencies i worked for knew anything about it until it was released. Even by the REMAC's own admission, the police chiefs were surprised by the orginal publication and of the policy statement at one of the initial meetings. None of that really changes any of my feelins on it though, but thanks for the info.

Edited October 14, 2012 by Goose

[Jybehofd 85]

They spent over 2 years researching it and in working with the police chiefs they extended the deadline from 1/1/2012 to 1/1/2013. A number of police depts. are in the process of implimenting EMD who would have never done it without a deadline.

I am glad they haven't move the date back further and are standing on it. i just hope this is the beginning to fix the issues

[Goose 188]

I am glad they haven't move the date back further and are standing on it. i just hope this is the beginning to fix the issues

What issues is it going to fix?

[firedude 985]

What issues is it going to fix?

The dispatcher hanging up when someone called 911 saying they need an ambulance. Maybe thats a bit of an exaggeration but we all know westchester's 911 communications are far from perfect. This can only help, right?

Edited October 14, 2012 by firedude

[v85 212]

You shouldn't need a separate computer system for EMD, it should integrate right in with the CAD system. The real issue I think will be with the private companies that operate in Westchester.

[Bnechis 3,961]

I'll take your word for it. But, none of the agencies i worked for knew anything about it until it was released. Even by the REMAC's own admission, the police chiefs were surprised by the orginal publication and of the policy statement at one of the initial meetings.

Some of that issue was the lack of understanding on the police chiefs part as to what was being asked of them. A surprising number of them did not know that they already had EMD. The initial reaction on some chiefs, was who is EMS to tell us how to manage dispatch, instead of working towards improvement.

[Jybehofd 85]

well it should fix and reduce the number of times a medic is sent to a BLS call. and freeing up resources for when they are truly needed. And there are alot of issues in the county, there is a nice report of them online done by a well credited group the county paid for a few years back.

[firedude 985]

there is a nice report of them online done by a well credited group the county paid for a few years back.

Are you talking about the 2008 Fitch Report?

Link to report: http://ebookbrowse.com/2008-ems-study-final-report-pdf-d295054334

[Jybehofd 85]

yes

[Goose 188]

well it should fix and reduce the number of times a medic is sent to a BLS call. and freeing up resources for when they are truly needed. And there are alot of issues in the county, there is a nice report of them online done by a well credited group the county paid for a few years back.

I've read through the ditch report and in it it also references some of the things I outlied in my OP. EMD is going to help the citizens of this county, I never doubted that. What it won't and was never designed to do is fix an ineffective ground transport system, or overwhelming dependency upon paramedic response as the only timely 24/7 EMS asset or dependency of some BLS providers upon paramedics to ensure them that a call is, in fact, BLS. I guess the bottom line in my mind is that while EMD will begin 1/1/13 I will still be sent to BLS calls, wait 20 minutes for a bus and have patients ALS RMA through med control so their loved ones can get them to the ER quicker than a bus can.

The Fitch study is a scathingly honest document. Just wish more change was brought about because of it.

[Jybehofd 85]

yes there is nothing emd can do about not getting transport. but hopefully it will reduce the amount of times ALS is sent to a true and solid BLS call that comes in. like the EDP that hasn't taken drugs or OD on something but needs txp to the hospital

[MoFire390 118]

Due to the fact that some of us in westchester get medics on automatic dispatch is the lack of BLS knowledge out there. EMD should always be done reguardless of the call volume. I cannot begin to discribe who pissed I become when I see "No EMD due to call volume" if its that busy hire more people and get the proper help needed. We are depriving that cardic arrest pt proper care because of someone playing russian roulet on how many dispatchers are needed to run an operations center. Let's face it the amount of EMS calls has gone up everywhere!!! Its time to get prepared. Get these guys some help!

[x635 4,066]

The real issue I think will be with the private companies that operate in Westchester.

Empress EMS has used NAEMD succesfully since the mid-90's.

[firedude 985]

While we are on this topic, who else besides Empress, Greenburgh PD and 60 Control are EMD certified for EMS dispatching?

Edited October 15, 2012 by firedude

[v85 212]

I wasn't really referring to Empress but some of the other private companies that I'm not sure if they use it or not.

Also, does anyone know if Yonkers FD is EMD certified?

[helicopper 1,050]

I wasn't really referring to Empress but some of the other private companies that I'm not sure if they use it or not.

Also, does anyone know if Yonkers FD is EMD certified?

I thought 911 calls in Yonkers that required EMD got transferred to Empress for it?

[INIT915 1,119]

So, if an EMS agency has a dispatch point (that they desire to remain with) which cannot or will not implement EMD by 1/1, they will revoke their ALS privileges?

[v85 212]

They probably do, I thought though that YFD was some kind of backup to Empress or had something to do with medical calls on night shfits

[Bnechis 3,961]

So, if an EMS agency has a dispatch point (that they desire to remain with) which cannot or will not implement EMD by 1/1, they will revoke their ALS privileges?

Correct.

In addition they will lose any REMAC authorization for medical control items (albuterol, epi pen, mark 1 kits).

There is a catch 22 here since DOH requires all agencies to have an ALS plan.

This move was approved was approved by the state.

Remac has advised those agencies that are activly working towards implementation will be given some leeway as long as they are kept advised of the status.

[x635 4,066]

I thought 911 calls in Yonkers that required EMD got transferred to Empress for it?

Yonkers does transfer EMS calls to Empress. Empress will also obtain the phone number to call back to EMD when the situation presents itself.

Additionally, Empress uses ProQA, which is intergrated into their CAD.

[WAS967 97]

What ALS agencies in Westchester provide PSAP dispatching and don't do EMD?

[Remember585 815]

EMD is an invaluable tool, and it is not and will not be used to it's fullest, most correct potential anytime soon.

So long as 911 calls keep going to so many Keystone and Mayberry Police agencies, where they continue to think it's the early 80's and it is the PD that dictate what/how EMS and FD's operate - nothing will really change.

As long as cellular 911 continues to get sent to the "closest" Cellular 911 answering point based on it's given location, we'll never get it right.

Assuming Cellular 911 in Westchester actually finds it's way to the TMC, who then transfers the caller (and they're good at this) to whatever EMS/FD Dispatch center they send it to - which is not just one location - we'll never make real progress.

If BLS agencies don't stop having Medics respond to EVERY CALL because EMTs are scared to make decisions or those Medics have to constantly ride in BLS jobs - it won't change anything.

And - as long as people are afraid to stand up and say that certain 911 / Dispatch Centers are understaffed, under-trained and poorly managed - yeah, thinking this EMD requirement will solve everything is nothing more than a wet dream.

If we want to see real change that will create real improvements for those calling 911, it's only a couple of key things that need to be done, but these things are so hard (read: impossible) to make happen, that I doubt it will happen in my lifetime.

1. Eliminate the exzuberent amount of 911 PSAP's in Westchester County. Let's all put on our big boy pants and stop the ego trips. 911 should go to one (maybe a few more in the bigger Cities) answering point with qualified, trained personnel. This central 911 center (or those in the bigger cities) should have capable, competent, trained and properly paid personnel that can handle call taking and dispatching. Yes, I know we need a facility for this, but that is the only way it will ever work. (I truly think Yonkers is the only City that could survive on it's own as a PSAP, the rest could be folded into one location - it's done in how many other areas of the world...)

2. Stop sending ALS units to BLS jobs. It's a waste of an invaluable service. Keep them free for legitimate EMS calls. (I personally remember too many incidents where a Medic was stuck on a BLS job and ALS was delayed to calls where people were DYING!)

3. BLS agencies - COVER YOUR CALLS. Stop tying up Medics and dispatchers trying to cover calls for you. It then trickles into Mutual Aid covering you, then Mutual Aid covering them, and so on. I'm not being a dIck, it's the truth.

4. Create better paying jobs for those in the EMS system. From the dispatchers to the EMTs to the Medics. If you pay everyone better, give them real benefits and retirement - there's better potential they will do their jobs better and with a better attitude. I hate seeing Medics working 3,4 or 5 jobs to make a living - it's an insult to them.

Well, now that I have successfully pissed in enough peoples' Cheerios, I will leave everyone with one thought. If you call 911, are you 100% confident the call will be handled properly?

Yeah, me either.

Be safe.

[WAS967 97]

The way I'm reading this plan, it's not really concerned so much with the operation of the PSAP but they dispatching of the medics. To simplify the language, it is basically saying that all EMERGENCY 911 ALS units in the county must be dispatched by an EMD certified dispatch center. I guess this really aims at the agencies like Harrison, PCRVAC?, Eastchester, MEMS?, WPEMS, MVEMS, OVAC, YVAC, MVAC etc who are (or maybe - some I dunno honestly) dispatched by PDs. And the goal is to make sure those PDs are properly performing EMD pre-arrival instructions.

Agencies like Empress, Greenburgh, CPP, WEMS, TC of NR should be okay as their dispatch centers have EMD capability.

It's too bad the powers that be don't have the power/balls to enforce proper transfer of EMS calls to 60 Control (or whomever). It's ridiculous how often it's not done.