Buffing Calls @ Private NYC Ambulances

[squirrel15]

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'm not in NY but I have a strong feeling you're reading something wrong. There is no possible way you are required to stop for someone flagging you down, especially if you have a patient on board. Could you post a link where you're getting this info from please.

 

[DrParasite]

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?

Just me shooting from the hip, but I would imagine duty to act laws come into play here. it's one thing to ignore an emergency when your off duty in your POV, but it's quite another to ignore a flagger while in an ambulance with lights and sirens. You might not get sued, but you can get dragged into an investigation.

Then there is the whole "court of public opinion" issue. You might not be sued, but the headline "paramedic drives by baby not breathing" with the sub-heading "doesn't even stop to help, was late to a non-emergency run" probably won't go over very well.

Hypothetically speaking, if you did have a stable patient in the back, why would you not stop and render aid? It's good PR, your patient isn't dying, so another 10 minutes won't affect his outcome, and if the patient is sick & dying, you can scoop and run the both to the closest ER. Obviously this wouldn't work if you are transporting to a sick and dying patient.

Speaking as a dispatcher, I would want you to tell me about the incident and I will tell you to stop or continue to your original assignment. I might have it already, or I might not. I might have a unit that will end up closer to your original job, at least compared to the flagged down call. If you are going to a toe pain, or other non-life threatening dispatch, I might tell you to stop, because the toe pain can wait a couple more minutes until another unit arrives. Best part about all this: if something bad happens, you can always say, "I advised dispatch, who is aware of all calls in the system, and they directed me to take that action. I was only aware of one call, so I assumed they knew the call was of a more pressing issue."

 

[Eddie2170]

In NY if im driving lights & sirens patient on board or not a flagger is going to assume im coming for their emergency.

This is strictly Duty to Act & Abandonment Im a NYS Emt or Medic in a NYS Certified Ambulance i am in service im responsible. I see the patient or am being directed to a patient regardless of me being assigned to another job. Im now responsible for them. End of story. Listen i know it sounds stupid i know its ridiculous. But this is NYC. Its old school its antiqued its slow reactive its barbaric. Medics do not have CPAP on some busses its not required by the city, its optional in the protocol. Let alone EMTs having glucometry god forbid. Were running 4000 calls a day. If i get flagged there's another ~400 911 dispatched ambulances to take the other one.

You can tell a difference between someone flagging or STANDING IN FRONT OF YOUR BUS IN THE CROSSWALK WHILE YOU'RE LIGHTS & SIRENS. Dead serious.

I will try to find an 'order' but this is straight medical legal. 1st day of the academy.

& i can name at least 4 emts & medics with lawsuits against them personally on top of the department & city for jobs. Yes its that. Crazy here.

 

[squirrel15]

In NY if im driving lights & sirens patient on board or not a flagger is going to assume im coming for their emergency.

This is strictly Duty to Act & Abandonment Im a NYS Emt or Medic in a NYS Certified Ambulance i am in service im responsible. I see the patient or am being directed to a patient regardless of me being assigned to another job. Im now responsible for them. End of story. Listen i know it sounds stupid i know its ridiculous. But this is NYC. Its old school its antiqued its slow reactive its barbaric. Medics do not have CPAP on some busses its not required by the city, its optional in the protocol. Let alone EMTs having glucometry god forbid. Were running 4000 calls a day. If i get flagged there's another ~400 911 dispatched ambulances to take the other one.

You can tell a difference between someone flagging or STANDING IN FRONT OF YOUR BUS IN THE CROSSWALK WHILE YOU'RE LIGHTS & SIRENS. Dead serious.

I will try to find an 'order' but this is straight medical legal. 1st day of the academy.

& i can name at least 4 emts & medics with lawsuits against them personally on top of the department & city for jobs. Yes its that. Crazy here.

OK so some rigs don't have cpap because its not required, San Mateo county in California doesn't require AEDs so maybe some rigs don't have them. I can show you the counties ambulance requirements. As well as county protocols.

Which is what we are asking for you to do. Because we are all calling BS on having to stop for someone flagging you down no matter what. You have people in the back doing CPR on someone and you think its ok to stop? If it was my family member in back, you're getting sued. And you would lose that lawsuit...

 

[Tigger]

Just me shooting from the hip, but I would imagine duty to act laws come into play here. it's one thing to ignore an emergency when your off duty in your POV, but it's quite another to ignore a flagger while in an ambulance with lights and sirens. You might not get sued, but you can get dragged into an investigation.

Then there is the whole "court of public opinion" issue. You might not be sued, but the headline "paramedic drives by baby not breathing" with the sub-heading "doesn't even stop to help, was late to a non-emergency run" probably won't go over very well.

Hypothetically speaking, if you did have a stable patient in the back, why would you not stop and render aid? It's good PR, your patient isn't dying, so another 10 minutes won't affect his outcome, and if the patient is sick & dying, you can scoop and run the both to the closest ER. Obviously this wouldn't work if you are transporting to a sick and dying patient.

Speaking as a dispatcher, I would want you to tell me about the incident and I will tell you to stop or continue to your original assignment. I might have it already, or I might not. I might have a unit that will end up closer to your original job, at least compared to the flagged down call. If you are going to a toe pain, or other non-life threatening dispatch, I might tell you to stop, because the toe pain can wait a couple more minutes until another unit arrives. Best part about all this: if something bad happens, you can always say, "I advised dispatch, who is aware of all calls in the system, and they directed me to take that action. I was only aware of one call, so I assumed they knew the call was of a more pressing issue."

In a previous post I stated I would not stop with a sick patient and was continuing on those grounds. If my patient is stable, then sure, why not stop. Interestingly, my AMR operation instructs us not to stop with any patient onboard, just call it in.

 

[DrParasite]

FDNY EMSC OGP 101-01 GENERAL REGULATIONS

4.1.15 Acknowledge and provide treatment to all flag down assignments, advising the
dispatcher as soon as possible.

The General Regulations of the EMS Command Operating Guide Procedures (EMSC OGP) 101-01 provides, in section 1.1, that the purpose of these regulations is "[t]o set forth standards of conduct for all members of the EMS Command." Under the heading "Member Code of Conduct," section 3.1 provides that "[t]he FDNY is a public safety service whose members must perform their duties according to the highest possible standard of conduct and ethics," and that "[t]his prescribed code of conduct is set forth to provide guidelines and define certain infractions, which are deemed serious and may result in corrective and/or disciplinary action." This section further states that "[e]ach member is responsible for adhering to these guidelines and each Supervisor is responsible for their enforcement." Under the heading "Responsibilities," section 4.1.15, which is known as the flag down rule, provides that "[m]embers of the EMS Command, regardless of job title or rank, shall…[a]cknowledge and provide treatment to all flag down assignments, advising the dispatcher as soon as possible."


While not official at all, the flag down rule is as follows: "The flag-down rule allegedly requires all personnel to render assistance to people who request it."

http://www.firelawblog.com/2013/06/27/fdny-dispatcher-cleared-in-au-bon-pain-case/

 

[squirrel15]

The only time I can find this is in the article you linked and the charges were dropped. And in what you posted the wording makes it seem as though it only applies to FDNY. So does every ems agency follow FDNY policy and procedure?

 

[DrParasite]

The only time I can find this is in the article you linked and the charges were dropped. And in what you posted the wording makes it seem as though it only applies to FDNY. So does every ems agency follow FDNY policy and procedure?

The charges were dropped because she wasn't an an ambulance. And because she should have never been charged in the first place, but the brass needed to do something to sooth the public outcry, not because of the actual facts of the incident. But I digress....

The FDNY rules only apply to FDNY and FDNY related units. so if you're not in NYC, you don't need to follow the rules and regulations of NYC or FDNY. FDNY policies and procedures are only enforceable by others in the FDNY system.

 

[squirrel15]

The charges were dropped because she wasn't an an ambulance. And because she should have never been charged in the first place, but the brass needed to do something to sooth the public outcry, not because of the actual facts of the incident. But I digress....

The FDNY rules only apply to FDNY and FDNY related units. so if you're not in NYC, you don't need to follow the rules and regulations of NYC or FDNY. FDNY policies and procedures are only enforceable by others in the FDNY system.

So op would only fall into the Flag down rule while working for FDNY then. And with that I can't find anything addressing whether you have a patient or not. And I if someone can point to it, I will be extremely shocked if you are required by law to stop when you have a patient in the back especially critical.

 

[DesertMedic66]

Wow, I never knew this was actually a thing. I am actually thankful that I have never heard of this and also thankful we do not have any volunteer ambulance companies here or anywhere close by.

Out here that sort of practice would be shut down instantly. Still alarms are fine and witnessed accidents are also fine (out here the 911 company would normally still respond and take charge of the patient).

What is the point of having a volunteer company if the only way for them to get calls is to jump calls that aren't theirs? In cities with a well established 911 EMS system there is zero need for a volly company.

 

[adamNYC]

Read all four pages. You will find that vollys DO get folks calling their private number. The most popular volly in NYC is hatzolah, and I highly doubt they buff at all since they are so busy. At all other vollys, we may get private calls, but what does one do between those calls? Sit around and wait? Thankfully, it is commonly acceptable to buff calls. 911 units are usually familiar and usedwith it, hell alot of guys in my volly also do 911 at their day jobs, and may even know the 911 ambulance staff. So its usually a friendly situation. Gives 911 guys a break from their usually busy tours as well, and some even appreciate it.

 

[TransportJockey]

I did read all four pages and still find it ridiculous. I don't get the point of volunteer units in a major metro area that has a well developed professional EMS system that touts itself (but in all reality isn't) as the best in the world

 

[adamNYC]

Some but not all vollys is affiliated with the FDNY EMS 911 system and has a radio designation. Our particular volley has been called on in disasters, snowstorms, etc to help out as needed. Thats 3 extra ambulances for the city to deploy as needed.

 

[Akulahawk]

Quite a few years ago, a company I used to work for had a reputation for doing exactly what is described here: listening to the scanner and trying to beat the 911 system units to the scene. This was something I learned about after I had stopped working for them, mostly because I work for them for a very short period of time. In fact, this particular company nearly lost their County license to operate because of their practice of obviously listening to the scanner and "coincidentally" just happening to be on scene way too many times. There have been times when non-911 units have ended up taking 911 calls simply because they just happen to be there, but as in general rule, this practice of "buffing" calls (we called it jumping calls) was highly frowned upon.

In other systems, it is certainly possible (and quite likely in NYC) that because of the way the system is designed and the sheer volume of calls, this practice is possibly unofficially condoned. Regardless, make sure that you know your system and whether or not you can do it, and exactly when, without getting your backside in trouble.

This is not a practice that I personally condone simply because of the issues that can pop up.

As to the requirement that an ambulance must stop when being flagged down by a bystander, regardless of ambulance status, my take on it is simply this: if I do not have a patient on board, I have not made patient contact in any way shape or form, therefore abandonment does not apply. If I do have a patient on board, and I leave my patient for any reason, then I potentially abandoned my patient. Therefore, if I have a patient on board, I will stop to gather information and relay that immediately to the dispatch so that an appropriate ambulance can be called. I know of a particular incident in Santa Clara County quite a few years ago where an ambulance crew failed to stop for an obvious medical aid, called it in as a noninjury MVA that they happen to somehow magically assess while driving by, and the patient ultimately was a major trauma victim. The crew was queried several times over the air about that particular incident that they drove by, and at some point they were directed to provide their certification numbers over the air. I have no doubt that they were severely disciplined.

If that crew had a patient on board at the time, they simply could have called it in as an "unknown injury MVA, unable to stop due to patient on board," and they would have been fine.

 

[adamNYC]

" If I do have a patient on board, and I leave my patient for any reason, then I potentially abandoned my patient. Therefore, if I have a patient on board, I will stop to gather information and relay that immediately to the dispatch so that an appropriate ambulance can be called."

At our private the rule is the tech will continue to stay with pt and the driver will treat the flagged down pt and call for another ambulance as well, either 911 or another private ambulance.

 

[Akulahawk]

Some but not all vollys is affiliated with the FDNY EMS 911 system and has a radio designation. Our particular volley has been called on in disasters, snowstorms, etc to help out as needed. Thats 3 extra ambulances for the city to deploy as needed.

Every place I have worked, every licensed ambulance, regardless of medical capability (BLS, ALS, CCT) could be pulled into the 911 system at any time. As an example, I used to work in Santa Clara County. In that County, within a couple of hours the number of 911 EMS system ambulances could effectively double in size. At the time, there were no volunteer ambulance services in that county. I believe that is the case still today. Even if there were volunteer ambulance services there, they all would be required to be licensed by the county and they all could be pulled into the 911 system for service.

 

[Akulahawk]

" If I do have a patient on board, and I leave my patient for any reason, then I potentially abandoned my patient. Therefore, if I have a patient on board, I will stop to gather information and relay that immediately to the dispatch so that an appropriate ambulance can be called."

At our private the rule is the tech will continue to stay with pt and the driver will treat the flagged down pt and call for another ambulance as well, either 911 or another private ambulance.

That is all fine and well and good as long as you have a relatively stable patient on board. As can sometimes happen, your patient could deteriorate and then you have delayed the patient's arrival to definitive care because you are no longer moving. I understand that NYC/FDNY does things a little differently. My point is that once that crew has made actual patient contact, their primary responsibility is that patient. If I'm flagged down while transporting, my duty to act is to simply alert dispatch of the flag down. If I'm not transporting, then I have a duty to act and can provide the full scope of care, including transport, if I'm flagged down or respond to a "still alarm" type of incident.

Different systems, different responsibilities.

 

[DesertMedic66]

Read all four pages. You will find that vollys DO get folks calling their private number. The most popular volly in NYC is hatzolah, and I highly doubt they buff at all since they are so busy. At all other vollys, we may get private calls, but what does one do between those calls? Sit around and wait? Thankfully, it is commonly acceptable to buff calls. 911 units are usually familiar and usedwith it, hell alot of guys in my volly also do 911 at their day jobs, and may even know the 911 ambulance staff. So its usually a friendly situation. Gives 911 guys a break from their usually busy tours as well, and some even appreciate it.

I did read all four pages and still find it ridiculous. I don't get the point of volunteer units in a major metro area that has a well developed professional EMS system that touts itself (but in all reality isn't) as the best in the world

TransportJockey summed up what I was going to say. Volunteer companies are great for rural areas where there are literally no calls and the closest established EMS system is hours away. Not so much for urban cities especially a busy city like NYC where there is a hospital and an ambulance on every street corner.

Also I had the chance to talk to several Hatzolah volunteers during hurricane Sandy. Let's just say our view points were very different on most topics and they were also a little mad that we were unable to let them use our fuel trucks when the city ran out of gas.

The point of most volunteer companies is to allow the volunteers to have a career and family and then occasionally do a station shift or go on calls. If you are that busy of a volunteer company you need to be an actual company.

 

[Carlos Danger]

Read all four pages. You will find that vollys DO get folks calling their private number. The most popular volly in NYC is hatzolah, and I highly doubt they buff at all since they are so busy. At all other vollys, we may get private calls, but what does one do between those calls? Sit around and wait? Thankfully, it is commonly acceptable to buff calls. 911 units are usually familiar and usedwith it, hell alot of guys in my volly also do 911 at their day jobs, and may even know the 911 ambulance staff. So its usually a friendly situation. Gives 911 guys a break from their usually busy tours as well, and some even appreciate it.

Yes, sitting around and waiting is exactly what one does between calls.

Or you could inspect and clean your rig and equipment, train, study, work out, watch movies. Stuff normal EMS professionals do between calls.

 

[Gurby]

From the other thread:

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.

Seems like it would be illegal to respond lights and sirens to a call you aren't dispatched to.