No Ambulances Available

SandpitMedic

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Oh boy.
 

Jim37F

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If they're at level zero and still having calls for resources, then they legit need to be calling these guys:
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I only just a little. Sirens was a comedy, but if CFD isnt being given enough resources by the City to handle the calls, they have to start calling mutual aid such as private ambulances , rather than letting people bleed out with no units being dispatched
 

SandpitMedic

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The more concerning issue is the attempt to cover it up or hide it by city leadership. Shady.
 

johnrsemt

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Maybe the 911 services need to use the private services. I worked both 911 and private for 8 years.

When I worked in Indianapolis 911 would call my private service when they got behind; and we would help them. Yes sometimes 911 would cherry pick between the 8 private services; and sometimes they would pick on them a little (standby at large fires so that their ambulances could stay in service).
But they never had 20-90 minute waits for an ambulance. But at the same time the ED's had their acts together and we didn't have to wait for beds for our patients either. So it takes cooperation from a lot of sides to make things work and work well.
 

BobBarker

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1. They should have a backup/mutual aid contract in place to reduce or eliminate these problems. However, if the mutual aid provider is running a lot of calls in Chicago because CFD can't get their act together, I'm sure they wouldn't want to continue.
2. They should contract with a private BLS company to send non-emergency transports to them, which would free up their rigs. They should still be able to recoup some money for the dispatch/treatment through the bls company.

I know in terms of private ambulance companies, a lot of fire agencies don't like them getting to calls first, especially in California. The fire's ego sometimes gets in the way of patient care which is unacceptable. Sounds like in this case, the firefighters are trying their best but need more resources and a backup plan.
 

E tank

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SFFD had something similar going on a few years ago...SF has always had private back up the county provider whether it was the old 3rd service system or now with the fire department. Been out of there for a while, but I think they've integrated the privates even more for 911 calls, even when there are fire units available elsewhere in the City to meet response time goals.

Anyone know different?
 

DrParasite

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There are a couple issues at play here:
1) Philly FD's EMS system has been grossly understaffed for decades. DECADES. There are a prime example of a poorly managed FD based EMS system, because they don't have enough EMS units for their call volume (an issue that happens in many urban cities throughout the US).

2) the commissioner is literally covering up the issue, vs addressing the root cause. Just because you don't announce over the radio that no units are available doesn't change the facts that there are no units available for the EMS calls.

3) Philly is not a small city. it is a large city, and the sole city in Philadelphia County. it has 1.5 million residents crammed into the second smallest county in the state of Pennsylvania. And the EMS system's funding and resources haven't kept up with the rising population growth and call volume.

4) Philly has 58 engines, 27 ladders, and 5+ staffed specialty units (rescue, hazmat, etc). And they are a busy department, and the PFD extinguished 2,525 structural fires in FY18, an average of seven per day, which increased to 4,849 in 2019, an average of 13 per day in 2019 (This year's structure fire number is much higher than previous years because the PFD has strengthened its reporting protocols). Now compare that to the 50 ambulances they have, plus 5 12-hour peak load trucks.... including Medic 8 who responded to 9,011 calls in 2018. They have 42 ALS units, and 18 BLS units (they used to only have ALS ambulance, but implemented BLS trucks because of staffing issues). However, their call volumes do not reflect their staffing, with their 2019 numbers being 49,526 fire calls, and 274,659 being EMS calls. At the end of the day, they need more AMBULANCES TO HANDLE THE RISING CALL VOLUMES.

5) Sending an engine, even a paramedic engine just stops the clock; not telling the engine crew that no ambulance is coming due to lack of availability is a poor way to manage the EMS crisis in Philly
 

CCCSD

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SFFD had something similar going on a few years ago...SF has always had private back up the county provider whether it was the old 3rd service system or now with the fire department. Been out of there for a while, but I think they've integrated the privates even more for 911 calls, even when there are fire units available elsewhere in the City to meet response time goals.

Anyone know different?
You are correct. Privates have a piece of the city and can run 911 calls all shift if it’s busy.
 

ffemt8978

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Phillyrube

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There are a couple issues at play here:
1) Philly FD's EMS system has been grossly understaffed for decades. DECADES. There are a prime example of a poorly managed FD based EMS system, because they don't have enough EMS units for their call volume (an issue that happens in many urban cities throughout the US).

2) the commissioner is literally covering up the issue, vs addressing the root cause. Just because you don't announce over the radio that no units are available doesn't change the facts that there are no units available for the EMS calls.

3) Philly is not a small city. it is a large city, and the sole city in Philadelphia County. it has 1.5 million residents crammed into the second smallest county in the state of Pennsylvania. And the EMS system's funding and resources haven't kept up with the rising population growth and call volume.

4) Philly has 58 engines, 27 ladders, and 5+ staffed specialty units (rescue, hazmat, etc). And they are a busy department, and the PFD extinguished 2,525 structural fires in FY18, an average of seven per day, which increased to 4,849 in 2019, an average of 13 per day in 2019 (This year's structure fire number is much higher than previous years because the PFD has strengthened its reporting protocols). Now compare that to the 50 ambulances they have, plus 5 12-hour peak load trucks.... including Medic 8 who responded to 9,011 calls in 2018. They have 42 ALS units, and 18 BLS units (they used to only have ALS ambulance, but implemented BLS trucks because of staffing issues). However, their call volumes do not reflect their staffing, with their 2019 numbers being 49,526 fire calls, and 274,659 being EMS calls. At the end of the day, they need more AMBULANCES TO HANDLE THE RISING CALL VOLUMES.

5) Sending an engine, even a paramedic engine just stops the clock; not telling the engine crew that no ambulance is coming due to lack of availability is a poor way to manage the EMS crisis in Philly
Chicago, not Philly.
 

Tigger

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How, in a major metro area, where there are presumably many neighboring agencies and private providers, can a large city department have no mutual aid agreements for ambulances at all? Isn’t Chicagoland known for it’s MABAS mutual aid thing?
 

DrParasite

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DrParasite

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How, in a major metro area, where there are presumably many neighboring agencies and private providers, can a large city department have no mutual aid agreements for ambulances at all? Isn’t Chicagoland known for it’s MABAS mutual aid thing?
It is... but Chicago is in an MABAS all by itself (MABAS 9 in case you were wondering). and MABAS is for fire suppression, for big fires, not because an area does have enough staffing to cover it's own "routine" call volume.

As for the lack of mutual aid, I can think of several reasons why they wouldn't use mutual aid or private providers, and rely solely on their own personnel:

1) there is no way for CFD to verify that the training levels that the provide ambulances have is the same as CFD (I'm hoping CFD does more than the bare minimum.
2) There is no way for CFD to track the closest private ambulance, or mutual aid ambulance, as they don't use a GPS system to track them.
3) there is no way for CFD to verify the competency levels of their mutual aid providers, or to ensure the providers are able to treat the Chicago residents to the same level of care as CFD, as directed by CFD medical director.
4) they have no way to verify that a private company has the same equipment as a CFD ambulance
5) a mutual aid unit will likely not know the geography of Chicago as well as a CFD unit.
6) Chicago is more than 10x as large (by population) than the second largest city in Illinois (Aurora is 200k, while Chicago is 2.7 million); so a mutual aid company won't want to get sucked into the CFD 911 system, and leave their primary unprotected. And it likely would become a one way aid system, not a "mutual" system.

The reality is, Chicago residents pay taxes for Chicago provided services, so the city has a responsibility to provide the service, particularly for the "routine" calls. Using mutual aid strips smaller agencies of their resources to protect their first due areas. In the case of an MCI, isolated disaster, or majory incident, I'm sure other "emergency" resources can be called, however it's inappropriate to use them regularly for "routine" calls, that's the responsibility of the AHJ, not mutual aid or private services.

BTW, since @Phillyrube pointed out that I thought this was about Philly, and not Chicago, lets looks over the staffing numbers for CFD:

Engines96
Ladders61
Squads4
Ambulances80 Advanced Life Support Ambulances, or 60 ALS and 15 BLS ambulances

So with 500,000+ calls annually., Chicago's fire department still has twice as many firetrucks as ambulances, yet the department gets 20 times more medical calls than fire calls.

And this isn't new information; NPR did a report on it 3 years ago https://www.npr.org/sections/health-shots/2017/04/11/523025987/why-send-a-firetruck-to-do-an-ambulances-job

Sounds like what they really need is to allocate funds to where the call volume is
 

CCCSD

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Why wouldn’t a company licensed and certified to work in Ill/Chi not be able to prove they provide the same level, BLS, ALS, than the FD?
 

Tigger

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because an area does have enough staffing to cover it's own "routine" call volume.
This is the crux about mutual aid, and it isn't acceptable. But even properly staffed, some days are going to be worse than others. Seems a bit foolish for a city to just say under no circumstances will anyone else provide service.

As for the lack of mutual aid, I can think of several reasons why they wouldn't use mutual aid or private providers, and rely solely on their own personnel:

1) there is no way for CFD to verify that the training levels that the provide ambulances have is the same as CFD (I'm hoping CFD does more than the bare minimum.
2) There is no way for CFD to track the closest private ambulance, or mutual aid ambulance, as they don't use a GPS system to track them.
3) there is no way for CFD to verify the competency levels of their mutual aid providers, or to ensure the providers are able to treat the Chicago residents to the same level of care as CFD, as directed by CFD medical director.
4) they have no way to verify that a private company has the same equipment as a CFD ambulance
5) a mutual aid unit will likely not know the geography of Chicago as well as a CFD unit.
6) Chicago is more than 10x as large (by population) than the second largest city in Illinois (Aurora is 200k, while Chicago is 2.7 million); so a mutual aid company won't want to get sucked into the CFD 911 system, and leave their primary unprotected. And it likely would become a one way aid system, not a "mutual" system
These are issues that are faced by many, many systems with functioning auto and mutual aid system. If the want is there, all of these are very obtainable. I'd be happy to outline how these were overcome in Boston, Denver, El Paso County CO, and probably some other large urban areas if we really wanted to. Most mutual aid is not perfect and pretty ad hoc, but that is just fine because as you say, the point is to have something workable for outlier periods of call volume.
 

DrParasite

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Why wouldn’t a company licensed and certified to work in Ill/Chi not be able to prove they provide the same level, BLS, ALS, than the FD?
Seriously? with all the fly by night pop up ambulance companies in the US, where they are more interested in profit than actual quality patient care, you need to ask that?
But even properly staffed, some days are going to be worse than others. Seems a bit foolish for a city to just say under no circumstances will anyone else provide service.
sure, but that is why statisticians get paid a lot to get good estimates based on historical data. It's also why we, as EMS professionals, need to convince the powers that be that we should have built in surge capacity, so you have extra units available for those "some days are going to be worse than others" days. Too many places think having all units on calls means the system is running at peak efficiency, forgetting that if they get one more call, they have no units available.
These are issues that are faced by many, many systems with functioning auto and mutual aid system. If the want is there, all of these are very obtainable. I'd be happy to outline how these were overcome in Boston, Denver, El Paso County CO, and probably some other large urban areas if we really wanted to. Most mutual aid is not perfect and pretty ad hoc, but that is just fine because as you say, the point is to have something workable for outlier periods of call volume.
I know nothing about Colorado, so I can't respond to your statements. Boston does have a mutual aid policy involving 12 predefined agencies, but a quick web search showed how it was used during the bombing and special events, and no mention of how often it is used for day to day incidents.

That all being said, the county I live in tries to handle most calls in house. if they run out of units, they request assistance from a neighboring county, and before they run out of units, they ask a neighboring county to stage on the county line in case they are needed. The issue is, most of the surrounding counties are even more short staffed, so they might not have available units. NO private ambulances (ALS, BLS, IFTs, CCT) are used in the 911 system for routine operations, including ones that are physically located in the county; if they need a 911 truck, they get a 911 truck from another 911 system. (disclaimer: I do not work for the EMS system in my county).

At previous employers, we used mutual aid a lot. typically we have one ambulance dedicated to the city, and if they were on a call, alternatives needed to be located. sometimes our mutual aid was paid, other times volunteer. Bigger systems tended to avoid calling mutual aid from smaller systems, because the smaller systems didn't have units they could spare, while still ensuring proper coverage for their primary area. Sometimes we were able to clear the hospital before our mutual aid units made it to the city. Again, policies were made that were above my paygrade.

You can name cities and counties that use mutual aid for routine operations (and for the record, so can I), but I can also name cities that don't use mutual aid (NYC and Cleveland are the first that come to mind, that's just off the top of my head), so it's all decided by people above my paygrade.
 

johnrsemt

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I have and had friends scattered around the country in different sized cities that work/ed EMS (FD, Private, Hospital and 3rd service):
Some would say that the 911 would not EVER call for help outside of other 911. Other would say they would only call for help if it was more than an hour wait for an 911 ambulance; some were 30 minutes.

When I worked in Indianapolis (and surrounding areas) 911 dispatch would call my private service and ask our dispatchers where we had trucks posted as they got busy: then call back when they needed them. We would go out with the engine crews, and usually get to the scene about the same time they did. Never did patients have to wait more than 10 minutes for an ambulance.
But the private services trained with the 911 services (or quite a few did) and the ones that didn't allow their crews to train together usually didn't get 911 rollovers very often).
 

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