New York Ambulance system... How does it work?

[Dutch-EMT]

How does the New York ambulance system works exactly?
I see there are multiple ambulance providers on the streets (SeniorCare, FDNY, New York Presbyterian, some volunteers, AMR, etc).
Are the ambulances always stationed at specific locations in the city for 911 calls when not on a call?
Or does the FDNY dispatcher let the ambulances (from all different providers) station randomly in the city?
And is the garage for service/maintenance and parking off-duty ambulances only, or do they also respond out of those garages?
Are the 911 ambulances also used for interclinical transports? Or are those services strictly seperated from 911 ambulances and assigned to special teams?
Thanks all!

 

[DrParasite]

So many different questions..... First off, I recommend you visiting https://en.wikipedia.org/wiki/New_York_City_Fire_Department_Bureau_of_EMS , which explains a little bit. Then feel free to check out https://emtlife.com/threads/ems-in-new-york-city.21301/

To answer your questions one by one:

How does the New York ambulance system works exactly?

poorly? It's a system that is called one of the best in the nation by those who work in it, which is an opinion shared by no one who works outside of it.

I see there are multiple ambulance providers on the streets (SeniorCare, FDNY, New York Presbyterian, some volunteers, AMR, etc).

you are correct; FDNY EMS has 2/3 of the ambulances within the FDNY EMS system; the remaining 1/3 are voluntary ambulances that are run by either the hospitals or private companies within NYC. They operate on a "closest ambulance" dispatch system, and in theory, all ambulances have the same capabilities.

Are the ambulances always stationed at specific locations in the city for 911 calls when not on a call?

Almost all the FDNY EMS units are posted on street corners throughout the city. some of the hospital based units are located in stations.

Or does the FDNY dispatcher let the ambulances (from all different providers) station randomly in the city?

no, each unit is assigned a particular area, IIRC, a 4 block area where they are supposed to post. hospital based units are typically located near their base hospitals.

And is the garage for service/maintenance and parking off-duty ambulances only, or do they also respond out of those garages?

as mentioned before, the vast majority of ambulances are posted on street corners. there are several "stations" where off duty ambulances are parked, but once a crew signs on duty, they are expected to leave the station and go to their street corner.

Are the 911 ambulances also used for interclinical transports? Or are those services strictly seperated from 911 ambulances and assigned to special teams?

To my knowledge, FDNY doesn't do interfacility transports, between hospitals.

To answer some more questions that weren't asked: FDNY EMS is the busiest EMS system in the US, in terms of overall call volume; however their number of calls per truck is no where near the highest, especially among urban EMS systems. FDNY EMS works 8 hour shifts; from what my former colleagues told me, typically call volume is 4 calls per shift... at 6, they consider themselves to be slammed. The majority of FDNY EMS employees are working EMS until they can (hopefully) "promote" to the suppression side.

There are "volunteer" EMS agencies (meaning, members of the organization who don't get paid to be on the ambulance) that operate in NYC; https://www.cpmu.com/ , https://en.wikipedia.org/wiki/Bedford-Stuyvesant_Volunteer_Ambulance_Corps and https://hatzalah.org/twotiered.php, http://lindenwoodvac.org/, http://www.glencoveems.com/ , http://www.fhvac.org/ all operate within NYC, but technically outside the FDNY EMS system. They have a self assigned coverage area, and will usually jump a call that they hear on the scanner, or will answer calls that are called into their dispatch center instead of go to 911. When the 911 system truck arrives, they just advise dispatch that an ambulance is on scene with patient care, and they go available.

TLR it's a huge mess.

 

[Dutch-EMT]

Ambulances from the private ambulance services and hospitals who are standby on streetcorners, do they do interfacility transports or are they only available for 911 calls? It doesn't make sense to me that an 911 standby ambulance has to do interfacility or private transports.
Or are interfacility transports coordinated by the callcenters from the ambulance companies or hospitals and respond from a garage?
In the Netherlands all calls are coordinated by dispatch (emergency and non emergency/interfacility).
112 ambulances (=911) do interfacility and (non) emergency. So i'm just curious.

 

[DrParasite]

To be perfectly honest, I am not sure.

I would imagine that all ambulances are physically capable of running 911 calls, and all crews are trained and equipped to run 911 calls (at least in theory), so if an assigned 911 crew goes OOS, they can be backfilled by a IFT crew in the short term, to ensure they are providing the proper number of units that they are contracted to provide the city with.

One of thing to consider: you have NYC 911 units (which are units that are dispatched by FDNY communications as closest unit), and contract emergency units (which are private ambulances, that handle "emergencies" for nursing homes and private facilities, that call the private ambulance dispatch center instead of 911). The "contract emergency units" (which is my term, not anything official) will respond lights and sirens to facilities when requested, and in theory, can do everything a 911 ambulance can do. They will also handle non-emergency transports to Dr's officers, dialysis clinics, discharges from hospitals to either rehab centers or residences, etc. you get the idea.

Also remember, a 911 ambulance that isn't on a run isn't making money for their employer, so a contracted IFT is usually guaranteed payment. While 911 might be a money loser in the US, IFT can be very profitable, so often a for profit ambulance service will take an IFT call because it make money, while a 911 ambulance not on a run doesn't.

IFT companies will likely also respond from streetcorners, because it cuts down on the time it takes them to get to their contracted facilities.

Other systems (not in NYC) operate on the "closest unit" theory, so if you are a 911 ambulance and you go on a call, and end up transporting to the ER, you can then handle a discharge from the ER to a SNF. then another ambulance is reassigned to cover that area. and you end up massively SSMed until you have toured the entire county.

Also check out https://en.wikipedia.org/wiki/Voluntary_ambulance_(New_York_City) for how the voluntary units operate.