# NYC Voluntary Hospital Employment



## 46Young (Feb 10, 2011)

An article I read about NYC planning to charge up to a million per 911 provider hospitals in 2012 prompted me to call my cousin, who is married to a FDNY EMS Capt, and also works per diem at North Shore LIJ. The thread:

http://www.emtlife.com/showthread.php?t=22035

She said it's true, and that NSLIJ isn't going to pay them anything. They're expanding their IFT, they have 911 contracts in Nassau County, and they also get a lot of emergent calls on their private line, instead of these pts calling 911. She said the're expanding, and need to hire. I would apply now. It certainly pays better than the pprivates, better benefits, wirking conditions, etc.


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## looker (Feb 10, 2011)

46Young said:


> An article I read about NYC planning to charge up to a million per 911 provider hospitals in 2012 prompted me to call my cousin, who is married to a FDNY EMS Capt, and also works per diem at North Shore LIJ. The thread:
> 
> http://www.emtlife.com/showthread.php?t=22035
> 
> She said it's true, and that NSLIJ isn't going to pay them anything. They're expanding their IFT, they have 911 contracts in Nassau County, and they also get a lot of emergent calls on their private line, instead of these pts calling 911. She said the're expanding, and need to hire. I would apply now. It certainly pays better than the pprivates, better benefits, wirking conditions, etc.



I am always surprise when I read that an ambulance company are able to do code 3 respond to a phone call without being contracted with the city for 911.


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## Minnick27 (Feb 11, 2011)

Why is that surprising? They are still an ambulance and they were called for an emergency. That being said, my company isn't allowed to run lights and sirens in Philly


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## looker (Feb 11, 2011)

Minnick27 said:


> Why is that surprising? They are still an ambulance and they were called for an emergency. That being said, my company isn't allowed to run lights and sirens in Philly



It is surprising because 911 is no longer under centralized control. Regarding your company not going code 3, is that city rule/law or your company decision?


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## 46Young (Feb 11, 2011)

My understanding is that in NYS, a private ambulance company must have an EMS permit. This permit allows them to run L/S. Just because you're not a 911 service, that doesn't mean thart you won't get private emergency calls. Dispatch at NS-LIJ would dispatch their own bus only if their ETA was reasonable, or they would call 911 for them instead. Some residents prefered us to the local vollies, or FDNY EMS in the city as the case may be. Emergent STEMI cath lab jobs need to be L/S. Same for a balloon pump job, a critical NICU or PICU txp, perinatal txp, etc. The privates in NYC, such as Hunter Ambulance-Ambulette, Transcare, Citywide, Seniorcare, AMR, First Response, etc. all have nursing home contracts, and get first shot at any NH emergent call, so long as they can be there within a certain time interval. I didn't know that running L/S as a private was not allowed in other areas until I moved out of NYC.


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## Minnick27 (Feb 11, 2011)

looker said:


> Regarding your company not going code 3, is that city rule/law or your company decision?



Nobody has ever given me a straight answer. I can't see how the city can say "ok the state has certified you as an ambulance, but we don't want you operating as one." it's basically like going to a nursing home for a call and having a nurse offer to call a "real" ambulance


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## firecoins (Feb 11, 2011)

So if a patient in a private amnulance begins to code, we should wait at red lights?


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## JPINFV (Feb 11, 2011)

I sorta of agree with Looker with this. Outside of critical hospital to hospital transfers (e.g. traumas not at trauma centers, MI patients not at cath lab hospitals, etc), if the patient is in such dire condition that they need to be treated and transported ASAP, then they need to get the closest paramedic level ambulance. In the vast majority of places, the closest paramedic level ambulance is going to be obtained through the 911 system. 

Now, if the non-911 crew arrives and finds out that the patient is critical and that the facility should have accessed the 911 system, then fine. They should be allowed to trasport emergently if they are a paramedic level ambulance, or transport emergently based on the ETA of the closest paramedics (regardless of if paramedics from that company or through the 911 system) and the estimated transport time.

Afterall, this is about the patient, not the company or the crew.


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## looker (Feb 11, 2011)

firecoins said:


> So if a patient in a private amnulance begins to code, we should wait at red lights?



No go you code that is what you have lights for unless intercept is closer(if you're bls) in which case you call for one and meet up at designated place. On the other hand what is being described is calling private company instead of 911.


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## looker (Feb 11, 2011)

Minnick27 said:


> Nobody has ever given me a straight answer. I can't see how the city can say "ok the state has certified you as an ambulance, but we don't want you operating as one." it's basically like going to a nursing home for a call and having a nurse offer to call a "real" ambulance



When someone have an emergency they should be calling an emergency centralized number which have the resources to get first available unit to that person. For ex if city own ambulance is not available the city calls back up contracted service if they are not available they either check another contracted service or back up service calls their own back up service etc. This way all calls go in to the same place. If something big go down first responders will have all the available info instead of getting it through second hands.


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## looker (Feb 12, 2011)

Minnick27 said:


> Nobody has ever given me a straight answer. I can't see how the city can say "ok the state has certified you as an ambulance, but we don't want you operating as one." it's basically like going to a nursing home for a call and having a nurse offer to call a "real" ambulance



Here is the language for Los Angeles regarding this 

"Owner's Responsibility- No Ambulance Service permittee or other person directing an ambulance shall:
a.	Respond to any emergency call that would normally be considered an emergency 9-1-1- call for authorized emergency transportation unless the call is either from public entity or an authorized emergency transportation 9-1-1- operator requesting backup service"


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## DrParasite (Feb 12, 2011)

looker said:


> When someone have an emergency they should be calling an emergency centralized number which have the resources to get first available unit to that person. For ex if city own ambulance is not available the city calls back up contracted service if they are not available they either check another contracted service or back up service calls their own back up service etc. This way all calls go in to the same place. If something big go down first responders will have all the available info instead of getting it through second hands.


that is how is works. when someone calls 911, it goes to the 911 center and the closest ambulance is dispatched (in theory anyway)

in the case a a nursing home, if 911 is called, then the nearest ambulance is sent.  if 911 is not called (for various reasons usually have nothing to do with patient care) and the doctor still wants the patient to go to the hospital,   a private service is called (which is contracted to provide services in a contract between the facility and the private service), and they are usually there within the hour.


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## looker (Feb 12, 2011)

DrParasite said:


> that is how is works. when someone calls 911, it goes to the 911 center and the closest ambulance is dispatched (in theory anyway)
> 
> in the case a a nursing home, if 911 is called, then the nearest ambulance is sent.  if 911 is not called (for various reasons usually have nothing to do with patient care) and the doctor still wants the patient to go to the hospital,   a private service is called (which is contracted to provide services in a contract between the facility and the private service), and they are usually there within the hour.


I understand that but article says they get a lot of calls on their private number for emergency respond. Which to me means code 3 lights and siren respond. If the nursing home have an emergency they should not be able to call their contracted provider to respond as emergency unless they are contracted as one with the city.


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## DrParasite (Feb 12, 2011)

hence the term nursing home 911.  believe it or not, nursing homes will call private companies for residents with chest pains, diff breathing, seizures, etc.  it's not right but it happens.  and yes, i have taken ALS requests from private companies who have BLS ambulances responding to ALS criteria emergencies.


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## looker (Feb 13, 2011)

DrParasite said:


> hence the term nursing home 911.  believe it or not, nursing homes will call private companies for residents with chest pains, diff breathing, seizures, etc.  it's not right but it happens.  and yes, i have taken ALS requests from private companies who have BLS ambulances responding to ALS criteria emergencies.



Can you explain why no protocol existed that would require operator to transfer the call to 911? Just seems like company putting profit above patient care but that is just my opinion.


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## DrParasite (Feb 13, 2011)

looker said:


> Can you explain why no protocol existed that would require operator to transfer the call to 911?


and the answer is:





looker said:


> Just seems like company putting profit above patient care but that is just my opinion.


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## 94H (Feb 13, 2011)

Back on topic, NS-LIJ is hiring

Is a CDL standard for companies in NYC/LI?


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## 46Young (Feb 13, 2011)

94H said:


> Back on topic, NS-LIJ is hiring
> 
> Is a CDL standard for companies in NYC/LI?



I was hired by NS-LIJ back in 2003. At that time, they still ran an ambulette. As a condition of employment, we were supposed to obtain a CDL BP within six months of hire. The ambulette program was discontinued later that year. The CDL requirement was also scrapped. I worked for Hunter Ambulance-Ambulette in 2002. Their ambulette service was seperate from their ambulance service. I don't know of any places that make you have a CDL to be an EMT. The places that have ambulettes were paying those drivers less than their EMT's, typically 7-9 bucks an hour.


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## looker (Feb 13, 2011)

46Young said:


> I was hired by NS-LIJ back in 2003. At that time, they still ran an ambulette. As a condition of employment, we were supposed to obtain a CDL BP within six months of hire. The ambulette program was discontinued later that year. The CDL requirement was also scrapped. I worked for Hunter Ambulance-Ambulette in 2002. Their ambulette service was seperate from their ambulance service. I don't know of any places that make you have a CDL to be an EMT. The places that have ambulettes were paying those drivers less than their EMT's, typically 7-9 bucks an hour.



Never seen ambulette term used till today. We just call it non emergency medical transportation(nemt). Learn something new everyday


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## 46Young (Feb 13, 2011)

looker said:


> Never seen ambulette term used till today. We just call it non emergency medical transportation(nemt). Learn something new everyday



http://www.hunterambulance.com/

Skip past the cheesy intro, and go to employment. It states the qualifications for ambulette driver. When I worked there, the 'lettes worked during the day, and the ambulances would take 'lette jobs at night - no PCR required, and we would be required to take $40 cash (2002) if payment was not pre-arranged. Looking back, I'm not sure if that was legal or not. The fact that you need a CDL to txp these customers, would suggest that using an ambulance to txp them instead is shady.


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## 94H (Feb 14, 2011)

Where I work now its the same deal with Ambulettes during the day and Ambulances taking them at night. However we dont need CDLs here


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## Jon (Feb 16, 2011)

Minnick27 said:


> Why is that surprising? They are still an ambulance and they were called for an emergency. That being said, my company isn't allowed to run lights and sirens in Philly



False. 

The City / Philly Fire's party line is that emergency calls are the sole responsibility of the PFD. If you are called for a non-emergency transfer, and the patient truly requires emergent transport, you are STILL a state licensed ambulance, and required to abide by the BLS/ALS protocols.

Additionally, if you come upon something (MVA, etc) while driving through the city (not on a transport) you are still obligated to stop and render aid. PFD medics can, and will, release transport to you if appropriate.

I work as a medic for a private provider in the city, and I've run hot a few times - usually because the patient condition changed, but also because I've transported legit emergencies in from event standbys.


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## Minnick27 (Feb 17, 2011)

Like i said, some people tell me that it's te city that won't let us run lights, some say it's our policy. Nobody seems to know the right answer.


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