How to buff calls in NYC?

[Tigger]

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.

 

[RedAirplane]

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.

 

[RedAirplane]

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.

 

[Fleury14]

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.

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.

 

[triemal04]

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.

 

[Tigger]

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.

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?

 

[Chimpie]

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.

 

[adamNYC]

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

 

[chaz90]

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.

 

[adamNYC]

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.

 

[chaz90]

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.

 

[DrParasite]

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?

 

[Jim37F]

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.

 

[46Young]

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.

 

[46Young]

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.

 

[Tigger]

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.

 

[phideux]

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.

 

[adamNYC]

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

 

[luke_31]

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.

 

[adamNYC]

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

Priority1: FDNY EMS + Voluntary Hospital EMS

Priority2: Volunteer EMS