# How to buff calls in NYC?



## adamNYC (Jul 19, 2015)

Buffing = Scanning PD/EMS radio and trying to get on scene before 911 ambulance does

NYC EMS guys who buff at volunteer ambulances: I desperately need help on how to buff better. Sure I get tips from guys at the volly but I want to know everything I can about buffing to increase my chances. I am frustrated at not getting calls on some of my volly tours. Here are some of what I picked up. Anyone else that can add to this please do so.

Please, this is not a place to debate about if buffing is the right thing to do or not. Bottom line, most vollys in NYC buff. Period. If you wanna have a debate about it please visit my other thread "Buffing @ Private NYC Ambulances"

1. Never buff house jobs. Wait for PD/EMS to arrive and offer assistance if they need it. Or roll by to see if anyone flags you down
2. Learn PD radio 10-codes. 53s and 54s are great. Are the "calls for help" any good?
3. EMS dispatch is a ***** because of the intersections, has a high failure rate, unless its a street job.
4. PD dispatch is awesome since they give exact addresses
5. Respond with Lights and sirens for a job 5-10 minutes away. Anything more than that you prob won't get there in time.
6. Radios that dual channel monitor are great. I monitor both PD & EMS at the same time. I swear by the BaoFeng UV5R ($27 amazon)
7. Even if EMS is on scene I ask if they need help with anything, in case they have multiple patients, etc.


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## Fleury14 (Jul 19, 2015)

This just sounds insane to me.


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## Carlos Danger (Jul 19, 2015)

This sounds like the intro to an EMS-themed Super Troopers type of movie.


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## Fleury14 (Jul 19, 2015)

Remi said:


> This sounds like the intro to an EMS-themed Super Troopers type of movie.


Has to be a parody account, right?


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## Chewy20 (Jul 19, 2015)

1. I constantly keep the ambulance in motion so I am one second ahead. Even if I have to drive in circles in a parking lot.
2. I walk around in the grocery store asking if people want to be evaluated. You never know.
3. If the on scene 911 crew has one pt. I say, "Move over, I got this."
4. I bring the cops donuts so they send me a text about a call that is about to drop.
5. Always get mad at my dispatch and tell them to get the address right so I can be there first and make a difference.
6. 11 minutes away? Pffht let the suckers take that one.
7. Use tshirt cannons to handout tourniquets while driving to another call, never know when someone will cut their leg off walking Sparky.
8. Every Sunday morning I will go out to the driveway and test my POVs lights and sirens. I will not be that guy with malfunctioning lights! Who says you have to go to church to be religious about something?!
9. Air drop thousands of flyers saying "Keeping the reaper at bay" with your number on it. Works wonders.
10. See therapist for how crazy I am. Or am I?
11. Rinse, repeat.


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## Tigger (Jul 19, 2015)

Step 1: Get hired at a service that provides legitimate 911 services to NYC.

Step 2: Go to work. 

Step 3: Attempt to forget about this stage in your career/life and move forward as a professional provider.


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## cprted (Jul 19, 2015)

Tigger said:


> Step 1: Get hired at a service that provides legitimate 911 services to NYC.
> 
> Step 2: Go to work.
> 
> Step 3: Attempt to forget about this stage in your career/life and move forward as a professional provider.


^This


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## Generic (Jul 19, 2015)

I think the OP accidently put this thread here and not where it should be located. 

http://emtlife.com/threads/what-defines-a-wacker-vs-a-normal-emt.41786/


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## ERDoc (Jul 19, 2015)

Here is the best way to buff calls in NYC:

1.  Don't


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## adamNYC (Jul 19, 2015)

Ive got a couple more months till i get my 6mos txp experience down along with volly experience before i start applying at 911 hospitals. The FDNY EMS civil service test is in september as well. Until then, buffing is the way I get 911 experience.

It is common practice for volunteer ambulances in NYC. I was actually expecting more constructive feedback and advice from other volly buffers.

Chewy20: Love that comedy writing genius


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## ERDoc (Jul 19, 2015)

You have gotten constructive feedback, it is just not what you wanted to hear.


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## adamNYC (Jul 19, 2015)

I need better results. A tour without a single successful call resulting in a pt txp to ER is a bad tour.


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## ERDoc (Jul 19, 2015)

So what.  It's the nature of the beast.  It's good to know that you want your fellow humans to get hurt or sick.


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## Chewy20 (Jul 19, 2015)

adamNYC said:


> I need better results. A tour without a single successful call resulting in a pt txp to ER is a bad tour.



Ugh. A bad "tour"? First of all its a shift, not a tour. Quit trying to be tacticool. Second of all, most of us do 911 on here and I think I speak for everyone and say a shift without a transport or call is the best freakin' thing in the world. You'll get a partner that will put things in reality for you one day, but until then, tone it down a notch or ten.


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## NomadicMedic (Jul 19, 2015)

Chewy20 said:


> Ugh. A bad "tour"? First of all its a shift, not a tour. Quit trying to be tacticool. Second of all, most of us do 911 on here and I think I speak for everyone and say a shift without a transport or call is the best freakin' thing in the world. You'll get a partner that will put things in reality for you one day, but until then, tone it down a notch or ten.



Actually, in NYC, its not a shift, it's a tour. The truck is a bus. A call is a job. The guy is a volly-whacker, but the terminology is NYC appropriate.


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## Chewy20 (Jul 19, 2015)

Even more reason for me not to like NY. Yankees was bad enough.


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## phideux (Jul 19, 2015)

adamNYC said:


> Buffing = Scanning PD/EMS radio and trying to get on scene before 911 ambulance does
> 
> NYC EMS guys who buff at volunteer ambulances: I desperately need help on how to buff better. Sure I get tips from guys at the volly but I want to know everything I can about buffing to increase my chances. I am frustrated at not getting calls on some of my volly tours. Here are some of what I picked up. Anyone else that can add to this please do so.
> 
> ...




5. How do you legally respond "lights, and sirens" on a call you are not assigned to?????


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## adamNYC (Jul 20, 2015)

Just gotta love all the different EMS slang/lingo that varies around the USA.

Maybe you want to sit around doing nothing, but I didn't get into EMS to sit on my ***. I need action!


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## ERDoc (Jul 20, 2015)

Chewy20 said:


> Yankees was bad enough.



Hey, easy there.



adamNYC said:


> Just gotta love all the different EMS slang/lingo that varies around the USA.
> 
> Maybe you want to sit around doing nothing, but I didn't get into EMS to sit on my ***. I need action!



No, you need to stop and come back when you are mature enough.  Once you see your pts as people and not as awesome calls to gloat about, then you will be ready for EMS, until then, please stop.


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## adamNYC (Jul 20, 2015)

yes dad


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## Jim37F (Jul 20, 2015)

If you want to run 911 calls, and need "action" so bad, why don't you go get hired on by a 911 provider vs work for free for someone who doesn't get the types of calls you want dispatched? 

There sems to be plenty of 911 providers all over the country who would love to compensate you for you spending 100 hours a week or so in their ambulance ...

I think I read that you said pretty much all your local 911 service providers require 6 months experience? The obvious implication is that you don't have that experience. That you are a brand spanking new EMT. When most of us here have worked for IFT only services when first certified/licensed, honestly, you really come out sounding like my last Army roommate, brand new soldier fresh from Basic, less than 6 months in the Army, complaining to me how they wouldn't let him direct commission in to be an officer with his law degree (of course he didn't do any ROTC or anything, he just did some school, talked to a recruiter am signed the dotted line, and then expected a sympathetic ear from me when he didn't get his way handed to him on a silver platter. Sound familiar?)

When I first got my cert, I worked for an IFT only company. 6 months on a BLS unit, you know how many calls that weren't pre-scheduled non emergent transfers? Zero. The only times we turned on the lights were when backing around traffic. The following three months on a Critical Care Transport unit, only 1 emergent call. Heck half the time we only got 1 or 2 calls a shift total. 

THEN I finally got hired on by a 911 company. We only got maybe 3 calls a shift, if 2 or more of those were 911 calls (everyone got both IFT and 911) you had a nice busy shift. But guess what? The way that city structured their 911 system, us on the BLS ambulance were NEVER dispatched emergent. The FD medic unit did go code, but if we showed up code when they didn't request us to upgrade would've meant I'd have been looking for a new job...We only transported Code 3 when the medics rode in with us (all BLS transports were strictly code 2 non emergent only). It was easy to go an entire week (3-4 12 hour shifts) without once ever turning on the lights. And because that was one of only 6 ambulance companies in the county with a 911 contract, out of almost 90 companies in the county (probably more) THAT was action packed compared to most everyone else.

So be very very glad you happen to be in pretty much the ONLY area of the country where "buffing" is so much as tolerated.


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## ERDoc (Jul 20, 2015)

Seriously, if you want to run calls that bad before you have the ability to run them, go out to Long Island.  There are plenty of vollies that more than busy enough.  I can't tell you where to go in Nassau but I could give you a few VACs in Suffolk.


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## Jim37F (Jul 20, 2015)

Also, there's a Recruiter (actually lots of them) with an 11X Airborne Ranger contract just waiting for someone to walk in their door asking for action....


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## ERDoc (Jul 20, 2015)

That is an even better idea.


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## Akulahawk (Jul 20, 2015)

adamNYC said:


> Just gotta love all the different EMS slang/lingo that varies around the USA.
> 
> Maybe you want to sit around doing nothing, but I didn't get into EMS to sit on my ***. I need action!


When I got started in EMS approximately 15 years ago, I worked for a little "mom & pop" type ambulance company. We did mostly IFT with the occasional emergency run. Most of the time, I worked 12 hour shifts (tours) and in that time, I'd average 8-9 calls (jobs). Here's the interesting thing: we stressed doing _good_ assessments for each and every patient we contacted. Therefore we got very, very good at doing them. I liked doing the emergency runs simply because that meant that I'd get the opportunity to go to the ED with a patient, present my findings and _learn_ from them what I did right and didn't do so well.

The company I worked for was so well regarded that when 911 calls (jobs) were solicited by the 911 dispatch center, we usually got assigned those calls (jobs). When we'd arrive on scene, we'd very often see a look of relief instead of a look of sheer contempt by the local FD's. They knew that we knew what we were doing. Later, when I got into 911, I'd usually have 15 calls (jobs) in 24 hours. A slow day was when we'd get maybe 8 or fewer. Fewest calls (jobs) I ever had in a 24 hour period was... zero. Most I'd ever had? 21. 

Now that I'm working in the ER, today I had just 10 patients in 12 hours. It was a slow day. Do I like busy days? Sure. It makes the day go by a little faster. Here's the thing though. Sure, I get to do a lot of things in the ED and I got to do a lot of things when I was out on the street. I never lost sight of the fact that for me to have a "good day" it usually meant that my patients likely had one of the worst days of their lives. I see them as people and these people have a problem that I can help them work through. Sometimes, for some very practical matters, I do have to sit on my *** because I need data that I must wait for. When it comes to doing various tasks/skills, I'm actually a minimalist. A lot of us are that way. I do only that which is needed instead of lots of things simply because I _can_. Eventually you'll learn that stuff too. 

Work on developing good, solid patient care skills and learn _why_ you do them and you'll more quickly be able to realize what we're all trying to tell you. You don't need to do any buffing to learn those skills. Do them by approaching each and every call (job) as if it's an emergency and dial things back from there as needed. Eventually you'll run everything using the same pattern and you won't miss anything substantial while doing just the necessary stuff. When  you step up to 911, the only real changes will be the lights and siren get used more and the patient acuity may be a little higher most of the time. 

You're not there yet. You're brand new, relatively speaking. I'm still a very new nurse and I still have lots to learn about my field... but put me on an ambulance and I'd be right at home whether it's an ALS or BLS ambulance (bus). It's not that I know it all, it's just that my experience base is much wider and deeper than yours... and a whole lot shallower and narrower than many others that post here. 

Hence the advice about buffing: Don't.


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## Chewy20 (Jul 20, 2015)

Jim37F said:


> Also, there's a Recruiter (actually lots of them) with an 11X Airborne Ranger contract just waiting for someone to walk in their door asking for action....



lol my recruiter would have smacked me upside the head if I said that. Luckily he was 11b himself and didnt spew me the whole, you'll have all the fun in the world if you join my Army BS.


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## RedAirplane (Jul 20, 2015)

I'm not a New York EMT, but I did sleep at a Holiday Inn Express last night.

The whole system of "jumping calls" really confused me; it seemed like something straight from Alice in Wonderland. I wanted to find out more.

I requested some information from the City of New York under the Freedom of Information Act but was met with a less-than-lukewarm response. A letter from the Fire Commissioner's Office would have me believe that the volunteer ambulances magically come into existence only when FDNY needs them, and they vanish into nothingness at other times.

I also managed to get my hands on dispatch protocols for one of the volunteer ambulances. It looks like there is a Memorandum of Understanding in place where although they are not dispatched via 911, they have unit numbers they can call FDNY dispatch to advise that they are on scene of the call and cancel the FDNY unit. The Memorandum also seems to imply that NYPD is more than happy to have their calls for ambulances jumped by the closer volunteer unit and when in the zone of that ambulance service will radio directly sometimes.

It's nuts, and I have my own thoughts on what should be done about it, but it seems that is how it is.

What I am not sure about is whether this practice extends to the private/IFT type ambulances. That is the question I would encourage OP to find out locally.

And while the entire situation is dizzying, if what OP is asking to do is in fact expected/condoned from his type of ambulance service, I am not sure one can blame him for figuring out exactly how to do what is expected but perhaps not spelled out.

Maybe I'm just someone who doesn't know anything, but this is my $0.02.


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## adamNYC (Jul 20, 2015)

Yes im a new EMT but not new to Healthcare. 4 years previous experience as CNA/PCT. I got in EMS because it got boring and I needed outdoor action. I also use to be a NYC bike messenger so I think you can tell im an adrenaline junkie.

Ironically, I did consider Army/Airborne/Ranger before but I have a son and love NYC too much. If I went I should have went when I was in my early 20s.

Redairplane: Exactly what Im saying. Buffing is standard volly practice between the private calls they receive from local neighbors.

Im also considering another volly in a supposedy bad part of Brooklyn that is known for its GSWs traumas and whatnot

As for privates buffing, its not allowed and I dont do it, but ive heard of guys who have and they simply tell our dispatcher they got flagged for the job. Plausible deniability and intentional serendipity is the name of the game they say


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## Carlos Danger (Jul 20, 2015)

EMS is probably not a good place for an "adrenaline junkie"....


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## Tigger (Jul 20, 2015)

Do you know what patients are? Or is your own ego so large that you don't generally see those on your tours?


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## OnceAnEMT (Jul 20, 2015)

Not to snuff out the OP or anything...

Why is "buffing" these "jobs" not prosecuted by PD? Or the OEM of the city even? There is not much volly EMS where I am at, and where there is, it is 911. I for one think it is silly that there is actually government EMS overlapping with volly. There is your problem. Go join a company, get paid, make a difference, be proud of what you do. As you are trying to race to a scene to beat up the reaper, you are also putting others in danger. But then again, you are wanting more patients. Spin that, see how it goes.

Seriously, this is ridiculous. Worse then Fire arguing over which side of the street they are the AHJ on (and restarting the argument when a structure fire drops).


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## NPO (Jul 20, 2015)

This is the most ridiculous thing I've ever heard. Listen to the feedback. This is a bad idea. It's probably illegal (it is in CA), especially if responding lights and sirens to a scene. I know an EMT who had his license revoked for this EXACT thing. 







So then I got to thinking. If you didn't "buff" calls, would your ambulance just sit there? Probably. So why does your agency exist? It's not covering an uncovered area, because you are trying to beat the REAL ambulance there, and most of the time you can't, so it doesn't sound undeserved either. 

So that leaves the question of why is it so important for you to race to calls, which are not yours, to get patients. 

For billing. Someone is profiting from this, at your expense. Who ever owns your agency could not secure any 911 contracts legitimately so you have to steal calls. Which is also illegal.

So far I count 3 serious illegal offenses, not counting the behind closed doors nonsense I'm sure we don't see.

Listen to us. Get out while you can, or go work for a legitimate transfer only service if that's all you can get. 

And I thought Los Angeles was bad. At least there you get a real ambulance when you call 911, even if it does have a firefighters in medics' clothing.


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## Chewy20 (Jul 20, 2015)

adamNYC said:


> If I went I should have went when I was in my early 20s.



Wait, you're not 17?


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## Carlos Danger (Jul 20, 2015)

Remi said:


> EMS is probably not a good place for an "adrenaline junkie"....



Just to clarify my earlier post.....

EMS is very stimulating and exciting at first, for everyone. But as anyone whose been in EMS for a minute or two knows, that quickly fades and it can become very mundane and routine 99% of the time.

The reason that's a problem is because it means getting into EMS for the excitement is very much the wrong reason. I think a big part of the reason there are so many disillusioned, burned out, miserable people in EMS is because they were sold something false about EMS. It isn't at all the "racing the reaper" stuff that they had envisioned it being. Rather, it's boredom, routine, and sometimes very stressful. It's very rarely fulfilling, if what you need to be fulfilled is stimulation.  

And the reason _that's_ a problem is that bored, stressed out, unfulfilled people have a hard time being good at what EMS really requires: selflessness, compassion, understanding. Knowing the medicine and being good at the skills is important, of course, but what the job requires 90% of the time is something very different than what most of us thought going into it.


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## ffemt8978 (Jul 20, 2015)

ERDoc said:


> Hey, easy there.
> 
> 
> 
> No, you need to stop and come back when you are mature enough.  Once you see your pts as people and not as awesome calls to gloat about, then you will be ready for EMS, until then, please stop.


^^^^ THIS ^^^^


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## adamNYC (Jul 20, 2015)

"Listen to us. Get out while you can, or go work for a legitimate transfer only service if that's all you can get"

As per my signature I do specify I do txp work for a private. Privates don't buff so I look forward to the occasional emergencies at docs offices, SNFs, & assisted living facilities. Not to mention hoping I get flagged down for a job, which happened quite a few times.

Remi: Very well said. That was drilled into us in class and after four FDNY EMS ridealongs I did not see any arrests, traumas, or MVAs.

Grimes: Vollys have a rich history in NYC EMS history. It started when city ambulances had slow response times so the local volly would get there faster. Goto any of their sites and you'll read about their history. There are some 40 or so volunteer ambulance organizations in NYC:

http://www.nycremsco.org/newsflash1.aspx

This particular volly gets alot of news coverage


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## Tigger (Jul 20, 2015)

History. Not a good reason to do much of anything.


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## adamNYC (Jul 20, 2015)

No lie I've been getting frustrated at the whole buffing thing myself. Just did a 4-hr volly tour with no calls. If all the vollies would rally together and demand to be part of 911 I would be all about that. Until then I am doing what I can to experience what I want to experience via:

- Joining a busier volly that is in service more often and gets more calls
- Doing ridelaongs with FDNY EMS more often, even if I'm the *****-*** observer helping to carry bags.
- Aggressively job hunting 911 hospitals in approximately 2 months when my 6mos experience is down.
- Taking the FDNY EMS civil service test this year and hopefully start academy next year.

Not a bad plan.


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## Chewy20 (Jul 20, 2015)

Yeah, you keep doing you. FDNY EMS will love you...Think its time to stop feeding him peoples.


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## ERDoc (Jul 20, 2015)

Take it from someone who grew up in the same system you are in.  You will learn far more about real medicine and caring for pts on your paid bus than you ever will as a volley.  Read the discharge summaries on every pt you transport.  Go home and read about the pathology.  Make a note of a disease one of your SNF pts has that you don't know much about and read about it.  Become a provider not a technician.  You will never learn anything from running 911 calls other than how to drive fast and dangerous.


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## NPO (Jul 21, 2015)

At the end of the day, buffing is cheating and cheating is wrong. You are going around the system for your companies profit. How do you not realize that.


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## Akulahawk (Jul 21, 2015)

ERDoc said:


> Take it from someone who grew up in the same system you are in.  You will learn far more about real medicine and caring for pts on your paid bus than you ever will as a volley.  Read the discharge summaries on every pt you transport.  Go home and read about the pathology.  Make a note of a disease one of your SNF pts has that you don't know much about and read about it.  Become a provider not a technician.  *You will never learn anything from running 911 calls other than how to drive fast and dangerous*.


That, right there, is _exactly_ why I really like doing IFT work. Sure, 911 is fun/flashy and all... but those IFT calls are great (even the discharges) because you get to read those discharge summaries (and sometimes more) and can start really getting into the pathology of your patients. Many times those patients you take to a SNF will be more sick than many people you'll encounter on the street, even though those D/C patients will be quite stable. As you begin to understand what's going on, you'll start seeing things in  your "emergency" patients that you never noticed before precisely because you've seen it in your d/c patients, only now the problem is acute. You should also start taking note of medications your patients are taking and look them up so that you have an idea why those meds are being taken. You'll start seeing patterns and you'll start asking questions when your patient says "I have no medical problems" but they've got a list of meds usually used for CHF, COPD, HTN... and so on.


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## ffemt8978 (Jul 21, 2015)

I learned more in 6 months of IFT than I did in 10 years 911 response by doing pretty much what Akulahawk described.


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## 46Young (Jul 21, 2015)

adamNYC said:


> No lie I've been getting frustrated at the whole buffing thing myself. Just did a 4-hr volly tour with no calls. _*If all the vollies would rally together and demand to be part of 911 I would be all about that*_. Until then I am doing what I can to experience what I want to experience via:
> 
> - Joining a busier volly that is in service more often and gets more calls
> - Doing ridelaongs with FDNY EMS more often, even if I'm the *****-*** observer helping to carry bags.
> ...



The only way it would be appropriate to have the vollies become part of the 911 system would be for each operational member to successfully complete a FDNY Top Class, just like every FDNY EMT on the street today. That is the best way to ensure a uniform competency standard. At my current department, we have a small volunteer component, where they are part of the 911 system. The EMT's had to pass the academy's standards, the medics had to complete an internship just like our probies, and the firefighters also had to do the fire academy at night and on weekends.


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## Bullets (Jul 21, 2015)

DEmedic said:


> Actually, in NYC, its not a shift, it's a tour. The truck is a bus. A call is a job. The guy is a volly-whacker, but the terminology is NYC appropriate.



Im my area, if you call for a bus youre getting one of these babys (pic related)



Remi said:


> EMS is probably not a good place for an "adrenaline junkie"....


Dunno where you work, but most of the EMTs and MEdics i work with all engage in some sort of adrenaline junkie behavior off duty....skydiving, scuba diving, jetskis skiing/snowboarding all seem like popular hobbies


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## Scott33 (Jul 21, 2015)

Bullets said:


> Dunno where you work, but most of the EMTs and MEdics i work with all engage in some sort of adrenaline junkie behavior off duty....skydiving, scuba diving, jetskis skiing/snowboarding all seem like popular hobbies



And 'eating'.


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## COmedic17 (Jul 21, 2015)

I feel like  you are trying to compensate for something by obtaining "street cred" and being some type of backyard hero. 

"Buffing" calls is not going to help your preDickament.


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## adamNYC (Jul 22, 2015)

"The only way it would be appropriate to have the vollies become part of the 911 system would be for each operational member to successfully complete a FDNY Top Class, just like every FDNY EMT on the street today. That is the best way to ensure a uniform competency standard"

What do voluntary hospital units go through for their 911 training?


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## Carlos Danger (Jul 22, 2015)

Bullets said:


> Dunno where you work, but most of the EMTs and MEdics i work with all engage in some sort of adrenaline junkie behavior off duty....skydiving, scuba diving, jetskis skiing/snowboarding all seem like popular hobbies


Anyone who goes into EMS in order to feed their "need for speed" is wrong.


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## 46Young (Jul 22, 2015)

Most have some sort of field internship, but it varies by agencies. That is why NYC protocols are so restrictive. It should just be one provider. FDNY EMS has the Top class, but the hospitals may have better equipment. For example, FDNY didn't have CPAP (maybe still don't have)?

What does the field internship at your volunteer company look like, and what is the minimal requirement for ride time every week?


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## Mufasa556 (Jul 22, 2015)

I remember the hours I've spent sleeping at punishment post after my sadist dispatcher decided we did not meet one of his stringent imaginary criteria. Those were real adrenalin filled, nail biting kind of nights.

The call buffing described here used to be standard practice here in Los Angeles. If you haven't seen Mother, Juggs and Speed I highly recommend it. During the time period, companies used the standard LA Sheriff 10 codes. To thwart other companies from jumping their calls and to keep the competition in dark as to their operations, companies implemented their own versions of the common 10 codes. Eventually LAEMS outlawed the practice of call jumping. Schaefer still uses their jacked up version 10 codes. In this day an age when FEMA recommends plain English, you have a company that's still using 10 codes. Not even commonly known 10 codes. Just gibberish they made up.

I really recommend you not call jumping. Aside from the legal complications of running unauthorized L&S and getting into an accident. EMS is a real small world. You don't want to step on toes and get the reputation as "that guy" with the local paid departments.


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## Mufasa556 (Jul 22, 2015)

From West coast to East coast, it appears the field is all the same. It blows my mind.


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## adamNYC (Jul 22, 2015)

Ems is a small world but NYC is a big city.


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## ffemt8978 (Jul 22, 2015)

adamNYC said:


> Ems is a small world but NYC is a big city.


So?  Do you really want to be known as "that guy", identifiable by pretty much anybody in EMS in NYC?


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## Chewy20 (Jul 22, 2015)

adamNYC said:


> Ems is a small world but NYC is a big city.



Do yourself a favor and stop talking. You have literally not said one thing that makes sense.


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## Mufasa556 (Jul 22, 2015)

adamNYC said:


> Ems is a small world but NYC is a big city.



Well played.


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## Akulahawk (Jul 23, 2015)

adamNYC said:


> Ems is a small world but NYC is a big city.


I used to work with someone that was "that guy" and everyone around him knew it too. He moved on to another company after about a year or so and about 2 years after that, his LEMSA revoked his EMT cert. While I didn't track him after he left the company I worked for at the time, I'm sure that he kept his antics up. Ultimately he earned himself a prohibiting conviction and my not ever practice in medicine again.

Yes, it's a very small world as I'm sure his reputation very much preceded him. I know he worked for at least 2-3 other companies after he left the place I worked.


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## adamNYC (Jul 23, 2015)

"Do yourself a favor and stop talking. You have literally not said one thing that makes sense."

I am merely one of hundreds of volly members who buff on the regular in NYC. All I wanted was how to do it better plain and simple. Once I'm in 911, I'm out of the whole volly gig. It feels like **** to be 2nd on scene knowing that technically I dont really belong there.


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## Flying (Jul 23, 2015)

What are you accomplishing by buffing/jumping calls? Is this early exposure to 911 really that important to you?

Others, namely ERDoc and Akulahawk, have given you really good advice. To excel at the Tx job and learn about your patients beyond what your peers care to know and make yourself stand out in that respect.

Doesn't it seem strange to you that you are alone in thinking that gaining "experience" for a hospital or FDNY at the expense of the public is all right?


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## Chewy20 (Jul 23, 2015)

adamNYC said:


> It feels like **** to be 2nd on scene knowing that technically I dont really belong there.



You don't belong there, so don't do it. Go find a hobby.


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## RedAirplane (Jul 23, 2015)

46Young said:


> Most have some sort of field internship, but it varies by agencies. That is why NYC protocols are so restrictive. *It should just be one provider. *FDNY EMS has the Top class, but the hospitals may have better equipment. For example, FDNY didn't have CPAP (maybe still don't have)?
> 
> What does the field internship at your volunteer company look like, and what is the minimal requirement for ride time every week?



In the pilot episode of _Emergency! _("The Wedsworth-Townsend Act") Dr. Kelly Brackett has a hard time accepting "paramedics" who get a 10 week first aid course as a replacement for doctors--he'd rather see more doctors and more hospitals.

Ultimately, he comes to support the paramedic initiative because *they don't replace him, they augment him*.

This is why, from my outsider's perspective, FDNY should embrace anyone who wants to play in 911 do so (provided they are fully qualified to BLS/ALS ambulance standards as provided by the jurisdiction). It should be coordinated so you don't have multiple needless units driving hot all over the place.

If you *don't *support that, you are essentially saying that you would tell a closer ambulance that it cannot respond to a true emergency in order to earmark it for a further away ambulance. That's unneeded lights/sirens driving, delaying patient care and possibly endangering the welfare of a patient, and seems plain dumb. 

Hell, PulsePoint and many PSAPs across the country are working on using an app to notify citizens with First Aid or CPR training of a medical emergency in their area to get them to respond, but we can't even integrate such citizens who happen to have fully equipped ambulances? Certain areas in New Jersey are targeting a 2 min response time for 911 medical emergencies using the PulsePoint app, and it sounds fantastic, but I digress...

It's not like FDNY would vanish overnight. Instead, it would still run calls, response times would be lower with the volunteers playing, and all those extra miles driving to calls eventually taken by the volunteers would be saved. I still don't get the arguments around the quality of the provider. The volunteers are all licensed by the jurisdiction as EMTs or medics. Would you rather a "more seasoned" EMT/paramedic get there 10 minutes later than have somebody with all the training and tools (and who knows the community a lot better) get there sooner?


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## RedAirplane (Jul 23, 2015)

adamNYC said:


> "Do yourself a favor and stop talking. You have literally not said one thing that makes sense."
> 
> I am merely one of hundreds of volly members who buff on the regular in NYC. All I wanted was how to do it better plain and simple. Once I'm in 911, I'm out of the whole volly gig. It feels like **** to be 2nd on scene knowing that technically I dont really belong there.



Are you asking this as a volunteer or doing private IFT? 

I strongly encourage focusing on your IFT to build up your medical knowledge BUT since "buffing" is common in NYC, consult locally. (In my investigation for one volunteer agency they have internal documents that have their dispatcher listen to radios and turn that information over to you on your radio).


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## LACoGurneyjockey (Jul 23, 2015)

RedAirplane said:


> The volunteers are all licensed by the jurisdiction as EMTs or medics. Would you rather a "more seasoned" EMT/paramedic get there 10 minutes later than have somebody with all the training and tools (and who knows the community a lot better) get there sooner?



Yes, I would rather wait a few more minutes for a higher level of care. There are very few instances where a few minutes will make a difference in EMS. Id rather wait for a qualified Paramedic to respond than some jack-*** Ricky rescue driving around in his POV with lights and sirens, or this douche adamnyc wanting to get his **** wet in a wild ad exciting world where one is judged by the number or bic pen crics they've performed. 
Volunteers are trying to make a hobby out of people's medical care. Because it's fun for them to play bad *** for a few hours on the weekend. But they have no place treating actual patients, And if I called 911 and this guy showed up with his Peter Griffin CPR Certified badge on his chest, Id lock my door and wait for real help.


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## RedAirplane (Jul 23, 2015)

LACoGurneyjockey said:


> Yes, I would rather wait a few more minutes for a higher level of care. There are very few instances where a few minutes will make a difference in EMS. Id rather wait for a qualified Paramedic to respond than some jack-*** Ricky rescue driving around in his POV with lights and sirens, or this douche adamnyc wanting to get his **** wet in a wild ad exciting world where one is judged by the number or bic pen crics they've performed.
> Volunteers are trying to make a hobby out of people's medical care. Because it's fun for them to play bad *** for a few hours on the weekend. But they have no place treating actual patients, And if I called 911 and this guy showed up with his Peter Griffin CPR Certified badge on his chest, Id lock my door and wait for real help.



I guess this is where I disagree.

Yea, most 911 calls aren't true time sensitive emergencies. But why do we have sirens and lights? For the ones that are. And if my dad went into cardiac arrest and I got the 8 minute guaranteed call-to-defib time and he died because of the shock not coming within the first 4 minutes-- but I learned that there was a BLS volly/IFT unit hanging out at the Starbucks two blocks over... I'd be pissed. 

As far as the higher level of care bit, if it's paramedic vs EMT, sure. But remember, they are licensed EMTs who have been through the exact same training. There is something to be said for a certain amount of professional experience, but I think volunteer providers can be professional (my org certainly tries) and conversely there's the occasional professional who provides sloppy care. So it should be about making sure providers are good, not lumping them into stereotypes based on their career track.

I certainly respect your point, but it hasn't convinced me.


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## Flying (Jul 23, 2015)

> Yea, most 911 calls aren't true time sensitive emergencies. But why do we have sirens and lights? For the ones that are.


L&S are there to alert other drivers, legally bypass the traffic system, and not take an absurd amount of time to arrive.
They are NOT for reaching an emergency in the shortest amount of time possible by expecting other drivers to comply. That mentality alone is deadly.



> And if my dad went into cardiac arrest and I got the 8 minute guaranteed call-to-defib time and he died because of the shock not coming within the first 4 minutes-- but I learned that there was a BLS volly/IFT unit hanging out at the Starbucks two blocks over... I'd be pissed.


Who wouldn't be pissed? In the end, we cannot design the system by appealing to probabilities.


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## adamNYC (Jul 23, 2015)

Redairplane: Very well said!

What cracks me up is the assumption that all volly members are weekend warriors. Some may be, but there are others in leadership positions who currently work in 911, at least in my volly they are.

To answer if I buff in IFT, no. I do in volly, and my other thread was asking about those who do buff in IFT, out of my own curiosity.


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## LACoGurneyjockey (Jul 23, 2015)

RedAirplane said:


> I guess this is where I disagree.
> 
> Yea, most 911 calls aren't true time sensitive emergencies. But why do we have sirens and lights? For the ones that are. And if my dad went into cardiac arrest and I got the 8 minute guaranteed call-to-defib time and he died because of the shock not coming within the first 4 minutes-- but I learned that there was a BLS volly/IFT unit hanging out at the Starbucks two blocks over... I'd be pissed.
> 
> ...


Ok, you found the one example that seems to support early CPR and early Defib, even if by volunteers or AdamNYC on his way to a dialysis call. But then why doesn't NYC have the highest rate of ROSC, or survival to discharge? Why do the leaders in these statistics exist in places with NO volunteer presence? 
Your EMT class was 100-something hours, and that alone does not make you professional. It does not make you qualified to the same level as, in this example, a 5 year FDNY EMT. They have not been through the same training, because you didn't go through an academy. You went thru EMT school. That's it. That's the only similarity. 
Look at the most effective EMS systems in the country, or even better outside the US, and take a look at the volly presence there. It's non existent. Because it doesn't work well. It's filling a void that isn't a void. You're not needed in NYC, because there's a professional system in place. 
Rural Montana is fine, backwoods Illinois, sure. But why do we have volunteers, who aren't needed, the the middle of a major urban city center.


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## Tigger (Jul 23, 2015)

RedAirplane said:


> I guess this is where I disagree.
> 
> Yea, most 911 calls aren't true time sensitive emergencies. But why do we have sirens and lights? For the ones that are. And if my dad went into cardiac arrest and I got the 8 minute guaranteed call-to-defib time and he died because of the shock not coming within the first 4 minutes-- but I learned that there was a BLS volly/IFT unit hanging out at the Starbucks two blocks over... I'd be pissed.


That is not why we have lights and sirens, otherwise we would be using them that way. Instead, we use them primarily based upon a misguided public perception. You pay lip service to the fact that the vast majority of 911 medical calls are not time sensitive, yet blow right past that to cardiac arrests, which make up a very, very small subset of calls. It does not make sense from a resource utilization perspective to have enough ambulances to reach calls in four minutes (your above standard) even though it only matters (probably less than) 1% of the time. At no point in any business (healthcare included) is it sensible to design a system to based on 1% of the tasks. 


> As far as the higher level of care bit, if it's paramedic vs EMT, sure. But remember, they are licensed EMTs who have been through the exact same training. There is something to be said for a certain amount of professional experience, but I think volunteer providers can be professional (my org certainly tries) and conversely there's the occasional professional who provides sloppy care. So it should be about making sure providers are good, not lumping them into stereotypes based on their career track.
> 
> I certainly respect your point, but it hasn't convinced me.


I really do not think you understand the the difference between paid, professional providers who run many more calls than volunteers, who do this as a hobby. Not to mention that such hobbyism does not do much for the image and compensation of the industry.


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## Tigger (Jul 23, 2015)

adamNYC said:


> Redairplane: Very well said!
> 
> What cracks me up is the assumption that all volly members are weekend warriors. Some may be, but there are others in leadership positions who currently work in 911, at least in my volly they are.
> 
> To answer if I buff in IFT, no. I do in volly, and my other thread was asking about those who do buff in IFT, out of my own curiosity.


I doubt that the majority of volunteer EMS providers are also fulltime EMS providers, so I don't get it. A few doesn't make it ok. And again. EMS is not a hobby, yet so many insist on making it while also whining about increased standards.


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## RedAirplane (Jul 23, 2015)

Tigger said:


> That is not why we have lights and sirens, otherwise we would be using them that way. Instead, we use them primarily based upon a misguided public perception. You pay lip service to the fact that the vast majority of 911 medical calls are not time sensitive, yet blow right past that to cardiac arrests, which make up a very, very small subset of calls. It does not make sense from a resource utilization perspective to have enough ambulances to reach calls in four minutes (your above standard) even though it only matters (probably less than) 1% of the time. At no point in any business (healthcare included) is it sensible to design a system to based on 1% of the tasks.
> 
> I really do not think you understand the the difference between paid, professional providers who run many more calls than volunteers, who do this as a hobby. Not to mention that such hobbyism does not do much for the image and compensation of the industry.



The crux of my point is not that we should ADD resources to have a really good response time for the 1% of calls, but rather, that the resources are sitting there and saying "pick me! pick me!" so in the case of the truly time-sensitive incident it seems silly not to use them.

Of course, that means having some way to track their location and notify them rapidly.

Out of curiosity, what do you make of the citizen responder initative discussed here?
http://www.newjerseynewsroom.com/he...time-in-country-goal-of-sub-2-minute-response


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## akflightmedic (Jul 23, 2015)

You have to be tuff, to work a code in the buff...


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## RedAirplane (Jul 23, 2015)

Tigger said:


> I doubt that the majority of volunteer EMS providers are also fulltime EMS providers, so I don't get it. A few doesn't make it ok. And again. EMS is not a hobby, yet so many insist on making it while also whining about increased standards.



Bit of a tangent, but since you bring up the volunteer vs paid thing, do you thing an all-volunteer service can be professional? I tend to think if it is done correctly, yes it can.

From the Virginia Beach EMS website:



> The Virginia Beach Department of Emergency Medical Services is the largest volunteer-based rescue service in the country with over 1150 volunteers serving the city of over 430,000 residents.





> Did you know that you are seven times more likely to survive cardiac arrest in Virginia Beach than in most other communities in the country?


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## RedAirplane (Jul 23, 2015)

akflightmedic said:


> You have to be tuff, to work a code in the buff...



Huh?


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## sirengirl (Jul 23, 2015)

Akulahawk said:


> That, right there, is _exactly_ why I really like doing IFT work. Sure, 911 is fun/flashy and all... but those IFT calls are great (even the discharges) because you get to read those discharge summaries (and sometimes more) and can start really getting into the pathology of your patients. Many times those patients you take to a SNF will be more sick than many people you'll encounter on the street, even though those D/C patients will be quite stable. As you begin to understand what's going on, you'll start seeing things in  your "emergency" patients...



This. I worked IFT for 8mos before getting hired at my 911 agency. I STILL work at my IFT part time, I've been here for 3 years this month. I learned more about chronic care, trachs, home vents, hospice, and clinical meds and pumps there than I did at school, whether I realized it or not. Don't get me wrong, I hated it and I was going nuts, but now I appreciate what it does for me. I read every single chart. I read symptoms, histories, meds, surgical notes, x-Ray and MRI results, everything. And I TALK to my patients. I have conversations with them and learn from them, too. And let me tell you what, learning how to safely transfer a dissecting AAA; transporting an active brain bleed 40+ miles; taking a confirmed C2 fracture over an hour to a trauma center because it's raining and the chopper isn't flying; working my *** off- alone- in the back of an ambulance to keep someone alive who has 3 large bore IVs pressure infusing, WITH dopamine, but still can't get their SBP above 60- for 50 miles on an interstate- those, my friend, THOSE are the things that help teach you how to save lives at 911, when you do have 4 sets of hands to help you and your destination is 10-15 minutes away.

You get these jobs to learn something. What you learn will save your future patients. If you're not learning where you're at, move somewhere else. And learn something.


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## ERDoc (Jul 23, 2015)

Tigger said:


> I doubt that the majority of volunteer EMS providers are also fulltime EMS providers, so I don't get it. A few doesn't make it ok. And again. EMS is not a hobby, yet so many insist on making it while also whining about increased standards.



I can't believe I am going to do this but I have to stick up for Adam on this point.  A large number of EMS providers and FFs in NYC start out as vollies in the suburbs and usually continue to volley while they are working for FDNY.


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## ERDoc (Jul 23, 2015)

akflightmedic said:


> You have to be tuff, to work a code in the buff...



I might have had a t-shirt that said that at one time, but I am not saying I did.


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## Tigger (Jul 23, 2015)

RedAirplane said:


> The crux of my point is not that we should ADD resources to have a really good response time for the 1% of calls, but rather, that the resources are sitting there and saying "pick me! pick me!" so in the case of the truly time-sensitive incident it seems silly not to use them.
> 
> Of course, that means having some way to track their location and notify them rapidly.
> 
> ...


I don't think that the volunteer agencies should exist except in cases where geography makes it too difficult to maintain adequate full time staffing. Even then, I sit here in my station as a paid provider covering well less than 10 thousand people in a 300 square mile area. If we can afford it, FDNY can afford to have a slow station or two. 

Though you say that the agencies should be the same in terms of care, they are not. Every respectable service I have worked for has had an extensive new hire program as well as mandatory continuing education that far exceeds recertifcation requirements. And while volunteer groups can do this, it is not a common practice. There is just too much variability to allow so many different volunteer groups to operate in the greater system, even if they were actually a recognized part of the system.

As for the citizen responder initiative, I am alright with that. Such individuals are not EMS resources and do not require the upkeep of being treated as such.


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## Tigger (Jul 23, 2015)

ERDoc said:


> I can't believe I am going to do this but I have to stick up for Adam on this point.  A large number of EMS providers and FFs in NYC start out as vollies in the suburbs and usually continue to volley while they are working for FDNY.


I suppose that is a regional variance. I know few fulltime providers here that volunteer on their days off and there are plenty of opportunities. These organizations are lucky to have these providers, but my issue is more with the organizations themselves. I don't like that so many allow EMS to be a hobby and there is no such thing as free. Volunteer organizations do cost money, and they do compete for resources within the EMS system. If they are not a needed part of the system, funding (whether grant or otherwise) should be directed to where it is needed.


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## 46Young (Jul 23, 2015)

RedAirplane said:


> In the pilot episode of _Emergency! _("The Wedsworth-Townsend Act") Dr. Kelly Brackett has a hard time accepting "paramedics" who get a 10 week first aid course as a replacement for doctors--he'd rather see more doctors and more hospitals.
> 
> Ultimately, he comes to support the paramedic initiative because *they don't replace him, they augment him*.
> 
> ...



The voluntary hospitals, the NYC 911 participating members, have units that are under contract with FDNY, and are given a CSL (post), just like FDNY units. These hospitals basically take the place of FDNY units. What I'm saying is that it would be better to have those hospital units be FDNY units instead. Service delivery is not affected (still the same amount of units), and there is uniform QA/QI, discipline, union regs, platoon schedule, academy training, etc. I'm not sure what you mean by saying (that I'm saying) that a further away ambulance would be responding, and endangering the welfare of a patient.

I worked for a hospital that really had its act together, great providers, and was militant with it's QA/QI. I really enjoyed working there, but this firemedic position was much better for my family and I, rather than sitting on street corners for 35-40 yrs (403b, no pension), with an extremely high cost of living. I also worked per diem for a few other hospitals, and observed it to be a mixed bag, very inconsistent KSA's of their EMT's and medics, and the work ethic varied widely as well. Some were per diem, and worked full time elsewhere, so they didn't much care if they got caught doing something unscrupulous. I feel that it is better to have just one agency provide EMS for an area. Volunteers can enjoy a greater degree of latitude with negligence and offenses where career people would get nailed to the cross, because they're volunteering. I've seen it in several states that I've worked previously.


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## 46Young (Jul 23, 2015)

RedAirplane said:


> Bit of a tangent, but since you bring up the volunteer vs paid thing, do you thing an all-volunteer service can be professional? I tend to think if it is done correctly, yes it can.
> 
> From the Virginia Beach EMS website:



A volunteer headcount tells us nothing; how many consistently put in hours, and how many do it once a week or less, or for only 4-8hrs at a time? Where I work, the volunteers work sporadically, some just come in for like 5 hrs, some do a couple of shifts a week, and some only show up for bingo, the installation dinners, and EMS standby events.

You know as well as I know that an all-volunteer department will not stand the test of time. I've researched the history of several departments in my area - they start out 100% volunteer, then a few weekday daytime paid crews, then a few stations staff during the week 24hrs, then some stations are 100% career and some are 100% volunteer, then eventually every station has 24/7 career personnel. This may differ in rural areas where the pay is abysmally low, and volunteers are all they can get.

Near to where I work, in a combo fire/EMS department, one volunteer first due has two 100% volly stations, and one combo station. Every year the county wants to put a 24/7/365 ALS bus in their houses, but the vollies get it pushed back. Meanwhile, they use copious amounts of automatic aid from several different counties that have mostly career units, to run their calls, because they can't keep their rigs staffed, sue to dwindling participation.

My problem with an all-volunteer organization is that typically the required hours to remain active are less than would be needed to fill every unit 24/7. You're not going to "fire" a volly because they can't pick up extra shifts, you'll just brown out those units. There is also the issue of ongoing training - it is difficult to get everyone to the inservices and drills, since the vollies ay have jobs, family requirements, etc.


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## 46Young (Jul 23, 2015)

If anything, I would not be so concerned with FDNY EMS being able to handle call surges, and needing to use the vollies. There are legions of ambulances canvassing the city. I would be much more concerned with a system that uses System Status Management/PUM. They are literally getting by with the bare minimum amount of ambulances as they can get away with deploying, and playing games with historical call volume tp post units where they think a call will drop. I would also be more concerned with systems that contract to the privates, where the 911 units also do IFT in their downtime. It is very tempting for the company to squeeze in some IFT runs, and chance not getting 911 calls. Also, the typical private provider, like a SSM/PUM agency, will deploy the bare minimum of ambulances required due to cost.

In my opinion, barring an earthquake, Tsunami, Hurricane, or riots, the vollies are pretty much irrelevant in the NYC 911 system.


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## adamNYC (Jul 23, 2015)

" I would also be more concerned with systems that contract to the privates, where the 911 units also do IFT in their downtime. It is very tempting for the company to squeeze in some IFT runs, and chance not getting 911 calls. "

I hear LIJs EMS units do both Txp/IFT & 911


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## RedAirplane (Jul 23, 2015)

46Young said:


> The voluntary hospitals, the NYC 911 participating members, have units that are under contract with FDNY, and are given a CSL (post), just like FDNY units. These hospitals basically take the place of FDNY units. What I'm saying is that it would be better to have those hospital units be FDNY units instead. Service delivery is not affected (still the same amount of units), and there is uniform QA/QI, discipline, union regs, platoon schedule, academy training, etc. I'm not sure what you mean by saying (that I'm saying) that a further away ambulance would be responding, and endangering the welfare of a patient.
> 
> I worked for a hospital that really had its act together, great providers, and was militant with it's QA/QI. I really enjoyed working there, but this firemedic position was much better for my family and I, rather than sitting on street corners for 35-40 yrs (403b, no pension), with an extremely high cost of living. I also worked per diem for a few other hospitals, and observed it to be a mixed bag, very inconsistent KSA's of their EMT's and medics, and the work ethic varied widely as well. Some were per diem, and worked full time elsewhere, so they didn't much care if they got caught doing something unscrupulous. I feel that it is better to have just one agency provide EMS for an area. Volunteers can enjoy a greater degree of latitude with negligence and offenses where career people would get nailed to the cross, because they're volunteering. I've seen it in several states that I've worked previously.



Essentially what I am saying is, the more the merrier. 

If we have FDNY units added in lieu of the hospital EMS units, but then kept the hospital units too, we'd have so many good resources. 

What I'm saying is that if a volunteer is willing to take calls, use him. It's just more units for the EMS system to use as it sees fit


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## Chris07 (Jul 24, 2015)

RedAirplane said:


> Essentially what I am saying is, the more the merrier.
> 
> If we have FDNY units added in lieu of the hospital EMS units, but then kept the hospital units too, we'd have so many good resources.
> 
> What I'm saying is that if a volunteer is willing to take calls, use him. It's just more units for the EMS system to use as it sees fit



So assuming the FDNY forms a relationship with volunteer agencies and "uses them" to augment their current force, how can the FDNY ensure consistent and uniform service between its own people and the volunteer agencies? How can they ensure that the volunteer agencies are properly staffed, supplied, and have appropriate documentation and QI? 

The FDNY has too much to lose if a lack of standards in the volunteer agencies causes trouble. The City of New York is a big target for lawsuit. If something goes wrong I can guarantee you lawyers will be looking into getting some dough out of the city (in a sort of guilty by association way).

To say that the quality of care or the quality of service is the same because the providers all went through the same training program is ridiculous to me. I personally know a few people, and I'm sure you do too, who got their EMT cert but are absolutely terrible EMTs. Just because I have a card stating that I met the requirements doesn't mean that I am truly competent. True competency comes through experience and further training.

What you have to understand is that the real world is NOT about efficiency. While it may seem that using volunteers to augment the current system is more efficient, the people in charge don't give a damn. Efficiency is kicked out the door in favor of cost effectiveness and reduced liability every time.

In the end, the fact is simple. The FDNY currently does not regularly use volunteers, despite their eagerness and willingness to help, and it seems that there are no plans to do so in the future (unless I am mistaken). When you "buff" a call, you're showing up uninvited. No one called you. You just showed up to the Wedding without an invite and are helping yourself to some cake. A total douche move regardless of where you are from. As many have said so far, get a real hobby. I don't post long winded rants like this normally, but congratulations, this topic and its twin really got to me. Someone once asked what the definition of a "whacker" was....well I think I've found it.


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## Jim37F (Jul 24, 2015)

Chris07 said:


> Someone once asked what the definition of a "whacker" was....well I think I've found it.


This.


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## SandpitMedic (Jul 24, 2015)

Chewy20 said:


> 8. Every Sunday morning I will go out to the driveway and test my POVs lights and sirens. I will not be that guy with malfunctioning lights! Who says you have to go to church to be religious about something?!
> .



LMFAO... I laughed so hard, Captain Crunch is all over my desk now. That is the funniest thing I've heard in a while. Dying... I can't believe this thread is a real 5 page thing...


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## SandpitMedic (Jul 24, 2015)

adamNYC said:


> Just gotta love all the different EMS slang/lingo that varies around the USA.
> 
> Maybe you want to sit around doing nothing, but I didn't get into EMS to sit on my ***. I need action!


HAHHAAHAHAHA.... I don't think I can read any further....

Jebus Criminy.....

Oh, to be young again.


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## adamNYC (Jul 24, 2015)

FDNY does use some maybe not all vollies in rare events such as disasters, snowstorms, etc you will note some vollies having the "FDNY 911 Participating Member" logo on their doors and they even have a radio designation.


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## Chimpie (Jul 24, 2015)

@adamNYC Please see this thread on how to properly quote posts:
http://emtlife.com/threads/platform-update-details.40268/


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## 46Young (Jul 24, 2015)

adamNYC said:


> " I would also be more concerned with systems that contract to the privates, where the 911 units also do IFT in their downtime. It is very tempting for the company to squeeze in some IFT runs, and chance not getting 911 calls. "
> 
> I hear LIJs EMS units do both Txp/IFT & 911



Units are dedicated to either 911 or IFT, and never mix. 911 units do not go OOS unless they go down mechanical. I was pulled from IFT occasionally to staff a 911 unit due to someone calling out sick.

When I worked there, I did two 12hr tours on 46Y and two 8hr IFT shifts every week.


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## RocketMedic (Jul 24, 2015)

adamNYC said:


> "Do yourself a favor and stop talking. You have literally not said one thing that makes sense."
> 
> I am merely one of hundreds of volly members who buff on the regular in NYC. All I wanted was how to do it better plain and simple. Once I'm in 911, I'm out of the whole volly gig. It feels like **** to be 2nd on scene knowing that technically I dont really belong there.


That feeling is sin and you are sinning.


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## ffemt8978 (Jul 24, 2015)

adamNYC said:


> FDNY does use some maybe not all vollies in rare events such as disasters, snowstorms, etc you will note some vollies having the "FDNY 911 Participating Member" logo on their doors and they even have a radio designation.


And that is still a far cry from "buffing calls" .... don't try to mix the two.


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## RedAirplane (Jul 24, 2015)

ffemt8978 said:


> And that is still a far cry from "buffing calls" .... don't try to mix the two.



Those units are rarely called into 911

But they are 911 participants, which means they can legally jump the call and once on scene cancel FDNY.

Source: the internal radio protocols of a particular volly agency, which I managed to obtain.

Yea...


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## Tigger (Jul 24, 2015)

RedAirplane said:


> Those units are rarely called into 911
> 
> But they are 911 participants, which means they can legally jump the call and once on scene cancel FDNY.
> 
> ...


I highly doubt there is anything to allow an ambulance not dispatched to a call to show up instead and then cancel the AHJ. How would that be efficient?


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## RedAirplane (Jul 25, 2015)

Tigger said:


> I highly doubt there is anything to allow an ambulance not dispatched to a call to show up instead and then cancel the AHJ. How would that be efficient?



It's not efficient at all.


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## RedAirplane (Jul 25, 2015)

If anyone is interested in the radio protocols I found for the volunteer agency in New York, let me know and I'll message them. Perhaps I'm interpreting something wrong from them.


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## chaz90 (Jul 25, 2015)

RedAirplane said:


> If anyone is interested in the radio protocols I found for the volunteer agency in New York, let me know and I'll message them. Perhaps I'm interpreting something wrong from them.


Why not just post a link? If they're publicly available anyway this allows anyone interested to see them.


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## Tigger (Jul 25, 2015)

RedAirplane said:


> It's not efficient at all.


Meaning that they again have no use to the EMS system.


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## RedAirplane (Jul 25, 2015)

chaz90 said:


> Why not just post a link? If they're publicly available anyway this allows anyone interested to see them.



Because I'm not sure if it is actually supposed to be on the internet.

But, as you say, since it is, here it is:

http://www.cpmu.com/wp-content/uploads/2013/01/CPMU-Radio-Communications.pdf


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## RedAirplane (Jul 25, 2015)

Tigger said:


> Meaning that they again have no use to the EMS system.



The inefficient part is having an FDNY ambulance respond from central, get almost on scene, and then have themselves cancelled by the volunteer.


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## Tigger (Jul 25, 2015)

RedAirplane said:


> The inefficient part is having an FDNY ambulance respond from central, get almost on scene, and then have themselves cancelled by the volunteer.


 Except for the part about that not quite being the case. Like most large urban areas, ambulances are spread throughout the area. And while some of the vollies are out in the relative sticks, many others are in developed neighborhoods with standard EMS coverage. That makes these groups inefficiency in the system.

It seems to me that it might be worth studying how currently accepted EMS deployment models work prior to deciding that those ways are wrong.


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## RedAirplane (Jul 25, 2015)

Tigger said:


> It seems to me that it might be worth studying how currently accepted EMS deployment models work prior to deciding that those ways are wrong.



That is, in fact, my intention. My background in science and my founded interest in EMS has me looking for graduate programs that focus on service markets, and in particular, deployment markets such as EMS.

I'm open to the fact I'm wrong. But thusfar I'm not sure how having fewer ambulances is better than having more ambulances. 

I know about dynamic deployment and I find it amazing.

The issue of FNDY coming from central / arriving late is derived from the fact that per the PDF I posted above, the volunteer cancels FDNY (so it gets there first at least some of the time), and other volunteer agencies talk publicly about FDNY having long response times / coming from far away.


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## RedAirplane (Jul 25, 2015)

Chris07 said:


> What you have to understand is that the real world is NOT about efficiency. While it may seem that using volunteers to augment the current system is more efficient, the people in charge don't give a damn. Efficiency is kicked out the door in favor of cost effectiveness and reduced liability every time.



If it's just a legal/CYA issue, laws assigning liability to the agency that ran the call could deal with that. And even if that doesn't happen, and the status quo remains, it doesn't affect the issue of what the "optimal" (from a market design viewpoint) EMS system looks like.

To clarify to all: I do not wish to judge, call out anything as "bad," or say that my idea is "better" than your idea. Ultimately I intend to study service markets in an academic context, but for now I am just questioning things and posing ideas as they come up, in the context of discussion.


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## Fleury14 (Jul 25, 2015)

RedAirplane said:


> That is, in fact, my intention. My background in science and my founded interest in EMS has me looking for graduate programs that focus on service markets, and in particular, deployment markets such as EMS.
> 
> I'm open to the fact I'm wrong. But thusfar I'm not sure how having fewer ambulances is better than having more ambulances.
> 
> ...


I don't think the issue is that having more ambulances being "bad" as much as it is having multiple trucks responding at the same time with what seems like zero communication between any of them. It's a safety thing. 
In Boston, and I'm sure other places, the city will call a private company and have them send a unit if they are all full. Probably not the perfect system but it works.


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## triemal04 (Jul 25, 2015)

RedAirplane said:


> Bit of a tangent, but since you bring up the volunteer vs paid thing, do you thing an all-volunteer service can be professional? I tend to think if it is done correctly, yes it can.
> 
> From the Virginia Beach EMS website:


Maybe somebody else already mentioned it, but I'd just like to point out that Virginia Beach EMS, despite what they would have the public believe, uses and relies on paid, career staff to both run the department, and respond to calls.  There certainly are volunteers, both don't kid yourself into thinking there isn't a large paid contingent handling the daily buisness.

If you actually look into all the big "volunteer" fire departments on the east coast you'll find the same thing.


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## Tigger (Jul 25, 2015)

RedAirplane said:


> That is, in fact, my intention. My background in science and my founded interest in EMS has me looking for graduate programs that focus on service markets, and in particular, deployment markets such as EMS.
> 
> I'm open to the fact I'm wrong. But thusfar I'm not sure how having fewer ambulances is better than having more ambulances.
> 
> ...


Central is just the name of their dispatch, not a location. 

More is not better if you have no control over the more. If the system wished to allow the volunteer groups to participate as the hospitals do, that would be one thing. Have the volunteers cover a specific area as their first due. Dispatch them just like all the other ambulances and provide ALS backup like the rest of the city. But that is not how it works here. Instead you have individuals like the OP advocating for driving lights and sirens to a call that they were not dispatched to just for "the action." And that's who we want responding to calls?


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## Chimpie (Jul 25, 2015)

When discussion like this come up, I try to imagine them happening in my local area (either of my two counties). I can't imagine for a second either one of them allowing a volunteer agency start buffing their calls. Heads would roll, licenses would be pulled, lawsuits would be served in a matter of hours. They would have so much gov't brass up their *** they wouldn't know what hit them.


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## adamNYC (Jul 26, 2015)

There should be a system where when vollys are "currently in service" to notify FDNY dispatch so they will dispatch us 911 calls. Because not all vollys are 24/7, just when theres staffing available. Park Slope I hear is usually staffed daily 0700-0000


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## chaz90 (Jul 26, 2015)

adamNYC said:


> There should be a system where when vollys are "currently in service" to notify FDNY dispatch so they will dispatch us 911 calls. Because not all vollys are 24/7, just when theres staffing available. Park Slope I hear is usually staffed daily 0700-0000


What need do you think this would fulfill? This would make some sense if there weren't ambulances already available and responding to these areas as part of the 911 system. I don't see why anyone would want to add the volunteer units, as an unknown and unregulated entity that may or may not be available at any given point, when they have staffed, professional units that are already integrated into their system already covering the area. 

As you mention so many times, the FDNY and hospital ambulances are clearly getting there reasonably quickly as you often have trouble beating them to scenes. There is no obvious plus side to letting volunteer units run calls as part of the 911 system as you suggest besides you and your friends getting their fill of excitement. 

NYC is the last place volunteer EMS should exist in the modern world. Get a job as an EMT at FDNY or a hospital after your 6 months of experience doing IFT and find another way to give back to the community that's actually worthwhile. Homeless outreach, youth mentoring, volunteering at a soup kitchen...The list could go on.


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## adamNYC (Jul 26, 2015)

chaz90 said:


> What need do you think this would fulfill?



Less strain on all overall units. The 40 or so vollys in NYC aren't going anywhere/closing down anytime soon so might as well let them be part of the action.


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## chaz90 (Jul 26, 2015)

adamNYC said:


> Less strain on all overall units. The 40 or so vollys in NYC aren't going anywhere/closing down anytime soon so might as well let them be part of the action.


Paid ambulances would have to be staffed to meet demand. If the dissolution of volunteer units meant call volume/transports went up enough to increase UHUs or response times noticeably, more ambulances would be added. 

If you cut them out of 911 response they'd be gone quite quickly. They are relics of a bygone age. History and tradition are one thing, but simply existing as a service when there is no need for it is just a waste of money and time to inflate people's sense of self worth and importance. I know there are good hearted people trying to do the right thing in their communities, but this isn't the way to do it. 

My advice earlier applies to all members of the volunteer services of NYC. Either get a job with one of the professional 911 services, or don't do EMS. It's not a hobby that you do to "be part of the action" as you so succinctly put it. I can't go be a volunteer mailman because I like it and think the "action" of driving those awesome white USPS trucks around looks cool. If I want to be a mailman and provide that necessary service, I apply for the position, compete with other applicants, go through the required training, then show up to my shifts and deliver mail. We're no different in EMS.


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## DrParasite (Jul 26, 2015)

46Young said:


> Units are dedicated to either 911 or IFT, and never mix. 911 units do not go OOS unless they go down mechanical. I was pulled from IFT occasionally to staff a 911 unit due to someone calling out sick.


if an IFT unit doesn't have a run, and a 911 call comes in and they are closer (or the 911 units for LIJ are unvailable), will they sent an IFT unit on the 911 or have a non-hospital unit respond?


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## Jim37F (Jul 26, 2015)

If you're going to have ambulances that are legally part of the system enough to jump calls w/out negative repercussions, then they NEED to be FULLY integrated in the 911 system. I.e. they are assigned a station/post/first in district by the central dispatch, and take ALL assigned calls, and NOT say "eh that nosebleed a block away sounds boring, but that traffic collision 5 blocks away sounds like it'll be a cool call, I'm going to go buff that one!" The volunteer units can then be treated as extra coverage units by central dispatch, in that they're not relied upon to meet the call volume but are nice to have when available to help out the full time units.

BUT if you're not willing to be a full member of the system and take all assigned calls (as a BLS unit you'll get lots of those non-emergent, not really exciting, not-tv-show-worthy "BS" calls) (or in other words, if you ONLY want to buff the "cool" calls and ignore the rest) then you have NO place, anywhere in the system and thus should not be able to legally take ANY 911 calls. Period.


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## 46Young (Jul 26, 2015)

DrParasite said:


> if an IFT unit doesn't have a run, and a 911 call comes in and they are closer (or the 911 units for LIJ are unvailable), will they sent an IFT unit on the 911 or have a non-hospital unit respond?



The IFT units were not permitted to take 911 calls under any circumstances. I've used an available IFT unit for a lift assist at the hospital, but that's about it. Their IFT division is run very tight - permitted up to 20 mins. P/U, 20 mins.drop off, and there had better be a legitimate reason why you're going over that time. Units would be pulled off of the floor to do a different IFT run if the sending facility staff weren't ready for us. Using an IFT unit for a 911 call could result in lost revenue in txp. We needed units to be available for STEMI txps, vented/sedated neuro txp's, NICU/PICU, things like that. We only had 3-4 units on the road at night, and didn't hit peak deployment until 1100 hrs, so no games we played in using an IFT unit to steal a 911 call in a NS-LIJ first due. The next closest 911 unit, either from us, FDNY, SVCMC (now defunct), Flushing, or NYHQ would be responding. The IFT dispatchers can see where you are, and where you're going, so it's obvious if you purposefully went toward a call to get "flagged down" vs a legitimate chance encounter.

The IFT units didn't have radios to listen for 911 dispatch (2007), although you can listen from a phone app nowadays. Enough of our people also did 911 already, so they got no "kicks" or "adrenaline rush" from jumping on a 911 call. As others have said, once you do 911 for a while, it becomes mundane, so you really do not care to run extra calls. The IFT units were already so busy, that they would prefer to get a little downtime to eat or get in a quick nap rather than get flagged for calls that they weren't asked to go on in the first place.


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## 46Young (Jul 26, 2015)

Really, the only people who want to buff NYC 911 jobs are those that are not in the 911 system, or those that are new to the system (less than a year). The rest of us would prefer a little downtime between calls. Pt outcomes will not improve from having a volly bus get on the scene 30 seconds before a contracted or municipal 911 unit.


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## Tigger (Jul 26, 2015)

adamNYC said:


> Less strain on all overall units. The 40 or so vollys in NYC aren't going anywhere/closing down anytime soon so might as well let them be part of the action.


With an increase in headache for FDNY. Now they have 40 separate agencies to regulate as well. 

My part time job covers a variety of combo fire districts. Over the last five years more and more of them have either done away with or significantly curtailed their volunteer side for two reasons: there is barely any cost savings as the administrative costs to manage such a division are quite large, and two, it's just not reliable. These departments would rather have three fulltime guys in the station guaranteed instead of two fulltimers and who knows how many volunteers, zero one day and seven the next. That's just too much to manage, especially since the volunteers are not able to supervise themselves, which is the case here. Your posts and talk of other organizations do not demonstrate (to me at least) that you or many of these groups should be allowed to drive an ambulance, much less provide patient care.


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## phideux (Jul 27, 2015)

adamNYC said:


> There should be a system where when vollys are "currently in service" to notify FDNY dispatch so they will dispatch us 911 calls. Because not all vollys are 24/7, just when theres staffing available. Park Slope I hear is usually staffed daily 0700-0000



I run with a volunteer squad and this is pretty much how we do it. We run a fully stocked ALS unit and when we are out there we sign in with dispatch. Technically our coverage area is also covered by 5 other City/County ambulances, we will stay pretty much centrally located and or move around a little to cover when the City/County units are on calls. If we are closer than one of the other units when the tones drop we'll tell dispatch that we'll take it and keep the other unit in service, if they are closer we ain't gonna race them to the call. Depending on the call, we'll respond with one of the other units, cardiac arrests, major trauma, MVAs, etc, and once on scene we'll help each other. I've spent a bunch of time in city/county ambulances helping them on calls, and they have all jumped into the back of my ambulance at one time or another. And when we do get 2 ambulances on scene, and only need one, we usually get the transport. Them guys know we are a poor unfunded squad that stays afloat by transports and billing. When things get busy, and it gets reallllllllllllllllly busy here, we keep county dispatch apprised of where we are and they dispatch us as a regular first due unit, with county/city fire or FR backup if needed.
But to go out and play radio roulette, jump calls, try to race other units to the scene, and worst of all, run code without dispatch and all the other units out there in the area knowing. You would be shut down here.


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## adamNYC (Jul 27, 2015)

Im going to get to the bottom of this. If we a FDNY 911 Participating Ambulance why does FDNY only call us during disasters snowstorms blackouts etc


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## luke_31 (Jul 27, 2015)

Most likely it is you are a participating ambulance service that is mainly used when the system is heavily overloaded, such as the scenarios above. Most volunteer and private services typically are only pulled into the 911 system when the system is unusually overloaded in those types of events.


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## adamNYC (Jul 27, 2015)

Privates arent FDNY associated. Voluntary hospitals are and are as good as FDNY ambulances.

Priority1: FDNY EMS + Voluntary Hospital EMS

Priority2: Volunteer EMS


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## chaz90 (Jul 27, 2015)

adamNYC said:


> Im going to get to the bottom of this. If we a FDNY 911 Participating Ambulance why does FDNY only call us during disasters snowstorms blackouts etc


I'll get to the bottom of my point too. 

Because the volunteers are unknown, unreliable, unregulated, and unneeded.


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## Chimpie (Jul 27, 2015)

adamNYC said:


> Im going to get to the bottom of this. If we a FDNY 911 Participating Ambulance why does FDNY only call us during disasters snowstorms blackouts etc



Because maybe they don't want you there for the day to day runs.


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## 46Young (Jul 27, 2015)

adamNYC said:


> Im going to get to the bottom of this. If we a FDNY 911 Participating Ambulance why does FDNY only call us during disasters snowstorms blackouts etc



If I had to guess, it's due to not wanting to forfeit any billing opportunities. Think about it, the city wants to have its cake and eat it too - only use vollies in times of crisis, and otherwise restrict you to a few flag downs and direct calls from citizens.

The hospitals especially would be very displeased to lose revenue to vollies. They do 911 to bring in revenue, or at the least get their name out in the street (advertising). While NS-LIJ did not do any PT steering to my knowledge, some other hospitals did - insured to their hospital, the uninsured to city hospitals


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## sirengirl (Jul 27, 2015)

Tigger said:


> With an increase in headache for FDNY. Now they have 40 separate agencies to regulate as well.



Where I work, we have nine- count them, 9- fire departments. For one county that has less than half a million people. And it is nothing but a constant pain trying to get to a place where we can work with them on calls. Two of them are volunteer. And there is a VAST difference between them and other, paid departments. Case in point the door to truck time for paid departments is <60seconds. The vollies? I've clocked them at 7 minutes before. The training isn't there. The enforcement isn't there. The discipline isn't there.


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## Flying (Jul 27, 2015)

sirengirl said:


> Where I work, we have nine- count them, 9- fire departments. For one county that has less than half a million people.


I raise you with 10 all volunteer fire departments serving a single township of less than 100 thousand.


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## sirengirl (Jul 27, 2015)

Flying said:


> I raise you with 10 all volunteer fire departments serving a single township of less than 100 thousand.



Godspeed to you, then. 

IF the mindset is to lower response times and get qualified, competent, and truly proactive care to people calling 911, fantastic. If the mindset is to swindle 911 calls from closer units to add notches to a belt, shame. 

When I volunteered the county would call us mutual aide if they deemed it a BLS transport (we were BLS only), and people had our direct phone number to call us for minor things (fall with an elbow lac needing stitches and no comorbidities, sniffles, etc). We had very strict protocols on things we could and could not transport, and it was not uncommon for us to call ALS backup to transfer care to the county for what our medical director deemed to be out of our scope. 

You're new. You have years and years ahead of you to get sick of running the FDGB, the sniffles, the DTs, the abdominal pains x17 weeks. You will get there. Be patient, and take every opportunity to learn something you can apply toward your next patient, even if it's checking a manual BP in a noisy rig on a BLS transfer.


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## Carlos Danger (Jul 27, 2015)

Flying said:


> I raise you with 10 all volunteer fire departments serving a single township of less than 100 thousand.


Amherst, NY?


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## Flying (Jul 27, 2015)

Pretty much any township in Somerset County, NJ
http://wiki.radioreference.com/index.php/Somerset_County_(NJ)

Seeing this area in action is like seeing the Freeway Patrol cartoons being played out in real life.


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## chaz90 (Jul 27, 2015)

Flying said:


> I raise you with 10 all volunteer fire departments serving a single township of less than 100 thousand.


Is this a competition now? 23 volunteer Fire/EMS departments in our county...


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## DesertMedic66 (Jul 27, 2015)

chaz90 said:


> Is this a competition now? 23 volunteer Fire/EMS departments in our county...


I'll call your bluff and raise you. We have 1 volunteer fire department in my county that I know of. 

That's how poker works right?


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## 46Young (Jul 27, 2015)

sirengirl said:


> Where I work, we have nine- count them, 9- fire departments. For one county that has less than half a million people. And it is nothing but a constant pain trying to get to a place where we can work with them on calls. Two of them are volunteer. And there is a VAST difference between them and other, paid departments. Case in point the door to truck time for paid departments is <60seconds. The vollies? I've clocked them at 7 minutes before. The training isn't there. The enforcement isn't there. The discipline isn't there.



Charleston County SC?


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## NomadicMedic (Jul 27, 2015)

chaz90 said:


> Is this a competition now? 23 volunteer Fire/EMS departments in our county...



But, for the most part, the DE people are fairly well trained and there's almost always a paid duty crews to staff the BLS trucks. They're not jumping each others calls. They're vollie departments that (mostly) employ EMTs. 

NY and NJ are very different.


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## ERDoc (Jul 27, 2015)

chaz90 said:


> Is this a competition now? 23 volunteer Fire/EMS departments in our county...



Amateurs.  Suffolk County, NY has about 139 separate FDs (some of which provide EMS) and VACs.  There are at least 6 different PSAPs that I know of.  There are multiple private EMS agencies and 2 University EMS services.


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## RedAirplane (Jul 28, 2015)

Tigger said:


> Central is just the name of their dispatch, not a location.
> 
> More is not better if you have no control over the more. If the system wished to allow the volunteer groups to participate as the hospitals do, that would be one thing. Have the volunteers cover a specific area as their first due. Dispatch them just like all the other ambulances and provide ALS backup like the rest of the city. But that is not how it works here. Instead you have individuals like the OP advocating for driving lights and sirens to a call that they were not dispatched to just for "the action." And that's who we want responding to calls?



That's what I am saying. 

Since they are running calls anyway, and it's stupid and dangerous to have multiple agencies racing to the same call, just integrate them like the hospital EMS units.


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## RedAirplane (Jul 28, 2015)

Jim37F said:


> If you're going to have ambulances that are legally part of the system enough to jump calls w/out negative repercussions, then they NEED to be FULLY integrated in the 911 system. I.e. they are assigned a station/post/first in district by the central dispatch, and take ALL assigned calls, and NOT say "eh that nosebleed a block away sounds boring, but that traffic collision 5 blocks away sounds like it'll be a cool call, I'm going to go buff that one!" The volunteer units can then be treated as extra coverage units by central dispatch, in that they're not relied upon to meet the call volume but are nice to have when available to help out the full time units.
> 
> BUT if you're not willing to be a full member of the system and take all assigned calls (as a BLS unit you'll get lots of those non-emergent, not really exciting, not-tv-show-worthy "BS" calls) (or in other words, if you ONLY want to buff the "cool" calls and ignore the rest) then you have NO place, anywhere in the system and thus should not be able to legally take ANY 911 calls. Period.



My understanding is the volunteers want to be part of the system properly.


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## Tigger (Jul 28, 2015)

Perhaps FDNY does not wish for them to be integrated for the litany of reasons listed?


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## 46Young (Jul 28, 2015)

RedAirplane said:


> My understanding is the volunteers want to be part of the system properly.



The problem is, if your wish is to be "part of the system properly," you need to have the ability to keep the units staffed all of the time, not just when members can find the time to pitch in. Inconsistent staffing, and lack of consistent drills and in-service training for all members are two common complanits against volunteers.

A good example of the volunteer staffing issue would be the Sterling Volunteer Rescue Squad. They are part of the Loudon County 911 system. They have two all-volunteer stations, and one combo station with the county. At full strength they would have two ALS units, and 3-4 Trauma (EMT-E) or BLS units. They have two ALS some of the time, maybe half the time, and otherwise just one ALS, sometimes none, just some guy in a chase car. The county wants to put paid ALS in their stations, but they refuse to let them in. Meanwhile, they use copious amounts of automatic aid from Fairfax, MWAA (Dulles Airport), and Prince William County. We had had up to 4 automatic aid units running into Sterling, and the career Loudon units are also tired of running into Sterling regularly. 

That is the problem with having volunteers being relied upon as the primary 911 staffing/deployment for a district. If you include the vollies a part of the normal 911 system, and give them a dedicated CSL (Cross Street Location, a post), they can't just decide to staff that post when they feel like it. It needs to be staffed 24/7 or 16 hrs/day if there is no tour1 (overnight) requirement. If you think that it's acceptable to have the vollies staff a CSL inconsistently, then FDNY would have to alter all surrounding units' CSL to reflect the vollie's posting. It simply doesn't make sense. 

If you want to play 911, your organization needs to be able to do it 24/7/365, not just when it's convenient for the members to drop in for a few hours. Perhaps the inability to fill this requirement is a good reason why the vollies don't have a dedicated CSL incorporated into FDNY's deployment matrix.


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## 46Young (Jul 28, 2015)

To use Sterling as an example again, they have gone so far as to (in the combo station) bump the paid medic crew from that ambo to the engine (career people are dual role FF/EMS, vollies are single role EMS), then downgrade that bus to trauma or bls, just so they could play 911.


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## DrParasite (Jul 29, 2015)

sirengirl said:


> Where I work, we have nine- count them, 9- fire departments. For one county that has less than half a million people. And it is nothing but a constant pain trying to get to a place where we can work with them on calls. Two of them are volunteer. And there is a VAST difference between them and other, paid departments. Case in point the door to truck time for paid departments is <60seconds. The vollies? I've clocked them at 7 minutes before. The training isn't there. The enforcement isn't there. The discipline isn't there.


sounds like apples and orange actually.  I'm betting the paid department's staff are in house 24/7, while the volunteers are all responding from home, which accounts for the disparity between time of dispatch to time of responding.  If you really want to look into it, look at NFPA 1710 and NFPA 1720.

By the way, in some areas, the paid firefighters and volunteer firefighters go to the exact same fire academies.  So the training they initially receive is the same.



Flying said:


> I raise you with 10 all volunteer fire departments serving a single township of less than 100 thousand.


now that sounds like my old stomping ground of Franklin Twp, but their population was less than 65k, over a little more than 45 sq miles.....


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## DrParasite (Jul 29, 2015)

46Young said:


> That is the problem with having volunteers being relied upon as the primary 911 staffing/deployment for a district. If you include the vollies a part of the normal 911 system, and give them a dedicated CSL (Cross Street Location, a post), they can't just decide to staff that post when they feel like it. It needs to be staffed 24/7 or 16 hrs/day if there is no tour1 (overnight) requirement. If you think that it's acceptable to have the vollies staff a CSL inconsistently, then FDNY would have to alter all surrounding units' CSL to reflect the vollie's posting. It simply doesn't make sense.


Respectfully disagree.

Volunteers can supplement the existing 911 system, but they shouldn't replace it, nor do they reduce the responsibility for the AHJ.  Using the Sterling Rescue example, who is responsible for EMS coverage?  Sterling or the county?  If it's the county, then an ambulance should be budgeted for and staffed to provide proper coverage, regardless of if Sterling has an ambulance available.  If Sterling has the ambulance available, they can take calls (provided they notify dispatch that they are in service), and the county ambulance can be relocated or be the backup and enjoy an easy night.  If not, then the county can cover the calls, as they are their responsibility.  If it's Sterling's responsibility, than they decide how they want to handle coverage (but that really sounds like a bad idea, esp if they have staffing issues)

If a volunteer ambulance wants to "play" in the 911 system, why not let them?  Assuming they are closer, answer all calls promptly, and follow the same rules and regulations that other 911 ambulances need to follow, why not?  I think having them listen to the scanner and buff calls is both stupid and bad, but if they are dispatched, because they are trained, equipped and closer, then why not?  And if they are not in service, than the Authority Having Jurisdiction needs to provide coverage, just like they would if the volunteer agency didn't exist.


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## adamNYC (Jul 29, 2015)

Worth reading:

http://www.emsworld.com/news/10407495/fdny-cuts-volunteer-ambulance-companies-from-911-system

This is a good discussion too.

http://www.reddit.com/r/ems/comments/211w5y/can_someone_explain_what_it_means_to_be_a_fdny/


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## Tigger (Jul 29, 2015)

DrParasite said:


> If a volunteer ambulance wants to "play" in the 911 system, why not let them?  Assuming they are closer, answer all calls promptly, and follow the same rules and regulations that other 911 ambulances need to follow, why not?  I think having them listen to the scanner and buff calls is both stupid and bad, but if they are dispatched, because they are trained, equipped and closer, then why not?  And if they are not in service, than the Authority Having Jurisdiction needs to provide coverage, just like they would if the volunteer agency didn't exist.


The FDNY manages EMS delivery in the within the city. Why would they want to have to take over oversight of an additional 40 agencies that barely provide any benefit to the system? Doesn't seem worth the headache to me.


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## TransportJockey (Jul 30, 2015)

Unless the vollies can staff 24/7 or two tours, why bother with the headache of trying to keep track of when they have staff and when they dont?


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## 46Young (Jul 30, 2015)

adamNYC said:


> Worth reading:
> 
> http://www.emsworld.com/news/10407495/fdny-cuts-volunteer-ambulance-companies-from-911-system
> 
> ...



From your first link:

_"About 35 community-run corps of volunteer EMTs dot the city, mostly in Queens, Brooklyn and Staten Island, staffing a fleet of about 50 ambulances.
The volunteers respond to an estimated 10,000 to 15,000 emergency calls annually, said Ryan Gunning, head of the state volunteer ambulance association."_

_"If it weren't for us, patient wait times would often be much longer. We get called in when the FDNY doesn't have an ambulance to send. This change comes at the patient's expense," said Alan Wolfe, president of the Forest Hills Volunteer Corps.
_
15k calls / 50 volunteer ambulances = 300 calls/ambulance per year, or 0.82/day (4 calls every 5 days). I'm not sure what Alan Wolfe meant when he said that if if it weren't for us, patient wait times would be much longer, and that this change comes at the patient's expense. The volunteers collectively are taking between 41 and 42 calls per day in the NYC 911 system. This is about 1% of all calls, since around 4,000 911 calls are dispatched daily. It is also more common for volunteers to run in the evenings, when paid units generally have more downtime than the mornings and afternoons. The 1% that they run isn't making much of a dent into the call volume.

If the volunteers are running less than 1 call a day, presumably they are not in-service much. I do not see how they could ever hope to consistently staff a unit at a CSL for 16 hrs/day on a consistent basis.

From your second link, one commenter breaks down the NYC 911 system quite well. BTW, the hospitals were the first to deploy 911 ambulances:

_"SO the 911 EMS system is as follows. The actual 911 system is run by the FDNY with their dispatches receiving and dispatching the calls, they regulate the protocols along with the REMAC committee, and their supervisors patrols the streets making sure everything sort of runs well. 


Historically, individual hospitals were the first ones to put out ambulances. I believe Bellevue hospital in manhattan had the first one in NYC, and the hospital I work for put out an ambulance in 1873 and was the first one in Brooklyn. Prior to the FDNY creating an EMS division, EMS was primarily run by HHC (Health and Hospital Corp.) and the non municipal hospitals. HHC ran into major budget issues, and the FDNY needed to increase their funding and many allege that FDNY needed to also improve their image of having a lack of minorities on their staff. Thus, they absorbed the municipal EMS ambulance that were run by HHC in the mid 90's, and the municipal ambulances have been run by the FDNY since. 


Also in the 90's came the rise of private companies contracting to hospitals to participate in the 911 system. The big players currently are Transcare and Seniorcare. They contract ambulances to specific hospitals and are part of the 911 system also. The ambulances will have the hospital logo on the side, but the vehicle, staff, equipment, and regulation are all run by the private company. So in the actual 911 EMS system, you have the municipal ambulances operated by the FDNY, the hospital based ambulances run by the actual hospital themselves (these are referred to as Voluntary ambulances), and the private contract ambulances contracted to the hospital. All are recognized by the FDNY EMS system, all the ambulances have specific unit designations, and all adhere to the rules set by the FDNY. The difference comes to pay, unions, and regulation within the departments themselves. 


Whew. Now we come to the volunteers. The organizations i'm familiar with in Brooklyn all have a long history. They were created in the 60's and 70's and were staffed by members of the community. They are not dispatched by the FDNY EMS system. BUT, they are acknowledged in the system as volunteer ambulances and are able to respond to calls within their communities. They monitor the radios, either PD, fire, or EMS, and self dispatch within their organizations to calls in their area. They must still adhere to the medical protocols set by the city, but their operational protocols may vary. As far as I was told, and if someone wants to correct me please do, buffing is allowed in their ambulances, but is not encouraged in their private vehicles (which a lot tend to do)."_


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## 46Young (Jul 30, 2015)

Tigger said:


> The FDNY manages EMS delivery in the within the city. Why would they want to have to take over oversight of an additional 40 agencies that barely provide any benefit to the system? Doesn't seem worth the headache to me.



Other than restricting pt. care and mandating the crew meet with their own OMD, FDNY cannot directly impose any punitive measures onto non-FDNY employees, and I don't see that being any different for the volunteers.


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## 46Young (Jul 30, 2015)

DrParasite said:


> Respectfully disagree.
> 
> Volunteers can supplement the existing 911 system, but they shouldn't replace it, nor do they reduce the responsibility for the AHJ.  Using the Sterling Rescue example, who is responsible for EMS coverage?  Sterling or the county?  If it's the county, then an ambulance should be budgeted for and staffed to provide proper coverage, regardless of if Sterling has an ambulance available.  If Sterling has the ambulance available, they can take calls (provided they notify dispatch that they are in service), and the county ambulance can be relocated or be the backup and enjoy an easy night.  If not, then the county can cover the calls, as they are their responsibility.  If it's Sterling's responsibility, than they decide how they want to handle coverage (but that really sounds like a bad idea, esp if they have staffing issues)
> 
> If a volunteer ambulance wants to "play" in the 911 system, why not let them?  Assuming they are closer, answer all calls promptly, and follow the same rules and regulations that other 911 ambulances need to follow, why not?  I think having them listen to the scanner and buff calls is both stupid and bad, but if they are dispatched, because they are trained, equipped and closer, then why not?  And if they are not in service, than the Authority Having Jurisdiction needs to provide coverage, just like they would if the volunteer agency didn't exist.



Sterling is responsible for it's own area, just like a FDNY or hospital unit is responsible for it's CSL and first due. Sterling, somehow, has enough political connection to keep the FD from deploying a paid ALS ambulance or two out of their stations. The county offers this on a continual basis. Sterling prefers to keep its stations 100% volunteer, and force county dispatch to request units from out of county to run their calls for them to make up for their continual lack of staffing. This happens very frequently, typically multiple times a day. Their is very infrequent reciprocation into the other counties. Fairfax had to staff it's M439 with two medics instead of the usual medic/EMT combination just because they run into Sterling so much. M404, another border station, has only one medic, so E404, which has a second medic, will oftentimes follow M404 into Loudon. Meanwhile, these medics, and E404 are not available to run calls in their home county, which the citizens expect in return for their tax $$$. In other automatic aid situations, like with Alexandria, Prince William, Montgomery Co. and Arlington, Fairfax gets back as much help as it needs from these departments. Sterling is the one that uses the aid all of the time without having the ability to return the favor.

Also, as I've said previously, when the volunteers want to "play" 911 in an area that already has a reasonable level of paid coverage, they are siphoning away billing opportunities from the paid department. That could make the difference of getting new equipment, an extra ambulance, replacing an old ambulance, hiring more people, getting a pay raise or not, or getting a COLA or not.


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## 46Young (Jul 30, 2015)

Professional 911 units are deploying from pre-determined street corners (CSL's), not from a station per se most of the time. Volunteers run maybe 1% of all calls in the system, which are calls that were dispatched, so the calls weren't sitting in the queue because they had no available units.


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## 46Young (Jul 30, 2015)

In my county, the volunteers put an ambo or engine in-service, and are in the system, and will get dispatched the same as paid units. Dispatch will frequently take the volunteer units and deploy them in other areas of the county, typically to fill in for units that are OOS for training drills and EMS on-duty Con-Ed. I would not be opposed to the idea of volunteers doing the same for FDNY EMS - pre-arrange to take the place of a unit so that they can go to training, without leaving a CSL vacant. The volunteers would log on, then be sent all over the city to cover areas with high call volume, kind of like how SSM works. You may not be able to run calls in your home neighborhood, but if you truly want to help the NYC 911 system, filling in for units doing training, or floating around the city would, in my opinion, be the best way to serve.

Edit: If you are deploying into your neighborhood, where there are already plenty of ambulances, you will need to race units to get to a call, which should tell you that you are not really needed in that situation. Go a few neighborhoods over, where multiple units are already running calls.


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## adamNYC (Jul 30, 2015)

Excellent point. I would love to go over to "rough neighborhoods" where there are no vollys, just FDNY working the streets by their city hospitals ie coney island, east new york, etc.


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## RocketMedic (Jul 30, 2015)

That, padawan, is why you are not ready for this alone.

You really want gritty urban 911? Move somewhere as a Basic and start running calls, or drop some apps and start working.


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## TransportJockey (Jul 30, 2015)

Detroit is hiring


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## Tigger (Jul 31, 2015)

46Young said:


> Other than restricting pt. care and mandating the crew meet with their own OMD, FDNY cannot directly impose any punitive measures onto non-FDNY employees, and I don't see that being any different for the volunteers.


Not employees, organizations. If the volunteers are not meeting response time or availability requirements, that will require action. And there is no sense in the "dual response" models. Either the volunteers are the first due coverage to their area 100% of the time or they do not operate. Otherwise it makes no sense from an efficiency standpoint.


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## 46Young (Jul 31, 2015)

Tigger said:


> Not employees, organizations. If the volunteers are not meeting response time or availability requirements, that will require action. And there is no sense in the "dual response" models. Either the volunteers are the first due coverage to their area 100% of the time or they do not operate. Otherwise it makes no sense from an efficiency standpoint.



True, but I was referring to what FDNY can do when an employee violates SOP's. The Conditions Boss (field supervisor) issues an NOI (Notice of Infraction). Punitive measures can come with an NOI. For a non-FDNY employee, their own supervisor will be made aware of the NOI, but it's up to them if they want to do anything about it or not. Things like roaming away from your CSL, holding signals, uniform issues, not bringing all of your equipment to a call, things like that.

We had a medic whose shift ended at 2000 hrs. If he wasn't on a call, he would routinely go be a park near the CSL to "get flagged" for a drunk. Basically, he would drive by the park at 1900hrs or so, where there were always a few drunks hanging around, find one that wants to go to the hospital for a meal and a bed. They would spend the allowable 20 mins. on-scene, take the long way for txp for another ten minutes, spend the allowable 20 mins. at the hospital, then go 10-99 - available in quarters checking equipment (less recommended for a call) if relief was there, or advise extended waiting for a bed, which took him right to 2000hrs. Conditions noticed a pattern, but no one from the employee's side did anything about it.


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## 46Young (Jul 31, 2015)

I hope that I'm not giving anyone any ideas with that last post hahaha


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## adamNYC (Jul 31, 2015)

As far as gritty 911 im joining another volly in a rougher neighborhood. Wish me luck


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## DrParasite (Jul 31, 2015)

adamNYC said:


> As far as gritty 911 im joining another volly in a rougher neighborhood. Wish me luck


out of curiosity, Bedford-Stuyvesant Volunteer Ambulance Corps, aka http://www.bsvac.org/ by any chance?


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## Tigger (Jul 31, 2015)

adamNYC said:


> As far as gritty 911 im joining another volly in a rougher neighborhood. Wish me luck


Lulz. Running EMS in "gritty" neighborhoods just means more crap. Do you think the crews and units who are paid to be there aren't going to beat you to a stabbing?


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## Bullets (Jul 31, 2015)

adamNYC said:


> Excellent point. I would love to go over to "rough neighborhoods" where there are no vollys, just FDNY working the streets by their city hospitals ie coney island, east new york, etc.



Jersey City and Newark are just across the river


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## 46Young (Jul 31, 2015)

Corona VAC can see some good stuff. My old CSL was at National/Roosevelt, but we would get as far as LIC and Ridewood at times. We ran Rikers Island a lot too.

When looking to join, maybe don't mention that you're trying to get on with FDNY EMS or the hospitals right away, just say that you like IFT but want to do some 911, to help out the community and see if you like it. Make it seem like if you get hired to a 911 provider, that you'll still volunteer. 

I used to work with Brenda. She's a really good, down to earth person, and an excellent EMS provider. She is on the Board of directors at GOVAC, and still works at NS-LIJ as far as I know. When I used to work 53Y/54Y, GOVAC was treated well by the paid crews, and they got their ambulances in-service a lot. They don't get tons of action, but you could sneak towards Cambria Hts, St. Albans, down Jamaica Ave or Hillside Ave (passing the Queens Village Vollies), to get more work.

http://www.glenoaksvac.org/board-of-directors.html


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## graycord (Jul 31, 2015)

lol, so many misconceptions in these posts here.

You do not just get hired by a 911 service in this city. It just doesn't happen. 911 experience with the vollies is usually a big factor in decisions, whether getting in to fdny or with the 911 hospital agencies. And a lot of paid workers show up to help up newbies like OP so that they don't go too far off the track. 
And while I agree that you do learn a lot doing ift, you're still lose something from not being in an actual pressure situation ever.



adamNYC said:


> Redairplane: Very well said!
> 
> What cracks me up is the assumption that all volly members are weekend warriors. Some may be, but there are others in leadership positions who currently work in 911, at least in my volly they are.
> 
> To answer if I buff in IFT, no. I do in volly, and my other thread was asking about those who do buff in IFT, out of my own curiosity.


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## Chewy20 (Aug 1, 2015)

graycord said:


> lol, so many misconceptions in these posts here.
> 
> You do not just get hired by a 911 service in this city. It just doesn't happen. 911 experience with the vollies is usually a big factor in decisions, whether getting in to fdny or with the 911 hospital agencies. And a lot of paid workers show up to help up newbies like OP so that they don't go too far off the track.
> And while I agree that you do learn a lot doing ift, you're still lose something from not being in an actual pressure situation ever.



So what "pressure situation" would you encounter on a BLS IFT truck?


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## squirrel15 (Aug 1, 2015)

Chewy20 said:


> So what "pressure situation" would you encounter on a BLS IFT truck?


A code brown after a taco bell lunch while transporting long distance


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## sirengirl (Aug 1, 2015)

graycord said:


> And while I agree that you do learn a lot doing ift, you're still lose something from not being in an actual pressure situation ever.



I agree with this. What he is trying to say is IFT world and 911 world are very different. I learn/ed a lot at my 8 months/continuing PT gig at IFT, but when I started at 911 it was like being sent back to school. IFT causes you to lose your sense of urgency, your snap-decision making skills, your pressure to get things done. IFT is so routine that a lot of the time I see providers who have to ask me to verify their manual BPs and lung sounds. I started 3 IVs in 8 months of full time IFT work, and now as a part timer there are medics there who have been there so long and are so far removed from the emergency game that they will literally ask me to perform the ivs and all the"advanced" interventions because they're rusty and are honestly afraid to do it themselves.  So yes, I agree that there is something to be learned from IFT, but there is also something to be lost, which is why I always encourage either working in an ER (hand on critical patients and some of your skills get used there), or volunteering- but doing so the right way.


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## akflightmedic (Aug 1, 2015)

I would like to pick apart your post and offer a different perspective and what I say is with respect to you, not to slam you in any way. If none of this applies to your particular situation, it may very well apply to others. (like the disclaimer?)



sirengirl said:


> I agree with this. What he is trying to say is IFT world and 911 world are very different. I learn/ed a lot at my 8 months/continuing PT gig at IFT, but when I started at 911 it was like being sent back to school.



I disagree. Both gigs are about assessing, treating if required and transporting. I know IFT has less treatment required and is more of a taxi service, I get that. But as you know, you can do and learn a lot at a higher level than you do in Emergency. You can build essential life skills or make weak skills stronger during the course of IFT and not even realize it. I have spoken about this before and it is a shame so many overlook it in our field. I am talking about developing a sense of empathy (not everyone has this ya know), social skills, knowing how to build rapport, manage difficult patients (even personality wise), how to document properly and more thoroughly, on and on. These skills have extreme value which may not provide obvious returns until years later. 

I equate this to when we lose weight. Sure we see some of it sometimes but if we do it slowly, the proper way...we do not really see our selves reshaping that drastically, right? But then when you bump into someone you have not seen in a couple months or longer, they are ecstatic, cause to them, the change is obvious and drastic.

Well this is the same in all those important skills I wrote above. You think you are not developing and refining them, but one day down the road, you will have that surreal moment, that epiphany when you self check and say "wow, I am pretty good at this". Your colleagues will have noticed, but the newbies...they will be coming to you for your wisdom, advice and respect your experience based on how you conduct yourself day to day. And you will think again...When did I grow up? How did this happen?



sirengirl said:


> IFT causes you to lose your sense of urgency, your snap-decision making skills, your pressure to get things done.



Sorry, I call BS on this one. I am never "pressured" to get things done. Pressure is not part of the equation. Education is what builds confidence. And when an assessment shows something needs to be done, we do it. In a calm, methodical method. Being pressured will lead to mistakes. It is not we do not care, we know time is SOMETIMES a factor, but the reality is the majority of interventions we perform or "snap decisions" are really not all that urgent. They can and could wait. You only get this if you have the knowledge.

I spoke before about skills. Skills can be taught to anyone. The actual performance of the skill is muscle memory. That comes with repeated attempts and eventually we get to the point where we can do it without thinking much about it. However, knowing WHY the skill is actually needed, unfortunately that skips many providers. They do it simply because they can or "it doesn't hurt anyways" or there is a very basic mental checklist which dictates they should.

Again, knowledge will build confidence. In my little bubble of the world and my perspective of experience (which is quite varied actually), I have yet to see anyone simply falter with a sense or urgency due to being out of the game. I have had medics return after YEARS ad climb right back on that bike.



sirengirl said:


> IFT is so routine that a lot of the time I see providers who have to ask me to verify their manual BPs and lung sounds.



Routine = Boring? I am unsure why the verification would be needed on those things, especially for routine work, however they could simply be putting you to work..?   Kind of shut up and get out of my hair. LOL Why are so many of them defaulting to you for verification? Are they that poor of a medic or is this another EMT asking? Maybe they do not know what they are hearing and are doubting themselves...again that knowledge breeds confidence. They lack both and maybe you display more of it, so they get confirmation that what thy heard is nothing to worry about. Sadly in these situations, there is a lost teaching moment.



sirengirl said:


> I started 3 IVs in 8 months of full time IFT work, and now as a part timer there are medics there who have been there so long and are so far removed from the emergency game that they will literally ask me to perform the ivs and all the"advanced" interventions because they're rusty and are honestly afraid to do it themselves.



Laziness of the provider cloaked in they are allowing it for your own good. I am guilty of this. There were times when I was in a funk and just "cruising along". And if I got an eager partner who seemed competent and capable....I would let them run as far as the leash would take them, until I had to choke it up a little. I had no issue saying, "hey that looks like a difficult stick, you want to try first?" 

It kept my partner busy, it was training for them as I felt I did not need it, and what is the harm, right? It never really was a case of being so far removed and being unable to do an IV, it was a case of being lazy. Lazy in the sense that those things do not bring the same "high" or challenge that they once did. We do our jobs, but the glory moments are sparse. Yes, there is an ego in all that we do, it is normal.

You sound excited and eager...I would do the same for you. Run Forest, run...



sirengirl said:


> So yes, I agree that there is something to be learned from IFT, but there is also something to be lost, which is why I always encourage either working in an ER (hand on critical patients and some of your skills get used there), or volunteering- but doing so the right way.



I agree. There is lots to learn in both. But I disagree on there being something to lose. That is only the case if you allow it...a self fulfilling prophecy if you will. This is why attitudes in IFT are so challenging. It is filled with a lot of EMTs and Medics who do not want to be there. It is a job but it is not The Job. But if you bring that negativity to the job, even if it is a little tiny seed in back of the brain...and you allow it to slowly grow, it will consume you, you will hate your job and be very unhappy. Then comes worse or low productivity, then comes moving on...


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## graycord (Aug 1, 2015)

Chewy20 said:


> So what "pressure situation" would you encounter on a BLS IFT truck?



In my experience, it has mostly been when things inside of a dialysis or nursing facility start to turn bad and you are literally in the right place at the right time.





sirengirl said:


> I agree with this. What he is trying to say is IFT world and 911 world are very different. I learn/ed a lot at my 8 months/continuing PT gig at IFT, but when I started at 911 it was like being sent back to school. IFT causes you to lose your sense of urgency, your snap-decision making skills, your pressure to get things done. IFT is so routine that a lot of the time I see providers who have to ask me to verify their manual BPs and lung sounds. I started 3 IVs in 8 months of full time IFT work, and now as a part timer there are medics there who have been there so long and are so far removed from the emergency game that they will literally ask me to perform the ivs and all the"advanced" interventions because they're rusty and are honestly afraid to do it themselves.  So yes, I agree that there is something to be learned from IFT, but there is also something to be lost, which is why I always encourage either working in an ER (hand on critical patients and some of your skills get used there), or volunteering- but doing so the right way.



---



akflightmedic said:


> Sorry, I call BS on this one. I am never "pressured" to get things done. Pressure is not part of the equation. Education is what builds confidence. And when an assessment shows something needs to be done, we do it. In a calm, methodical method.



I disagree. To me, education builds knowledge. And repetition builds confidence. In this crowded city where potential flag downs are literally everywhere, I've heard of more than a few instances where a bls ift crew stumbles upon a scene and freak out in a situation because their daily routine is just so different.


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## NightHealer865 (Aug 2, 2015)

Running emergency traffic to call you weren't dispatched on? What happens when you hit someone running emergency traffic and kill someone? I'm the prosecution would eat you alive. People tend to use emergency traffic was to liberally.


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## triemal04 (Aug 2, 2015)

graycord said:


> In my experience, it has mostly been when things inside of a dialysis or nursing facility start to turn bad and you are literally in the right place at the right time.


So there is a lot of pressure involved in picking up the radio and saying "we need a paramedic at this location"?  Or calling 911 and doing the same?  Or, if you are the thinking type, just beating feet for the nearest appropriate ER if that is faster than waiting for a paramedic?  Sorry, not seeing a lot of pressure here.

Let's be honest.  At the EMT level there is very, very little that you are going to be doing for someone when things "start to turn bad."  So what is there to get worked up over?  You do your job, which is to either a) call for the appropriate resources, or b) get the patient to those appropriate resources.


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## adamNYC (Aug 3, 2015)

In IFT/Txp I can say I was privileged to encounter quite a few flag downs including MVAs, ped struck, and a Cardiac arrest. In our private ambulance we do respond to emergencies with L&S at docs offices, assisted living, SNFs, and assist Hatzolah w/ their txp for their housejobs (mostly for the sick) I've heard of privates that mostly do dialysis and rarely run L&S i.e. Midwood, Priority1, etc. and am glad I don't work for a strictly non-emergency company.


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## evantheEMT (Oct 25, 2015)

This is why I love my company I work on the transfer truck but we do both routine calls and emergencies.  Just never know what the night or day will be like.


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## LACoGurneyjockey (Oct 25, 2015)

evantheEMT said:


> Youre very limited if you think emts can do very little.


1). How long have you been doing this?
2). What are you going to do if something goes bad? O2, shock position, rapid transport? Maybe some bleeding control? CPR? Am I missing anything?


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## evantheEMT (Oct 25, 2015)

LACoGurneyjockey said:


> 1). How long have you been doing this?
> 2). What are you going to do if something goes bad? O2, shock position, rapid transport? Maybe some bleeding control? CPR? Am I missing anything?


"If something goes bad" like what? Difficulty breathing, dizziness? What a way to leave it wide open.


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## LACoGurneyjockey (Oct 25, 2015)

evantheEMT said:


> "If something goes bad" like what? Difficulty breathing, dizziness? What a way to leave it wide open.


Difficulty breathing, chest pain, syncope, ALOC, tension pneumo, airway compromise, what more do you want? What are you really going to do for them? This is the point where you sit, read my response, and realize that O2, vitals, shock position, and rapid transport tends to be the end of it.


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## Tigger (Oct 25, 2015)

evantheEMT said:


> "If something goes bad" like what? Difficulty breathing, dizziness? What a way to leave it wide open.



Does it matter? What as an EMT will you do (and me for matter) besides take the patient to the hospital? Not only do EMTs have limited education, they also have nothing to treat their findings with and potentially fix the problem. So again, what will you do?


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## LACoGurneyjockey (Oct 25, 2015)

Tigger said:


> Does it matter? What as an EMT will you do (and me for matter) besides take the patient to the hospital? Not only do EMTs have limited education, they also have nothing to treat their findings with and potentially fix the problem. So again, what will you do?


"Get mad and complain about the scenario, hold off on the ALS backup because that's a waste of resources, make sure to seek out congrats at the hospital for BLSing a respiratory failure."


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## Bullets (Oct 26, 2015)

LACoGurneyjockey said:


> "Get mad and complain about the scenario, hold off on the ALS backup because that's a waste of resources, make sure to seek out congrats at the hospital for BLSing a respiratory failure."


you forgot "Post about it on Social Media"


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## DesertMedic66 (Oct 26, 2015)

LACoGurneyjockey said:


> "Get mad and complain about the scenario, hold off on the ALS backup because that's a waste of resources, make sure to seek out congrats at the hospital for BLSing a respiratory failure."


That is something that I hate. We have had some BLS providers in my area try to brag about drips the have transported that are not in the BLS scope or even the ALS scope. That quickly ended once management found out what they were doing.


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## RedAirplane (Oct 30, 2015)

TransportJockey said:


> Unless the vollies can staff 24/7 or two tours, why bother with the headache of trying to keep track of when they have staff and when they dont?



Since this thread appears to have been resuscitated...

I don't think it's that hard at all. A log in / log out procedure is what they used when my volunteer team and the fire department were jointly covering a large event. 

Team XYZ logging in, 
Team XYZ temporarily out of service,
Team XYZ logging out. 

Then the main dispatch can post you where they need you.

When you log out, they go to the deployment plan for one less ambulance.


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## DrParasite (Oct 31, 2015)

LACoGurneyjockey said:


> 1). How long have you been doing this?
> 2). What are you going to do if something goes bad? O2, shock position, rapid transport? Maybe some bleeding control? CPR? Am I missing anything?


1) 15 years.  2) if you think a paramedic can deal with every situation that "goes bad" than you are obviously new to EMS.  3) Paramedics are great at treating many cardiac and respiratory problem  but there is a huge list of things that paramedics can't do anything to fix.


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## NomadicMedic (Oct 31, 2015)

DrParasite said:


> 1) 15 years.  2) if you think a paramedic can deal with every situation that "goes bad" than you are obviously new to EMS.  3) Paramedics are great at treating many cardiac and respiratory problem  but there is a huge list of things that paramedics can't do anything to fix.




I never understood this argument. Paramedics are specifically trained to deal with the most statistically common life-threatening issues.  By virtue of additional training, paramedics are better equipped and better trained to handle these emergencies.

Playing the "what if" game is simply burying your head in the sand. Yes, paramedics are great at treating cardiac and respiratory issues. They're also much better equipped to treat anaphylaxis, start treatment for sepsis, deal with hypoglycemia, hypertensive crisis, or manage an overdose, aren't they?

Tell me about the things that go wrong during a typical transport and what paramedics can't manage as or more affectively then a BLS crew?


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## triemal04 (Nov 1, 2015)

DEmedic said:


> Tell me about the things that go wrong during a typical transport and what paramedics can't manage as or more affectively then a BLS crew?


Cue the standard response of "well this one time I saw a paramedic forget to..." or "paramedics never do..."  or the oldy but goody, "OMG BLS before ALS paramedics can't BLS OMG OMG EMT's save paramedics OMG!!!!!!!!!!!"

You all know it's coming...


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## Martyn (Nov 1, 2015)

And don't forget

Paramedics save lives...EMT's save paramedics


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## gotbeerz001 (Nov 1, 2015)

.....


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## LACoGurneyjockey (Nov 1, 2015)

DrParasite said:


> 1) 15 years.  2) if you think a paramedic can deal with every situation that "goes bad" than you are obviously new to EMS.  3) Paramedics are great at treating many cardiac and respiratory problem  but there is a huge list of things that paramedics can't do anything to fix.


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## SeeNoMore (Nov 1, 2015)

Amazing. I had no idea this was a thing. I am trying to imagine a Volunteer Ambulance zooming up to assist with calls. Just amazing.


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## DrParasite (Nov 4, 2015)

LACoGurneyjockey said:


> View attachment 2348


yes, silence occurs when one has a life outside of EMTlife.... I'd find a meme, but it's not worth my time.


DEmedic said:


> I never understood this argument. Paramedics are specifically trained to deal with the most statistically common life-threatening issues.  By virtue of additional training, paramedics are better equipped and better trained to handle these emergencies.


and yet, the state of delaware still doesn't require a paramedic on every ambulance.


DEmedic said:


> Playing the "what if" game is simply burying your head in the sand. Yes, paramedics are great at treating cardiac and respiratory issues. They're also much better equipped to treat anaphylaxis, start treatment for sepsis, deal with hypoglycemia, hypertensive crisis, or manage an overdose, aren't they?


well, EMTs can give epinephrine for anaphalaxis (which is starting treatment), and if they hypoglycemic patient is conscious, can check BGL and give sugar orally.  I do agree that a paramedic can do more, especially for more serious cases.

what can a medic do for a hypertensive crisis?  last I checked, it was still establish IV access, monitor and transport to the ER.  for sepsis, you are STARTING treatment, but the ER is actually fixing the problem.  And what are you giving for a cocaine overdose?  what about an alcohol overdose?  If you are talking about a heroin overdose, sure, EMTs can give narcan too.


DEmedic said:


> Tell me about the things that go wrong during a typically transport and what paramedics can't manage as or more affectively then a BLS crew?


what interventions are paramedics going to do for a stroke, that EMTs can't?  or abdominal pain (outside of pain meds, of course)? or a multi system trauma?

DEmedic, think of it this way, out of all the calls you are dispatched to during a shift, how often are you taking the person to the ER?  and how much does that compare to when the BLS crew takes them to the hospital without you?  

Going one step further, then why doesn't your state require a paramedic on every EMS call?  Using your logic, they should, because otherwise, people will be dying left and right


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## chaz90 (Nov 4, 2015)

DrParasite

I believe the original statement made by DEmedic was asking "what paramedics can't manage as or more effectively than a BLS crew." 

This doesn't mean that ALS level care will make a difference in every case, but it does clearly mean that everything in the BLS scope of practice also falls under the ALS scope. If an ALS crew is confronted with a time sensitive CVA or trauma patient, they can load and initiate transport as quickly as a BLS crew if needed.

In direct answer to your questions, many systems, including my own, carry beta blockers for treatment of symptomatic hypertensive crises. The merit of their pre-hospital use is debatable, but it is still a treatable condition from what I carry in my drug bag at this moment. We can treat cocaine overdoses with benzodiazepines as necessary and provide treatment for cardiac arrhythmias when/if they appear. No, we do not fix the problem of sepsis, but initiating treatment with fluid, early recognition, and pressors in severe cases can certainly be important. 90% of the time, all we do is initiate treatment and not fix the problem itself, so I don't understand how you're using that as an argument against treating these conditions earlier. 

Additionally, saying an EMT "can" administer various drugs doesn't mean it's not better used in the hands of a higher level provider. I'm all for patients or EMTs carrying Epi-Pens for early treatment of anaphylaxis. Administering it early is great and has a positive impact on mortality rates of anaphylactic episodes, but follow up care from a higher level provider with additional interventions and monitoring capabilities is certainly advisable. Same goes for Narcan. I've used the argument before that just because a lower level provider has a medication or intervention available doesn't mean they are the most qualified to use it. I consider myself halfway decent at performing intubations and reading 12 lead EKGs for a paramedic. If a cardiologist or anesthesiologist is available though, God knows they are more qualified than I and should be interpreting the 12 lead or intubating the patient. Same goes for EMTs and some of these interventions. If no one else is around, carry on with epi, narcan, CPAP,  aspirin, and albuterol. If someone more qualified is available however and closer than the hospital, perhaps they should be using their additional education to more appropriately assess and manage that patient.

I can't speak for DE, but I don't think any of this really directly applies to whether a paramedic needs to be on every ambulance. That's an argument for another thread at another time.


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## NomadicMedic (Nov 4, 2015)

I was writing a response, but @chaz90 hit all the high points, and was far more eloquent than I would have been.


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## Tigger (Nov 5, 2015)

DrParasite said:


> y
> 
> Going one step further, then why doesn't your state require a paramedic on every EMS call?  Using your logic, they should, because otherwise, people will be dying left and right


What the law says and what the best practice is are not always the same thing. Not a new concept.


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## NomadicMedic (Nov 5, 2015)

DrParasite said:


> well, EMTs can give epinephrine for anaphalaxis (which is starting treatment)



But they certainly don't need any fluid, right? Or an Epi Drip? Benadryl? Maybe a surgical airway when it goes sideways? Nah. That's silly. Throw 'em in a BLS truck and drive to the hospital.



> ...and if they hypoglycemic patient is conscious, can check BGL and give sugar orally...



But if they can't swallow, they're SOL? That whole thing with  D50 or Glucagon is silly. Throw 'em in a BLS truck and drive to the hospital.



> what can a medic do for a hypertensive crisis?  last I checked, it was still establish IV access, monitor and transport to the ER.  for sepsis, you are STARTING treatment, but the ER is actually fixing the problem.



If you don't understand that a truly septic patient will require large bore access, a significant amount of fluid and may need pressors, well, that's a deficiency in your education. POC lactate to help rule in sepis anyone? Screw that. Throw 'em in a BLS truck and drive to the hospital.



> And what are you giving for a cocaine overdose?  what about an alcohol overdose?



Benzos? Yeah. I use those for stimulant ODs. Should I mention tricyclic ODs? Or Organophosphate poisoning? Or suspected or known cyanide poisoning? How about a kid who eats Grandma's beta blockers? I carry stuff for all of that. But you believe that someone should just throw 'em in a BLS truck and drive to the hospital.



> If you are talking about a heroin overdose, sure, EMTs can give narcan too.



What happens when that narcan wears off and you realize that they had been given a boatload of opoid to counteract the crazy bath salt/cocaine reaction. Oh I know. Throw 'em in a BLS truck and drive to the hospital.

What else you got?


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## Mufasa556 (Nov 6, 2015)

Protocols would be so much easier to learn if the treatment for everything simply stated: Diesel Bolus.


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## RedAirplane (Nov 7, 2015)

Thought you all might find this interesting:
http://www.nysvara.org/news/2008/dec/081221.pdf


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## escapedcaliFF (Nov 11, 2015)

Im late to the party but let me give my 2 cents. Buffing should be illegal period. Its illegal in most states. CONS and AORs are assigned for a reason. Volunteer EMS is basically stealing from companies who have the authority to operate. Until we get away from volunteer EMS you can expect to contiue to see the low pay. You want an adventure and excitement join the military. I have a whole other speel about voluteer fire but thats for another time.


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## adamNYC (Nov 11, 2015)

Military ain't for everyone


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## Chewy20 (Nov 11, 2015)

Neither is buffing calls like an idiot.


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## escapedcaliFF (Nov 12, 2015)

Running around in a substandard ambulance with the siren and lights going to a call you where not dispatched to is dangerous plane and simple. Risk vs. reward and the reward is very small except to fill ego.


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## H33 (Nov 12, 2015)

Don't have enough free time to read all of this but my thoughts from what I have is that the idea of "buffing" is that it would add a lot of unknowns into the equation. I typically  love all the help that I can get to show up, for the most part, but I am not certain that I would be comfortable handing over my patient to an agency that was not sent. In our state we can hand over to a lower level provider if they will have the capacity to care for the likely needs of the patients, and we have volunteer ems agency's and I have both played on them and turned patients over to them, but they work within the established system, not certain I would be ok with handing off to any one that just showed up regardless of if it said ambulance on the side or not, just my two cents on it.


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## RedAirplane (Nov 12, 2015)

I don't think anyone is saying that "buffing" is the ideal solution. It is unsafe and leads to confusion.

In summary, it sounds like there are multiple ambulance companies not officially part of 911, but not officially banned either. This leads to the legal gray area discussed here, especially when, as some have suggested, you need to do this "buffing" thing to even get into a proper service.

I stand by my original stance: integrate everyone. It's not that hard to use a log-in/log-out system where a volunteer unit logs in with 911 communications, is assigned calls, and logs out when its "tour" is over. Although I don't live in NYC so I may be over simplifying something.

Sounds like the biggest barrier is politics.


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## TransportJockey (Nov 12, 2015)

RedAirplane said:


> I don't think anyone is saying that "buffing" is the ideal solution. It is unsafe and leads to confusion.
> 
> In summary, it sounds like there are multiple ambulance companies not officially part of 911, but not officially banned either. This leads to the legal gray area discussed here, especially when, as some have suggested, you need to do this "buffing" thing to even get into a proper service.
> 
> ...


Politics are the only reason a vollie service exists in a major metro with adequate professional EMS it seems.


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## RedAirplane (Nov 12, 2015)

TransportJockey said:


> Politics are the only reason a vollie service exists in a major metro with adequate professional EMS it seems.



As for the exist/shouldn't exist debate, I don't think that's relevant here, but my $0.02 is that I am very pro-volunteer (I'm a volunteer so I'm obviously biased).

In any regard, they exist and that's not changing. If they vanish overnight, then there's one integrated EMS system. Otherwise, the system can either accept this condoned jumping of calls, or acknowledge the resources in use and organize them more appropriately.


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## RedAirplane (Nov 12, 2015)

As an aside, someone in San Francisco appears to agree with some of my crazy ideas about ambulance deployment (namely, if there are resources in your area, USE THEM). Their latest EMS operation manual includes:

Dedicated 911 ALS ambulances from SFFD, AMR, King 
IFT ALS ambulances from a bunch of companies
All ALS ambulances (IFT or 911) required to have the mobile data computer
IFT ALS units to switch off the computer when on an IFT call and turn it on between calls
This allows tracking of positions of all available ALS resources in the city. 
Charlie, Delta, and Echo calls are passed to the nearest ALS ambulance, regardless of whether its an IFT or 911 ALS unit.
Alpha, Bravo calls passed to 911 dedicated ALS ambulances 
Source: http://www.sfdem.org

There are a few foreseeable hiccups there, but why couldn't something like that work in NYC? Volunteer ambulances simply turn on a data terminal and can thus be tracked just like FDNY when they are available for service?


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## Chewy20 (Nov 12, 2015)

Because vollie departments for the most part are going to be way less expierienced, and have not been through the academy. If I'm a medical director I'm not letting vollies practice under me without going through the cities required training. I'm also sure there's a million other headaches not worth it when FDNY EMS has/is handling their city...


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## adamNYC (Nov 12, 2015)

Thing is we do log in and out and FDNY dispatchers are well aware specifically when our volly is in service. They will however only call us for "mutual aide" during disasters, blackouts, snowstorms, hurricanes, etc 

Some believe that the city doesn't want to give away the jobs/money that would be otherwise be going to the city or hospital based EMS. Either way, the vollies are getting those jobs, and 911 providers are giving the patients away to us all the time, even if we are second on scene.


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## RedAirplane (Nov 12, 2015)

Chewy20 said:


> Because vollie departments for the most part are going to be way less expierienced, and have not been through the academy. If I'm a medical director I'm not letting vollies practice under me without going through the cities required training. I'm also sure there's a million other headaches not worth it when FDNY EMS has/is handling their city...



The same could be said of a questionable private company.

All ambulances have to meet whatever minimum standards are set in the region. Yes, it is nice to have more training and experience, but you make it sound like a medical director is soliciting clowns to respond in their shoe cars.

The medical director is somehow able to keep oversight of FDNY and the various private/hospital services that do 911 through the FDNY system. They already have these "million other headaches" for those companies, so what makes doing the same for the vollies so much more complicated?


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## RedAirplane (Nov 12, 2015)

And by the way, I'm all for more training. Why not make the FDNY academy training open to the volunteers and maybe even make that the standard for EMT-Basic licensure in NYC, if it is as much of a factor as you make it out to be?

Maybe adamNYC will know this, but do the hospital-based 911 providers in NYC have to do the FDNY EMS academy?


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## adamNYC (Nov 12, 2015)

No they don't. 

I'll give you an example. Private companies have 911 contracts with hospitals. From what I heard to make the transition from IFT isn't that elaborate. One takes a test, does ridealongs, goes through a day of classroom stuff, then has to put an application in to FDNY EMS to get a shield number. This is known as "getting vaxed" because they now have this FDNY EMS shield number, they can get employed at other 911 hospitals easier. If they intend to work for FDNY EMS, they still have to go through the FDNY EMS academy.


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## escapedcaliFF (Nov 12, 2015)

Going from an IFT based company to doing 911 is a drawn out complex process and not as easy as your obviously not informed on the process. Also ambulance companies make their bread and butter doing IFT.


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## adamNYC (Nov 12, 2015)

I'm talking about the process of how an EMT or Medic would switch from IFT to 911 within the same company


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## Chewy20 (Nov 12, 2015)

adamNYC said:


> I'm talking about the process of how an EMT or Medic would switch from IFT to 911 within the same company



That's completely different and not even comparable.


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## escapedcaliFF (Nov 12, 2015)

Chewy!!!Call up the RickyRescue Vollie squad we need help asap Hillary is trapped in another one of her pant suits and we need assistance on extrication!!!


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## adamNYC (Nov 12, 2015)

Just saying that's how it's done at the private I work at, not saying it's the same for all other privates. Just one example. One thing is certain: there's no extensive training that's conducted for months like FDNY EMS academy. 

It consists of:

- Working IFT for 3-6+ months
- Passing a 70 question test
- Two 12hr tour Ridealongs
- 4 hour orientation

That's it


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## escapedcaliFF (Nov 12, 2015)

Adam I think you need to hang out with this guy. Hes only across the way in New Jersey and has a stethoscope hanging from the rear view mirror. You and him can respond in his POV. 




RobertAlfanoNJEMT said:


> I have a magnet on the back of my car that says Emergency Medical Tecnitian with the star of life... Mostly so police will be easier on me when I get pulled over.. I have my stethoscope around my review mirror too for the same reason and easy access


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## TransportJockey (Nov 12, 2015)

escapedcaliFF said:


> Adam I think you need to hang out with this guy. Hes only across the way in New Jersey and has a stethoscope hanging from the rear view mirror. You and him can respond in his POV.


NJ, NY same thing right?


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## adamNYC (Nov 12, 2015)

I hear NJ vollies get dispatched 911


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## Flying (Nov 12, 2015)

adamNYC said:


> I hear NJ vollies get dispatched 911


True. Municipalities put out contract requests and volly agencies can put in a bid like any other private agency.


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## escapedcaliFF (Nov 12, 2015)

TransportJockey said:


> NJ, NY same thing right?


Pretty Much


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## CALEMT (Nov 12, 2015)

I now remember why I stopped paying attention to this thread (until recently). All this talk about buffing calls makes my brain hurt. 

Here's how to buff calls in ANY system: Don't.


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## escapedcaliFF (Nov 13, 2015)

CALEMT said:


> I now remember why I stopped paying attention to this thread (until recently). All this talk about buffing calls makes my brain hurt.
> 
> Here's how to buff calls in ANY system: Don't.


 Do you need the RickyRescue Vollie Squad for transport to your local ER maybe its a bleed. They just cleared the extrication scene with Hillary.


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## Tigger (Nov 13, 2015)

RedAirplane said:


> The same could be said of a questionable private company.
> 
> All ambulances have to meet whatever minimum standards are set in the region. Yes, it is nice to have more training and experience, but you make it sound like a medical director is soliciting clowns to respond in their shoe cars.
> 
> The medical director is somehow able to keep oversight of FDNY and the various private/hospital services that do 911 through the FDNY system. They already have these "million other headaches" for those companies, so what makes doing the same for the vollies so much more complicated?



I doubt that FDNY's medical director(s) have any role in the hospital or private providers. That's the whole point, FDNY can subcontract much of their EMS to hospitals and forget about it. It gets done without their involvement. Can the vollies do this? I have no idea, but I don't think so. I'm yet to see a volunteer agency that wasn't heavily reliant on the existing EMS infrastructure already in place.


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## RedAirplane (Nov 13, 2015)

Tigger said:


> I doubt that FDNY's medical director(s) have any role in the hospital or private providers. That's the whole point, FDNY can subcontract much of their EMS to hospitals and forget about it. It gets done without their involvement. Can the vollies do this? I have no idea, but I don't think so. I'm yet to see a volunteer agency that wasn't heavily reliant on the existing EMS infrastructure already in place.



Good volunteer services should have their own medical director, continuing education, QA/QI, etc. What else did you have in mind?


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## Flying (Nov 13, 2015)

RedAirplane said:


> Good volunteer services should have their own medical director, continuing education, QA/QI, etc. What else did you have in mind?


Unless you are somewhat lucky, all of that is outsourced if you want to stay afloat. From what I've seen, volunteer services generally piggyback off of existing communications/dispatch systems and don't have the man hours to sustain a significant orientation/FTO period without cutting corners or doing away with them altogether.

Compare that to the hospital systems, which have the capital and personnel to sustain the very basics and more.


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## Tigger (Nov 13, 2015)

RedAirplane said:


> Good volunteer services should have their own medical director, continuing education, QA/QI, etc. What else did you have in mind?


Good volunteer services. As far as I can tell, none of these services possess any of this or the wherewithal to do so. The attitudes displayed here and in other venues do not make me think that these services wish to provide a quality EMS service. They want to get their rush or whatever with as little outside inconvience possible.

And that makes me unhappy. At all three of my jobs (different service models and locations), I work with consumate professionals who seek to better themselves and the profession. I am not going to get behind something that allows "providers" to do the opposite. That's not what this industry needs. There is a reason that no large urban areas rely on volunteers to provide primary 911 EMS services, and more and more areas that are not urban are also realizing that it is not sensible to rely on volunteers to provide what is an essential service.


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## RedAirplane (Nov 13, 2015)

Tigger said:


> Good volunteer services. As far as I can tell, none of these services possess any of this or the wherewithal to do so. The attitudes displayed here and in other venues do not make me think that these services wish to provide a quality EMS service. They want to get their rush or whatever with as little outside inconvience possible.
> 
> And that makes me unhappy. At all three of my jobs (different service models and locations), I work with consumate professionals who seek to better themselves and the profession. I am not going to get behind something that allows "providers" to do the opposite. That's not what this industry needs. There is a reason that no large urban areas rely on volunteers to provide primary 911 EMS services, and more and more areas that are not urban are also realizing that it is not sensible to rely on volunteers to provide what is an essential service.



I guess I am a big advocate of the professional volunteer service. I don't like services that respond in POVs, without uniform, etc. But it sounds like the volunteer ambulances in NYC are here to stay for better or for worse, so they should be integrated. I think the attitude you describe is more a byproduct of the system than the volunteers, but who knows. 

I'm curious / I had imagined that each of these ambulances had proper equipment, training, QA/QI, oversight, etc. Perhaps someone knows more specifically?


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## Tigger (Nov 13, 2015)

They are not professional volunteer services, making their integration into the system a poor idea. 

Most states have incredibly lax QA requirements and the medical director may be in name only.


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## escapedcaliFF (Nov 13, 2015)

Tigger said:


> They are not professional volunteer services, making their integration into the system a poor idea.
> 
> Most states have incredibly lax QA requirements and the medical director may be in name only.


I agree very much with Tigger on this. Having been involved with a Department of Emergency Medical Services audit of a volunteer EMS agency I can tell you that the medical director hadnt been involved for years and was surprised when called that his name was still listed as such. He swore he was no longer the MD but the volunteer agency said he was.


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## ERDoc (Nov 13, 2015)

I think the volunteer thing is very dependent on where you are.  Where I came from we had a full time county medical director who made 6 figures.  A large portion of the providers also worked a paid gig but there were still quite a few weekend warriors but they were usually not by themselves.


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## triemal04 (Nov 13, 2015)

ERDoc said:


> I think the volunteer thing is very dependent on where you are.  Where I came from we had a full time county medical director who made 6 figures.  A large portion of the providers also worked a paid gig but there were still quite a few weekend warriors but they were usually not by themselves.


Ah, you mean one of those...special...departments you find on the east coast.  You know the ones I mean...the ones that scream and ***** and whine about how they are such a supercool superawesome supereffecient department and do just as good IF NOT BETTER than a professional, paid department and they do it ALL WITH VOLUNTEERS...except they forget to mention that they have a paid staff doing the bulk of the administration and running the department, and have fulltime paid personnel working (often 24/7) to "supplement" the volunteers...you know...the ones that do all the "real" work.

One of those places?  Because places like that are just...so...precious...


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## ERDoc (Nov 13, 2015)

triemal04 said:


> Ah, you mean one of those...special...departments you find on the east coast.  You know the ones I mean...the ones that scream and ***** and whine about how they are such a supercool superawesome supereffecient department and do just as good IF NOT BETTER than a professional, paid department and they do it ALL WITH VOLUNTEERS...except they forget to mention that they have a paid staff doing the bulk of the administration and running the department, and have fulltime paid personnel working (often 24/7) to "supplement" the volunteers...you know...the ones that do all the "real" work.
> 
> One of those places?  Because places like that are just...so...precious...



Maybe.


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## RedAirplane (Nov 13, 2015)

Tigger said:


> They are not professional volunteer services, making their integration into the system a poor idea.



Would integration be worse than the status quo of volunteers legally jumping 911 calls, thus having two (or more) units all scurrying to the scene of the same emergency?


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## adamNYC (Nov 13, 2015)

No one gets paid at our volly


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## Tigger (Nov 14, 2015)

RedAirplane said:


> Would integration be worse than the status quo of volunteers legally jumping 911 calls, thus having two (or more) units all scurrying to the scene of the same emergency?


It is not legal to drive code three to calls you were not dispatched to. So the ideal solution would be to legally stop them from running unless they were specifically called. 

There is not a way that you can convince me that allowing poor excuses for EMS organizations to participate in a major metropolitan EMS system is of benefit. It is certainly not a benefit to me or anyone who wishes to further EMS as a respected part of healthcare.


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## RedAirplane (Nov 15, 2015)

Tigger said:


> It is not legal to drive code three to calls you were not dispatched to. So the ideal solution would be to legally stop them from running unless they were specifically called.
> 
> There is not a way that you can convince me that allowing poor excuses for EMS organizations to participate in a major metropolitan EMS system is of benefit. It is certainly not a benefit to me or anyone who wishes to further EMS as a respected part of healthcare.



About the Code 3 bit, it seems New York is a bit special as it either does not have this law, or de facto doesn't have it. 

The New Yorkers on here have already indicated that the volunteers aren't going anywhere because of their political power. While we may disagree on whether that is a good or a bad thing, it appears to be an invariant of the situation. 

So, given that, how would you propose making things better? I think improving oversight (if needed) and integrating them is a lot better than pretending they don't run 911 calls.


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## Tigger (Nov 15, 2015)

RedAirplane said:


> About the Code 3 bit, it seems New York is a bit special as it either does not have this law, or de facto doesn't have it.
> 
> The New Yorkers on here have already indicated that the volunteers aren't going anywhere because of their political power. While we may disagree on whether that is a good or a bad thing, it appears to be an invariant of the situation.
> 
> So, given that, how would you propose making things better? I think improving oversight (if needed) and integrating them is a lot better than pretending they don't run 911 calls.


Operating an ambulance in an emergent mode while responding to a call you were not dispatched to is not operating the vehicle with due regard. They are not running 911 calls, they are listening to a scanner and jumping them. In this day and age of 911 education, I cannot imagine that their seven digit phone is being used much.

I also do not understand what sort of political power they actually have. Sure some neighborhoods may say they support their presence, but if FDNY just said stop, what would happen? Who know? I'd imagine that FDNY really just does not want to deal with the headache of getting them to stop, and lets be honest, FDNY EMS is not exactly known for its managerial prowess.

Improving oversight is not a free process. Where will the money come from to do this, especially since many of these places are already struggling to survive?


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## adamNYC (Nov 15, 2015)

How to integrate: When we log in, give us jobs, spread em around.

How I see our role as NYC Vollies:

1) We often are local-based so we arrive to the scene first along with FD's CFRs, therefore getting pt's treated and txp faster.

2) We give overburdened 911 crews more breaks, as evidenced by their willingness to give up their patients, even if we are second on scene

3) We assist ALS when there's no BLS backup

4) We are officially called upon when 911 is backed up, such as severe weather conditions.

How I see the value of vollying for those fresh out of EMT school:

- It is the fastest route to doing patient care on street/911 jobs ie unconcious, ped struck, mvas, cardiac, diff breather, etc.

- The long hard way being: Work txp for 6-12 months, hope you land a job in hospital based EMS, or wait 1-2 years for FDNY EMS, or hope you get lucky getting flagged down while doing txp work.

Or one could commute epic distances to new jersey, long island, or upstate NY and get 911 dispatched, maybe even paid for vollying.


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## Flying (Nov 15, 2015)

adamNYC said:


> How I see the value of vollying for those fresh out of EMT school:
> 
> - It is the fastest route to doing patient care on street/911 jobs ie unconcious, ped struck, mvas, cardiac, diff breather, etc.
> 
> - The long hard way being: Work txp for 6-12 months, hope you land a job in hospital based EMS, or wait 1-2 years for FDNY EMS, or hope you get lucky getting flagged down while doing txp work.


Been there very recently. The "fast" route happens to be the hard way for those who want to do well.


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## RedAirplane (Nov 15, 2015)

adamNYC said:


> How to integrate: When we log in, give us jobs, spread em around.
> 
> How I see our role as NYC Vollies:
> 
> ...



I agree that the volunteer ambulances should be integrated in EMS. However, I am slightly concerned that you see volunteering as a shortcut than as a way to make the community better. 

Others can say a lot more about the value of non emergent EMS but I'll share my two cents. 

As I am learning, caring for the NOT SICK patients is important to be able to deal with the sick patients. What should I do if the patient's relative is screaming at me? What if they keep forgetting about the conversation and wandering off? What if they're dancing while you're trying to take a blood pressure? 

I'm just beginning to feel the tip of this thing and there's a lot more to go. Even though I volunteer and have another full time career, I'm looking at per diem IFT roles for the BLS calls because I want to improve myself as a provider. 

Did you do ride alongs as part of EMT class? If so, you probably saw that most 911 calls are not true emergencies. But those patients need your help. 

Now here's a thought. What if the vollies took all the grandmas in their neighborhoods to doctors and dialysis, free of charge?


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## Flying (Nov 15, 2015)

RedAirplane said:


> Now here's a thought. What if the vollies took all the grandmas in their neighborhoods to doctors and dialysis, free of charge?


Then there would be no vollies, unfortunately.


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## luke_31 (Nov 15, 2015)

Flying said:


> Then there would be no vollies, unfortunately.


I like that response. A lot of what we do is getting people to places that they can't get to on their own in the IFT side. Not all of them truly need the ambulance, but sometimes you have to use what's available.


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## Tigger (Nov 15, 2015)

Flying said:


> Then there would be no vollies, unfortunately.


Yup. You have the OP talking about how volunteering is a "good" way to see the "good" calls. If suddenly they don't get to choose what calls they go on and have to do relatively benign IFT type calls, I don't imagine people motivated by adrenalin will last.


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## adamNYC (Nov 15, 2015)

I do enough txp/IFT is my full time job I do 40-50 hours a work trying to make ends meet beleive me i have my IFT down the only thing that drives me to continue is that I'm months away from having a 1 year of experience, we also do get emergencies from SNFs, doc offices, assisted living, and txp for hatzolah when they don't have a bus available. I tell everyone the value of IFT work and the experience gained. Also getting flagged down happens too which is nice.

The crap IFT pay sucks though I'm looking into other things like driving uber and making 2-3x more. A good temp job till a hospital or FDNY calls me up. Vollying on weekends is all I need.


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## RedAirplane (Nov 16, 2015)

Since the hospital EMS "voluntarily" participate in the 911 system and are sent to calls, I think the best bet would be for volunteer agencies to demonstrate a high quality service and then ask to be extended the same courtesy.


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## RedAirplane (Nov 16, 2015)

RedAirplane said:


> Since the hospital EMS "voluntarily" participate in the 911 system and are sent to calls, I think the best bet would be for volunteer agencies to demonstrate a high quality service and then ask to be extended the same courtesy.



I suppose the key point of contention is whether they would actually be able to demonstrate a superior quality service. In the name of volunteers everywhere, I certainly hope so.


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## squirrel15 (Nov 16, 2015)

RedAirplane said:


> I suppose the key point of contention is whether they would actually be able to demonstrate a superior quality service. In the name of volunteers everywhere, I certainly hope so.


I don't always respond to my own posts, but when I do, its because I got flagged down.


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## adamNYC (Nov 16, 2015)

Did you know hospitals pay $1m/year to participate in the FDNY 911 system?

http://www.wsj.com/articles/SB10001424052748703493504576007743046682606


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## escapedcaliFF (Nov 16, 2015)

AdamNYC, It sounds like you need a hobby. Jumping 911 calls is not a hobby. I enjoy dirt bike riding and hunting as a reprieve from work. Granted hunting in NYC is not really an option unless your hunting hookers like in American Physco and that might be your thing for all I know. I digress though and offer my insight. You will probably not be happy with EMS unless you leave NYC and go work for a real 911 system. I average 25-45 min response times running code to a call in rural america. Then another 45 mins to level 4 trama center. We fly most things out if need be. You need to find a system like this that will give you that "fix". Granted after a month you will probably wish you never had to run 911 again. We gets lots of burn put down here being its not for everyone.


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## adamNYC (Nov 16, 2015)

I'm gaining valuable experience that will benefit me in FDNY EMS and/or NYC Hospital EMS


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## DrParasite (Nov 16, 2015)

DEmedic said:


> But they certainly don't need any fluid, right? Or an Epi Drip? Benadryl? Maybe a surgical airway when it goes sideways? Nah. That's silly. Throw 'em in a BLS truck and drive to the hospital.


well, EMTs can give benedryl too.... and I would wager your entire 2015 salary that your performed less than 2 surgical airways last year.  Probably a safe bet that your entire agency did less than 25 since January 1.  But it's a great straw man argument.  





DEmedic said:


> But if they can't swallow, they're SOL? That whole thing with  D50 or Glucagon is silly. Throw 'em in a BLS truck and drive to the hospital.


Didn't say that, but nice try.  I love D50 and Glucagon.  Great for waking up unconscious diabetics.   But not ever diabetic call gets D50 or glucagon.  But absolutely, send the paramedics on those calls where the patient can't swallow or isn't alert.





DEmedic said:


> If you don't understand that a truly septic patient will require large bore access, a significant amount of fluid and may need pressors, well, that's a deficiency in your education. POC lactate to help rule in sepis anyone? Screw that. Throw 'em in a BLS truck and drive to the hospital.


Actually, I understand that probably better than you, enough to understand that while the septic patient will need large bore access, the amount of fluid you put in will only be a fraction of what the patient needs.  And last I checked, most EMS agencies can't run labs in the field.





DEmedic said:


> Benzos? Yeah. I use those for stimulant ODs. Should I mention tricyclic ODs? Or Organophosphate poisoning? Or suspected or known cyanide poisoning? How about a kid who eats Grandma's beta blockers? I carry stuff for all of that. But you believe that someone should just throw 'em in a BLS truck and drive to the hospital.


ok, lets be real: how often have you given sodium bicarb for tricyclic poisoning?  or atropine for organophospate poisoning?  Not saying you don't carry that stuff, but how often do you actually use it?





DEmedic said:


> What happens when that narcan wears off and you realize that they had been given a boatload of opoid to counteract the crazy bath salt/cocaine reaction. Oh I know. Throw 'em in a BLS truck and drive to the hospital.


well, if you don't know the difference between an opoid OD and a bath salt one, than you have bigger issues at hand.

The data (you know, the whole evidence based medicine concept) supports a tiered response EMS system, and says mortality is better when you don't have an all paramedic system.  You can straw man argument all you want, but at the end of the day, what evidence do you have to support your opinion?


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## RedAirplane (Nov 16, 2015)

squirrel15 said:


> I don't always respond to my own posts, but when I do, its because I got flagged down.



I had an afterthought. Is replying to yourself bad? Are you going to 5150 me for talking to myself or something?


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## squirrel15 (Nov 16, 2015)

RedAirplane said:


> I had an afterthought. Is replying to yourself bad? Are you going to 5150 me for talking to myself or something?


Depends on what the voices are telling you to do. And I'll write the hold myself. I may not be a doctor but I stayed at a holiday inn last night


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