Buffing Calls @ Private NYC Ambulances

[CAR1]

I speak as a resident of NYC and a former vollie EMT. There is currently no purpose for vollies in NYC.all the vollies in NYC get their calls via listening to PD and buffing. Yes there are some vollies who have a loyal following of patients who actually call their emergency hotline number (mainly hatzolah), but those are few and far between. vollies were created in NYC when the ems coverage stank. now in 2015 my personal feeling is that most vollies should be shut down, problem is they are all friends with the politicians who get them grants for new ambulances, and if the city would shut them down there would be a whole outcry about how the city doesn't care about dying patients, and 95% of voters have not a clue how the ems system works. This will all come to an end one day when unfortunately someone will get hurt by a speeding ambulance to a call they were not really assigned to. This was my main reason for leaving the vollie, I couldn't stand risking my life to beat a dispatched ambulance to the call.

(I should also mention that there technically is a mutual aid agreement between FDNY and the vollies, most agencies can count on one hand the times they have been called)

 

[RedAirplane]

I speak as a resident of NYC and a former vollie EMT. There is currently no purpose for vollies in NYC.all the vollies in NYC get their calls via listening to PD and buffing. Yes there are some vollies who have a loyal following of patients who actually call their emergency hotline number (mainly hatzolah), but those are few and far between. vollies were created in NYC when the ems coverage stank. now in 2015 my personal feeling is that most vollies should be shut down, problem is they are all friends with the politicians who get them grants for new ambulances, and if the city would shut them down there would be a whole outcry about how the city doesn't care about dying patients, and 95% of voters have not a clue how the ems system works. This will all come to an end one day when unfortunately someone will get hurt by a speeding ambulance to a call they were not really assigned to. This was my main reason for leaving the vollie, I couldn't stand risking my life to beat a dispatched ambulance to the call.

(I should also mention that there technically is a mutual aid agreement between FDNY and the vollies, most agencies can count on one hand the times they have been called)

Or... If there is a valid resource, use it?

If an ambulance is licensed, equipped, and trained to minimum standards, it shouldn't be stopped from participating in 911. I mean legitimately.

It just reduces response times.

 

[Flying]

Or... If there is a valid resource, use it?

If an ambulance is licensed, equipped, and trained to minimum standards, it shouldn't be stopped from participating in 911. I mean legitimately.

It just reduces response times.

Agencies can have the shiniest equipment and the best training, but when the people staffing the ambulance are not compensated adequately for their time and labor, the system as a whole suffers.

 

[RedAirplane]

Agencies can have the shiniest equipment and the best training, but when the people staffing the ambulance are not compensated adequately for their time and labor, the system as a whole suffers.

I don't understand. Are you saying volunteers are inadequately compensated? If they were compensated any more, they wouldn't be volunteers.

And being a volunteer myself, I'm partial to volunteers (with professional standards, not the respond from home in pajama types).

 

[RedAirplane]

And personally, I'd rather have a 3 minute response time when my heart stops, knowing that any ambulance (private, public, or volunteer) may respond, rather than wait in arrest for 4-5 minutes for the fire pros.

 

[Tigger]

Or... If there is a valid resource, use it?

If an ambulance is licensed, equipped, and trained to minimum standards, it shouldn't be stopped from participating in 911. I mean legitimately.

It just reduces response times.

It's not just about response times. In fact, response times have been shown to be of little impact to patient outcomes.

Not to mention that EMS service is provided (professionally) by FDNY, private companies, and hospitals. All of them are accountable for the area that they serve, yet they have no control over these volunteers. Not to mention, these providers need the revenue from transport to sustain their operations to provide service to their area. If an agency just came in and snatched up their patients, how are they supposed to that? There is a reason contracts are signed.

 

[Flying]

I don't understand. Are you saying volunteers are inadequately compensated? If they were compensated any more, they wouldn't be volunteers.

What I meant is that people who volunteer have little incentive to provide a certain level of service outside of wanting experience, feeling important or what we could collectively call "goodness".

In terms of the system, goodness can only go so far when trying to provide a consistent service to a growing patient population.

Generally, "wanting to help people" can go only so far as a reason to want to continue doing this for years as a profession.

Personally, I gave it an honest shot and eventually decided that performing manual labor and being expected to be clinically competent is something that I should be paid for.

 

[RedAirplane]

What I meant is that people who volunteer have little incentive to provide a certain level of service outside of wanting experience, feeling important or what we could collectively call "goodness".

In terms of the system, goodness can only go so far when trying to provide a consistent service to a growing patient population.

Generally, "wanting to help people" can go only so far as a reason to want to continue doing this for years as a profession.

Personally, I gave it an honest shot and eventually decided that performing manual labor and being expected to be clinically competent is something that I should be paid for.

I have a lot of thoughts on this matter, and disagree, but I can respect your viewpoint.

 

[RedAirplane]

It's not just about response times. In fact, response times have been shown to be of little impact to patient outcomes.

Not to mention that EMS service is provided (professionally) by FDNY, private companies, and hospitals. All of them are accountable for the area that they serve, yet they have no control over these volunteers. Not to mention, these providers need the revenue from transport to sustain their operations to provide service to their area. If an agency just came in and snatched up their patients, how are they supposed to that? There is a reason contracts are signed.

Think ICS. When there is a disaster, resources of a type are grouped. Fire engines, BLS ambulances, ALS ambulances. Then they are deployed where they are needed, instead of where they are ordinarily contracted to be. So similarly, any ambulance that wanted to be in the system (and there was a need for) could be deployed.

I'm not primarily EMS, I'm a software guy looking at getting into economics. I love efficiency.

The whole business of-- AMR takes 911, Pro takes IFT, Rural/Metro takes CCT... rather than factoring calls in based on proximity wreaks of inefficiency. I know **why** it is the way it is today (exclusive operating zones and what not), but I think with some economic modeling we could come up with legislation that makes companies happy, reduces response times, and most importantly for me, always has the closest appropriate unit respond.

 

[Tigger]

Think ICS. When there is a disaster, resources of a type are grouped. Fire engines, BLS ambulances, ALS ambulances. Then they are deployed where they are needed, instead of where they are ordinarily contracted to be. So similarly, any ambulance that wanted to be in the system (and there was a need for) could be deployed.

I'm not primarily EMS, I'm a software guy looking at getting into economics. I love efficiency.

The whole business of-- AMR takes 911, Pro takes IFT, Rural/Metro takes CCT... rather than factoring calls in based on proximity wreaks of inefficiency. I know **why** it is the way it is today (exclusive operating zones and what not), but I think with some economic modeling we could come up with legislation that makes companies happy, reduces response times, and most importantly for me, always has the closest appropriate unit respond.

I'm not disagreeing on its relative inefficiency, though I think you are seeking a solution for a problem that does not exist. Companies that run transfer services rely on extreme efficiency in that they need their ambulances to be patient loaded as much as possible. No patient is no money, so as soon as a drop off is complete it's time to head elsewhere for another transfer. The smart company runs at backbreaking UHUs if they want to make money. There just isn't that much room or time for them to be running 911 (which often is not financially worth it). It isn't like there are dozens of ambulances sitting around waiting for transfers while 911 calls are dropping right next door.

 

[Eddie2170]

There are a lot of different topics being thrown around here.

Firstly (from my understanding) the OP both Volunteers outside of NYC & operates as an EMT with a Private based Contract & IFT EMS service. Very different areas, different rules, etc.

Within NYC you have 4 types of services

FDNY EMS - municipal EMS members operating under the FDNY Bureau of EMS

FDNY EMS Participating Hospital Units (Called Voluntaries - note different from Volunteer) 911 unit essentially identical FDNY units except either hospital employees or outsourced. Dispatchers see no difference in these units, computer sends closest unit.

Community Ambulance Corps, run by Volunteers - i.e. Central Park Medical Unit & College Point Ambulance Corp. (Staffed by volunteers - ability to be dispatched by FDNY EMS in the event of a Mobilization of the Mutual Aide Task Force)

Private Ambulance Services - Contracted to Facilities & Businesses as well as Hospitals for Facility Emergencies or IFTs

911 Calls are answered by the closest available 911 unit - Municipal (FDNY) or Voluntary (Hospital) 911 unit. Again the CAD (computer) sees no difference in these - closest goes.

Volunteers can receive direct calls to their station. Usually elderly or family/friends etc. That have used the volunteer service since the early days of NYC EMS. They typically only do this in the community served by their ambulance. OR! They 'Buff' meaning they listen to both the NYC EMS frequency &/or the NYPD precinct frequently and will beat the 911 unit in order to bill & serve the community.

** Usually ** this is not a big deal. Most 911 units actually appreciate it, (although the supervisors may not) the unit remains available & they may get a break. There are plenty (1.6 million jobs in 2014) of jobs to go around. Unless it is a 'good' or 'bad' job depending on your outlook they may get a little lip from the crew. But again usually not a big deal & the 911 units in the area generally are aware of the volunteers local to them.

Privates on the other hand have their own dispatch their own call takers etc. Etc. & are completely independent of the 911 system & in many cases will drop calls to 911 in times of unforseen high volume. They are very busy without 911 calls.

If a private crew were to take it upon themselves to 'buff' by radio & respond to a 911 call they could absolutely do so. The 911 crew dispatched again probably wouldnt care as most are slammed all day with jobs. Again unless it seemed like a 'good' job. IF they were to get in an accident along the way & were using lights & sirens they would certainly be reprimanded if not fired. The private company would probably not mind either as long as the pt were insured.

The only time i think this would be a big deal is if it was a both ALS & BLS dual response because the FDNY units would more than likely not be able to be driven by a Private crew if both Medics were treating the pt.

NOW- if ANY Ambulance is 'flagged' by a civilian or patient, regardless of Unit status or type of Ambulance THEY MUST STOP. so while going to another call & you stumble upon an MVA or Security outside a residence says there is a call inside the building that Crew Must Stop. They are not required to transport the patient but they MUST stop make pt contact & provide treatment until either the 911 unit arrives or they choose to transport the patient themselves. They are a walking billboard they will get in trouble or even lose their state cards if they did not stop. They are a NY STATE certified ambulance with a State Certified EMT on board and they are licensed to work within NYC. The public & lawyers dont care who you work for. With a patient on board out of service due to whatever reason doesnt matter. If you have a critical patient simply explain the situation & document appropriately.

To answer the OP's question. If i were working a private i would not buff 911 jobs. I used to get slammed enough working for a private to want 911 jobs. If you get in an accident or are seen by another crew or supervisor going lights & sirens unauthorized youre probably getting fired & if you get into an accident you're probably getting sued too, bet you have a drivecam in your Bus, reckless endangerment taking it upon yourself to drive dangerously when not instructed to do so. If you get flagged you get flagged is what it is. If you 'happen' to be 'near' a job that drops, take a slow roll by & see if you beat the 911 crew. But dont get in trouble. Get your 911 experience on a 911 truck.

 

[Bullets]

And personally, I'd rather have a 3 minute response time when my heart stops, knowing that any ambulance (private, public, or volunteer) may respond, rather than wait in arrest for 4-5 minutes for the fire pros.

If your in NYC, you arent getting an ambulance in 3 minutes no matter who is staffing the rig and providing the service

There are a lot of different topics being thrown around here.


NOW- if ANY Ambulance is 'flagged' by a civilian or patient, regardless of Unit status or type of Ambulance THEY MUST STOP. so while going to another call & you stumble upon an MVA or Security outside a residence says there is a call inside the building that Crew Must Stop. They are not required to transport the patient but they MUST stop make pt contact & provide treatment until either the 911 unit arrives or they choose to transport the patient themselves. They are a walking billboard they will get in trouble or even lose their state cards if they did not stop. They are a NY STATE certified ambulance with a State Certified EMT on board and they are licensed to work within NYC. The public & lawyers dont care who you work for. With a patient on board out of service due to whatever reason doesnt matter. If you have a critical patient simply explain the situation & document appropriately.

.

Wait, if an ambulance is dispatched to a call and while enroute to that call someone tries to flag them down, they HAVE to divert and treat that flag down?

 

[Eddie2170]

Wait, if an ambulance is dispatched to a call and while enroute to that call someone tries to flag them down, they HAVE to divert and treat that flag down?

If you were to be on the way to a call regardless of the priority & get flagged down you have to stop (or put on blinders) but you really wouldn't know what it is until after you stop. & once you stop you have to act. If someone is waving you down youre obviously going to stop & then obviously its too late.

If you had a critical pt on board & were on the way to the hospital you simply speak to the flagger & explain the situation & notify dispatch & document appropriately.

If you didnt stop you better watch your back, hope they didnt take a picture or get the #of bus etc etc. & even if they didnt nothing a quick 311 call couldn't fix. It's much easier to just stop. Happens often enough too.

 

[Tigger]

We aren't stopping if we have a sick patient on board, that's poor patient care. I'll happily call it in, but to stop is silly. You aren't going to get in trouble for that, even if someone complained.

 

[Eddie2170]

We aren't stopping if we have a sick patient on board, that's poor patient care. I'll happily call it in, but to stop is silly. You aren't going to get in trouble for that, even if someone complained.

Im not saying you have to even get out of the bus, but you at minimum have to acknowledge the flaggers existence & tell them you're notifying dispatch. I agree with you its not in your patient on boards best interest however like i said you really don't have a choice.

& forbid the patient is critical that you dont stop for & especially if your patient on board is BS like a stable drunk, i wouldnt put it past most stupidvisors to Command Discipline you on it. Every NY resident knows 311 for a civilian complaint. & if that patient you didnt stop for dies regardless of your original patients condition i guarantee you'll be in court. Id bet my card. They may not win bit that's up to your agency lawyer & the judge

No one said NYC EMS was progressive & NYC politics rules regulations & lawyers rule the land.

Just be able to justify anything and everything you do & make sure it's not in violation of anything

 

[Jim37F]

Yikes, that's horrible, what if you never saw the flagger, or legitimately thought they were flagging down that taxi cab? And I thought LA was lawsuit happy...:/

 

[Tigger]

Im not saying you have to even get out of the bus, but you at minimum have to acknowledge the flaggers existence & tell them you're notifying dispatch. I agree with you its not in your patient on boards best interest however like i said you really don't have a choice.

& forbid the patient is critical that you dont stop for & especially if your patient on board is BS like a stable drunk, i wouldnt put it past most stupidvisors to Command Discipline you on it. Every NY resident knows 311 for a civilian complaint. & if that patient you didnt stop for dies regardless of your original patients condition i guarantee you'll be in court. Id bet my card. They may not win bit that's up to your agency lawyer & the judge

No one said NYC EMS was progressive & NYC politics rules regulations & lawyers rule the land.

Just be able to justify anything and everything you do & make sure it's not in violation of anything

I would like to see some sort of citation stating that I must do stop. Unless it is law or company policy, I am not stopping. Also I have no idea how I would end up in court, on what grounds would that occur?

EMS fears court like the boogeyman. While it is true that you can be sued for anything, there is nothing to say that such a suit would even move forward to a trial.

 

[ERDoc]

It might be policy for FDNY but it is not universal in NYS. My VAC had the policy that your duty was to the first call. If you passed by an MVA or got flagged down, you called it in and proceeded to the first call. I don't know if it was based in any law or was just dept policy.

EMS fears court like the boogeyman. While it is true that you can be sued for anything, there is nothing to say that such a suit would even move forward to a trial.

Don't forget, he lives in NYS. Never underestimate the power of a stupid lawsuit in NYS.

 

[Bullets]

words and such

Yeah, unless i can clearly see the patient is dying, and im not already enroute to an ALS job we dont stop. Once i have a patient, then my priority is to that patient, not a potential patient.

Thats messed up

 

[Chewy20]

If you had a critical pt on board & were on the way to the hospital you simply speak to the flagger & explain the situation & notify dispatch & document appropriately.

Calling absolute BS on this until you can show me written policy on it. Makes absolutely no sense, even in the EMS world. If you have a critical pt I assume you are going code 3 to the hospital. The flagger should be noticing the lights and sirens and call 911 like everyone else. They can take all the pictures they want, they don't get to interfere with my pts care because they decided to run out to the sidewalk and wave you down like a taxi.

If you are driving and go past an MVC, and you can safely switch tac channels to tell dispatch where it is then, ok I guess. Would lose zero sleep about it though, because 50 other cell phone heroes have already called it in as well.

You sound like you have read this said policy before, so waiting to see it.