Single Provider vs Multiple providers

[Veneficus]

So if they're dispatched to an interstate MVA, how does this save money and time on the response? Do they just go, do the extrication, then pack up the patient and all their gear and leave?

The typical response that 46 was talking about is a reported interstate MVA at X mile marker, westbound would get a rescue engine or rescue company and a medic going east AND the same response going west, given the unique traffic woes of the NOVA area. Whoever gets access to the scene first is the one that handles the call.

The cost of a rescue truck is considerably less than an engine. The unit is set up to be as autonomous as possible. An interstate MVA would get a rescue company. If there was a report of fire it would also get an engine and a truck as well.

Once on scene if the situation required, additional resources could be called. With the exception of a few certain areas during peak traffic, the response delay wasn't appreciable.

But in my time there, extra help was usually a truck company (brings more men, equipment, can sweep stuff off the road and makes a fine road block) or an ambulance (ambulance so alternate hospitals could be used so as not to flood one ED or to clear the rescue company if it was a busy day for fires or people getting themselves stuck in amazing ways.)

With the capability to extricate and transport multiple patients at once, there isn't need to call for help often on an MVA. (But it does happen occasionally like when somebody plows a car into a house and the structure needs to be stabilized.)

If the rescue was capable of handling the situation it would be the only unit utilized. Even being manpower heavy, it reduces the need to send multiple units on a regular basis. Less maintenence, less fuel, etc.

If you send 1 rescue, you send max 8 guys. 1 vehicle.
If you respond with an engine, (4-5 people) a truck, another 4, and a medic, 2 you would have 10 people average, and 3 vehicles. With the capability to transport only 2 patients.

The situation you described is sending 4 units. How many are often cancelled?

Also from the economic point and my opinion, a rescue pumper is a terrible waste of money. Too much gear, plus a pump, and usually some water. All that will need replaced one day.

You also get more skill dilution. I think there is more proficency to have a couple of medics who perform rescue and truck operations all day then it is to have a couple of medics who have to perform engine, truck, and rescue operations. You just get better at what you do.

I realize everyone does stuff different, because they have different needs, so there is no right or wrong, but it doesn't change the fact that the more stuff you send, the more it costs per incident, and the more you need to handle your volume. The system I was at might not work for your area, but it is always good to compare and share.

Perhaps we should talk about fire ops via PM. This isn't really the forum.

 

[Veneficus]

Single provider always.

Before we say the area is too big go look at Ambulance Victoria, the Ambulance Service of New South Wales and Alberta Health Services they are some of the largest geographic services in the world and do it pretty well.

It is not the size, but the density that causes issues in my opinion.

 

[MrBrown]

It is not the size, but the density that causes issues in my opinion.

Finally a man who admits size aint everything

Not sure I see density as a problem if you have sufficent resources. Unless you go bonkers like the London Ambulance Service and ORCON

 

[Veneficus]

Finally a man who admits size aint everything

Not sure I see density as a problem if you have sufficent resources.

Who has sufficent resources?

 

[abckidsmom]

It is not the size, but the density that causes issues in my opinion.

LOL, Brown beat me to it, but is this a foot-in-mouth moment?

The only urban environment I've ever worked in was just 60 sq miles with a million inhabitants by day and 100K by night. Smallish city, and fairly easy to manage. Even when it was completely nuts, it was still relatively managable.

I'm happy to not be able to comprehend the volume experienced by NYC. Beyond just getting through the day, how would you even start to QA that mess?

 

[Veneficus]

LOL, Brown beat me to it, but is this a foot-in-mouth moment?

depends on what you like.

I'm happy to not be able to comprehend the volume experienced by NYC. Beyond just getting through the day, how would you even start to QA that mess?

A regonal medical director who all EMS providers had to answer to.

Of course politically, nobody would go for that.

It has worked in other places where multiple agencies share an area.

But a council is not good enough. It has to be somebody with an executive authority.

 

[MrBrown]

I'm happy to not be able to comprehend the volume experienced by NYC. Beyond just getting through the day, how would you even start to QA that mess?

You don't ..... because we know that "quality" means "I know what I do makes a difference because its what the textbook said and it seems to make people get better and I get to use all this flash gear I got down at the Galls store and drive real fast because the patient looks sick which is why I gave him high flow oxygen on the ten minute drive to the hospital" .... right?

 

[DrParasite]

The question is how much taxes are people willing to pay in order to get that level of service.

I agree.

Take for example Philly or Detroit.

perfect examples. lets ask the question: when a house in on fire in Philly or Detroit, what is the FD's response time? 4 minutes? maybe 8? and we both know that both cities never have more than one structure fire going at the same time. EMS is run by the FD in both cities. If you call for an ambulance, what's the response time? 12 minutes? 15? 30?

Where I work, the FD has a 4 minutes response time to all calls. that means a fire unit is on scene within 4 minutes to all calls. now EMS? we sometime have calls coded as low priority waiting over an hour.

FD has 16 engines, 9 Trucks, and a Rescue. The city contracts with my hospital to provide 4 ambulances. That's all they pay for, and at 5am, that's all you get. the ratio of fire calls to EMS is roughly 4:1 (statistically speaking nationwide), yet the city has 26 fire supression units, and pays for 4 EMS units. Anyone have any other questions as to why the FD has a 4 minute response time, and EMS takes up to an hour for some calls?

and I know Detroit and Philly are exactly the same way, with the exact same problem. The city doesn't want to pay for more units.

Look at the reduction in FDNY responses in areas where they do have alternate transport providers. If you suddenly added that to FDNY you would have to increase resources. The same with LA. Again, who is going to pay for this?

Raise taxes, sure, I agree, but the current political clime is rather toxic for suggesting that tax money actually buys essential services. Too many morons out there.

No one wants to fund EMS until they personally need it and then it takes too long. Lets cut costs, run the units into the ground, and do more with less, that's how city managers think of EMS.

almost every EMS system is understaffed, especially urban ones. and its obscene that the public permits this, instead of demanding change. If it takes too long for a fire truck to get to a fire, there are protests, and investigations are made. if it takes too long for EMS to get some place, there might be protests, but the response is "cut corners, and do more with less" not lets give EMS enough money to do the job right.

it all comes down to properly funding and staffing the existing ems system.

 

[FDNYRescueMedic]

FDNY-EMS is slowly taking over much of the city but remember that with all the cut backs it will be a long road. We have a city with over 8 million people and a call volume of 3k to 4k a day! EMS in this city provides a service to many residents that are below the poverty level with many not having any insurance to pay for the services provided. It takes money to provide these services so we need our voluntary brothers to help out a cover certain areas. Many hospital based services have been around longer then FD-EMS and some of these hospitals if not all cover afluent parts of the city and have strong political ties. eg. Lenox Hill and Presby. Even though our union wants to see an all FDNY-EMS service and is slowy turning that way, politics and money dictates the day. The bottom line is that FD or voluntary, pt's get top quality care and we are all on the same page when it comes to pt. care. In my eyes we are one! My voluntary brothers do a great job and I would hate to see them lose their jobs. Someone mentioned less fire units and more EMS. Sounds great but it will never happen. You want to talk about a powerful union!!! Politics brothers, politics! I know it sucks but for now we do the best we can with what we have.

 

[46Young]

Us voluntary employees always got along great with the FDNY EMS folks. It was some of the Conditions Bosses and Capt's that gave us beef. Howie Sickles a prime example. That was one miserable guy.

I don't know if you're aware, but much of the country has engine EMS first responders, often ALS. I think they were referring to reducing those types of responses, since they're a crutch for a lack of txp units. In the case of the FDNY, they'll keep the CFR program, since they can show call volume. It irritated me that these CFR engines would often be onscene before us by a minute or so. We're sitting on a street corner, and they have to all run down to the engine, jump in, fire it up, get out of the station, etc. I found out that they received the job before we did, so they always got the jump on us.

 

[46Young]

Here's a Unit Location Chart for both FDNY and the voluntaries, for anyone that's interested:

http://fdnyems.com/EMS Unit Location Charts.pdf

 

[FDNYRescueMedic]

We all know Howie, I had him as a captain in Harlem and morale was not the greatest. I agree with the CFR engines but they are getting better since a lot of them worked EMS at one time or another and I don't cancel them until they come upstairs and I know they are not needed for CPR or gaining access etc. I'll tell chief Howie you send your love. Lol!

 

[FDNYRescueMedic]

From that chart you can see how many units come out of the Lenox Hill #11. Upper east side and very afluent! Thanks brother for posting that chart.

 

[46Young]

For that matter, look at H35 and H77. Not quite as affluent, but they turn out three ALS (46Y!) and eight BLS. It's not just the affluent areas, either. I used to per diem for Jamaica, and by proxy Flushing and Brookdale. That's a whole bunch more out of H33, 34, and 41.

I miss the job and environment there. I think, when a couple of years pass, I might look into getting my old job back on a per diem basis. My schedule allows for three four day breaks a month. I could knock out a double or a pair of 12's and bring the wife and kids if there's no school. The straight pay is comparable to my OT here. Really, I felt like I did a lot more in the NYC 911 system. Here, like most other parts of the country, we run everything, not just ALS. You know how it is. Depending on the area, you can see a few sick pts a shift. Here, it's like a few a month. You get rusty.

I used to work 46Y Sun1 and Tues1, and constant OT on the Sat1. You had Corona, J. Heights, Elmhurst, F.Hills, the GCP and LIE. All varieties of jobs. I once took a cook from Riker's down to Brooklyn Hosp just so I would be recommended for jobs down in Bed Stuy and surrounding areas, just for a change in pace. We spent the whole night down there. It was great! I heard that it slowed down since the 46Y 89 moved from Nat'l and Roosevelt down to the white Castle across from the old H39 on QB :sad: N.S. picked up 46F, though. Flushing lost that spot years ago when the crew asked for a Boss because the pt would not agree to go to Flushing Hosp! This was near 108 st and Corona Ave. Pt steering at it's finest.

 

[abckidsmom]

I miss the job and environment there. I think, when a couple of years pass, I might look into getting my old job back on a per diem basis. My schedule allows for three four day breaks a month. I could knock out a double or a pair of 12's and bring the wife and kids if there's no school. The straight pay is comparable to my OT here. Really, I felt like I did a lot more in the NYC 911 system. Here, like most other parts of the country, we run everything, not just ALS. You know how it is. Depending on the area, you can see a few sick pts a shift. Here, it's like a few a month. You get rusty.

You could be happy in Richmond, just sayin'. I hear that so much from people who work in systems like yours.

Figure the gas, lodging and food, and the money would come out equal, I'd bet.

 

[46Young]

You could be happy in Richmond, just sayin'. I hear that so much from people who work in systems like yours.

Figure the gas, lodging and food, and the money would come out equal, I'd bet.

I've thought about it. Still strongly considering it. I've heard that they require 24 hours a pay period, and they start new medics at 15/hr. I have five years ALS and another three as a basic, but I can't imagine they would give me an hourly in the 20's. They use system status management, after all, so they're penny pinchers by definition. I'm in contract for a house up in Frederick Co, so that might be a little bit of a hike. Not too bad from Stafford, but quite a bit more from the Winchester/Front Royal area.

The question is, is it more worth it to travel to NY, do 24-32 hours over a couple of days for 32 an hour or so, or make two shorter trips for half the pay, but be able to sleep in my own bed? RAA may be in my future, if the wife's okay with it. I miss the urban environment, and the busy nature of SSM wouldn't bother me like it does the full timers, since that's what I'd be there for.

It's whatever the wife agrees to. My OT here is in the low 30's/hr.

Do you or anyone else have any info as to their hiring process, orientation requirements, and hourly requirements to keep the per diem status? I contacted someone from this forum a while back, but I can't remember who they were or the particulars.

 

[46Young]

ABC, I just checked google maps. If I put in Richmond, and then my new address, it's 138 miles. The site says it takes 2hrs45min. It's 295 miles to get to Forest Hills, NY, 5 1/2 hours. Time and mileage wise, Richmond has a very slight edge in miles. But half the pay. Remember, I'd do two shifts on one trip to NY, and have to make two trips to get the same hours at RAA.

Edit: Really, NY gets the edge, since they run only ALS calls, I get to see family, and also take my family with me if school's out. Thanks for mentioning RAA, though. I might do it anyway, if their hourly requirements are lax.

 

[abckidsmom]

ABC, I just checked google maps. If I put in Richmond, and then my new address, it's 138 miles. The site says it takes 2hrs45min. It's 295 miles to get to Forest Hills, NY, 5 1/2 hours. Time and mileage wise, Richmond has a very slight edge in miles. But half the pay. Remember, I'd do two shifts on one trip to NY, and have to make two trips to get the same hours at RAA.

Sure. Your location is Stafford. That's just about an hour from Richmond. That's all I was going on.

ETA: 24 hours a month. My husband gets his done in 2 6s and a 16. He works the 6 hour shifts on his in-between days from the real job in NOVA.