New York City - Critical Shortage Of EMS Workers

[zephyrnyc]

It's just as I feared in another thread...





New York City - Critical Shortage Of EMS Workers
06-15-2008 - 2:17 PM


New York City - A shortage of medics and a surge in heat-related 911 calls left the city struggling to respond to medical emergencies last week - and the dangerous situation could worsen as summer intensifies and more FDNY EMS workers jump ship to become firefighters, sources told The Post. Dozens of ailing people waited more than an hour for a response after dialing 911 last week. During one two-hour period on a sweltering afternoon, six calls were stacked up for more than an hour, and 12 were delayed more than 30 minutes, according to Emergency Medical Service dispatch records reviewed by The Post.
A shrinking work force strained to respond to a flood of about 15,000 calls over four days - the same amount the city of Boston averages in a month. On a normal working day, the city’s 2,000 emergency medical technicians, paramedics and their supervisors get about 3,200 medical calls.
But last week demand spiked abruptly, going as high as 4,606 during one 24-hour period as temperatures sizzled. Eight people suffered heat-related deaths last week, the city medical examiner said. The sudden surge left dozens of calls queuing in EMS dispatch centers in The Bronx and Brooklyn. An overheated 65-year-old woman with high blood pressure waited nearly two hours for a crew.
Medics didn’t reach a 37-year-old woman suffering from vomiting and stomach pains for an hour and 14 minutes.

Article printed from Vos Iz Neias - (Yiddish:What’s News?): http://www.vosizneias.com
URL to article: http://www.vosizneias.com/17032/2008/06/15/new-york-city-critical-shortage-of-ems-workers/

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[leviathan]

It's just as I feared in another thread...





New York City - Critical Shortage Of EMS Workers
06-15-2008 - 2:17 PM


New York City - A shortage of medics and a surge in heat-related 911 calls left the city struggling to respond to medical emergencies last week - and the dangerous situation could worsen as summer intensifies and more FDNY EMS workers jump ship to become firefighters, sources told The Post. Dozens of ailing people waited more than an hour for a response after dialing 911 last week. During one two-hour period on a sweltering afternoon, six calls were stacked up for more than an hour, and 12 were delayed more than 30 minutes, according to Emergency Medical Service dispatch records reviewed by The Post.
A shrinking work force strained to respond to a flood of about 15,000 calls over four days - the same amount the city of Boston averages in a month. On a normal working day, the city’s 2,000 emergency medical technicians, paramedics and their supervisors get about 3,200 medical calls.
But last week demand spiked abruptly, going as high as 4,606 during one 24-hour period as temperatures sizzled. Eight people suffered heat-related deaths last week, the city medical examiner said. The sudden surge left dozens of calls queuing in EMS dispatch centers in The Bronx and Brooklyn. An overheated 65-year-old woman with high blood pressure waited nearly two hours for a crew.
Medics didn’t reach a 37-year-old woman suffering from vomiting and stomach pains for an hour and 14 minutes.

Article printed from Vos Iz Neias - (Yiddish:What’s News?): http://www.vosizneias.com
URL to article: http://www.vosizneias.com/17032/2008/06/15/new-york-city-critical-shortage-of-ems-workers/

It's only going to get worse, my friend. Thankfully the examples of calls they had left waiting for 1-2 hours didn't sound critical, but it won't be long before you start having code 3 calls waiting in queue. I know 2 days ago I was dispatched routine to a call for a "fall + shoulder dislocation". On the way we got redirected to a motor vehicle accident, cleared that call, and got sent back to the same call from before. By that time it had probably been an hour before we finally arrived.

 

[zephyrnyc]

It's only going to get worse, my friend. Thankfully the examples of calls they had left waiting for 1-2 hours didn't sound critical, but it won't be long before you start having code 3 calls waiting in queue. I know 2 days ago I was dispatched routine to a call for a "fall + shoulder dislocation". On the way we got redirected to a motor vehicle accident, cleared that call, and got sent back to the same call from before. By that time it had probably been an hour before we finally arrived.

Wow. Do you work in Vancouver?

 

[zephyrnyc]

Please write our mayor. Write YOUR mayor. Write everyone! I already have.

http://www.nyc.gov/portal/site/nycg...=http://www.nyc.gov/html/mail/html/mayor.html

 

[cavalier329]

NYC EMS works with priority dispatch. Yes, there is a limited number of crews out, but those "hot jobs" will never go unanswered.

This is essentially how it works...FDNY will get dispatched to a "leg pain", then perhaps in the same sector a cpn comes out and no other units are available to take it, so that unit will be redirected to the cpn.

Now, if there is no other unit to take that job and everyone is on a priority call, you will have a local ED unit pick it up as a mutual. That is-if these units dont buff it already. Reality of the situation is critical jobs (critical MVA's, GSW's, stabbings, etc) are usually taken by the first unit who gets there because many will respond that are looking for the call-whether they are the primary bus in the area or not.

There is probably a shortage, but I wouldn't worry about the priority jobs being left unanswered in the future...there are plenty of people who want to take those. The intox will probably get ****-canned though and you will see BS calls get the raw-end of the deal for the short handed crews.

Things aren't critical in the city, but FDNY does need to be paid more. Unfortunately, that probably won't happen no matter how many e-mails you want to send bloomberg. It can't hurt, but trust me, the NYPD just got a nice raise, the FDNY isnt far behind so the EMT's will follow.

 

[cavalier329]

those 2 examples are fairly rare in the business...but theres certainly no denying that more FDNY EMT's are needed. We shall see what happens.

Don't hold your breath though, NYC is pretty damn cheap when it doesn't involve big business. Its unfortunate, but true.

 

[leviathan]

Wow. Do you work in Vancouver?

Among other places, yes.

 

[MadMack]

The problem with the FDNY is that the department isn't dual role. You're Fire or you're EMS; leading to a critical shortage of Paramedics and EMTs, because the FDNY actually considers Firefighter to be a higher ranking position then Paramedic, and pays accordingly. More stress for less money, I can't imagine why they're experiencing a shortage.

They should consider adopting the model from Palm Beach County; dual role Fire EMS with a majority of your force being able to provide ALS care, whether they arrive by engine or by rescue.

 

[docB]

The problem with the FDNY is that the department isn't dual role. You're Fire or you're EMS; leading to a critical shortage of Paramedics and EMTs, because the FDNY actually considers Firefighter to be a higher ranking position then Paramedic, and pays accordingly. More stress for less money, I can't imagine why they're experiencing a shortage.

They should consider adopting the model from Palm Beach County; dual role Fire EMS with a majority of your force being able to provide ALS care, whether they arrive by engine or by rescue.

Good points. I think Rogue Medic would disagree with you because he feels it causes a dilution of skills to require firefighters to be medics. We're seeing both ends of the spectrum here.

 

[deleted6669]

Good points. I think Rogue Medic would disagree with you because he feels it causes a dilution of skills to require firefighters to be medics.

yup, me too. la county does that and you get a bunch of yahoos on ems calls who could care less about being medics and just did it to get on with the dept.....let firefighters be firefighters and medics be medics. if I need lifting assistance I'll call a fireman, otherwise keep them off my scene....if my pt catches on fire I'll let you know...seattle has it right. medics (medic 1) are part of the fire dept chain of command but can be promoted to higher pay grades, etc without leaving their role of medic...and they don't have to be fire fighters at all......

 

[leviathan]

yup, me too. la county does that and you get a bunch of yahoos on ems calls who could care less about being medics and just did it to get on with the dept.....let firefighters be firefighters and medics be medics. if I need lifting assistance I'll call a fireman, otherwise keep them off my scene....if my pt catches on fire I'll let you know...seattle has it right. medics (medic 1) are part of the fire dept chain of command but can be promoted to higher pay grades, etc without leaving their role of medic...and they don't have to be fire fighters at all......

Or you can completely remove the EMS system from the fire department, as we have it. Fire here are first responders who know how to do CPR, use an AED, provide oxygen therapy, and a bit of spinal immobilization. They take care of vehicle extractions and rescue situations as well. The rest of the medical / trauma stuff they leave up to us when we arrive.

 

[jbar]

One suggestion was that most units be able to provide ALS. First of all I don't think you need a medic on every engine. Most medical calls can be handled by BLS for the ten minutes it takes to get a medic there. Secondly while a system like that might work well in a smaller area, it would be very very hard to do in such a large system. FDNY has something like 500 fire units (engine and ladder). So if they are having trouble staffing their current medic units, finding another 300 or 400 medics to be on the trucks will be pretty impossible.

Someone else suggested separating fire and EMS. This has some tricky historical issues since FDNY and NYC EMS were two different agencies until they merged a number of years ago (late 80s or early 90s). So it would be much harder to go back to an older system than it would be to create a new system.

 

[cavalier329]

merging will never happen. Its better the way it is. They are two entirely separate jobs, and some FF's dont want anything to do with the medical aspect, they just like breaking stuff. You don't want someone like that taking care of people. Leave it to those who are passionate about patient care and leave firefighting to those who...like fire i guess, idk.

 

[cavalier329]

The system is among the most efficient in the country as it is, there just needs to be a better incentive for people to join FDNY EMS and to stay there.

I mean, for people who want to be firefighters, its a pretty good deal. If the list isnt taking anyone at that point, join FDNY EMS, put some time into your pension, then when your number is called for fire, leave EMS and carry over the pension and get a raise...why not?!

Maybe making the pay = will retain more EMT's? We shall see if that happens in the next century...

 

[MadMack]

Departments in Palm Beach County are fairly unique in how wide a berth we're given when we work in the field. The majority of our population is extremely wealthy and extremely old; couple that with the fact that we outlawed Fire in 1965 and Fire has been pretty good about abiding by that rule. I would say, about 90% of the calls we PBC Fire Rescue gets are Medical; the ratios even higher when you hit municipal departments like Boca Raton; around here Fire is EMS, so much so, that cities like Boca, where we have 15 year veterans that have never fought a structure fire, are only hiring Nationally and State Certified Paramedics and no longer requiring you to be fire certified before you come in.

I should probably paint a picture of how our EMS system works. The majority of the time a rescue is going to be dispatched to the call; the rescue is going to have anywhere from 3-4 personnel on it. Generally it consists of the Rescue Lieutenant, and two other Paramedics; though sometimes it's the Lt. one other Medic and an EMT. Though its becoming more and more common for everyone on the Rescue truck to be a Paramedic, and most of the EMTs get pushed on over to the Engine. The Engines are generally staffed with a staff Lt. or Captain, a Paramedic and two other Firefighters; if its an ALS engine, most of those firefighters are going to be Paramedics as well. The reason we have so many Paramedics, is because our demographic demands it. Our entire County is ALS, meaning companies like AMR are required to have at least one Paramedic, one EMT and a driver on all their trucks. Having old people who enjoy calling for general weakness, and then coding while talking to you has necessitated a dual role Fire/EMS service with an increased ability to provide ALS support no matter which unit initially responds; rescue or engine. If you can efficiently intertwine the systems like we do in Palm Beach and Miami-Dade County, you can provide a seamless integration of Fire and EMS services to your community without necessitating two separate entities.

While I disagree with the thought that a lot of medics dilutes the quality of the service, I will agree that it can be a bad thing. What Boca Raton learned was that when you have three Paramedics responding to an unknown medical call and the patient starts showing signs and symptoms of Hypovolemic shock everyone's running around setting up life packs, spiking bags and setting up two 16g IV lines, and no one stopped to listen to lung sounds, get the guy in trendelenburg and put some blankets around him. Too often people forget that ALS comes after BLS. Maybe its because I get it pounded into my head in the ER, in Labs and in scenarios but I don't even consider a lot of ALS options; outside of getting EKGs on a medical patient until I've ruled out BLS treatment for them.

Medics in general are only good when they keep the patient's well being in the forefront of their mind; that sometimes means the best thing you can do for them is treat them using the skills you learned as a Basic and the assessment skills you learned as a Paramedic.

-e-

I got sidetracked and lost track of my point. Suffice to say; you can increase the number of medics in a service without decreasing the overall quality. It might be a damned good idea for FDNY to get some ALS capable engines in their Fire Departments if they have people willing to take the courses, or already have their certifications.

 

[jbar]

I am still not convinced that you need ALS engines. I haven't seen any data that having ALS first responders saves lives vrs. having EMT/FR on the fire trucks with an ALS ambulance a few minutes behind. In fact, there are a number of studies that show that having medics on scene for things like trauma either doesn't help or increases mortality. I just heard about a study where a major city in Asia added ACLS and medics to the streets, with no increase in survival of cardiac arrest patients. Etc, etc. Now I'm not arguing that there should be no paramedics, but I think you have to have some evidence that medics on engines make a difference, rather than just making everyone feel better that there is someone with more training there sooner. It costs a lot more to staff all your engines with fire medics than to have a lot of FF/FR and few medic ambulances. If the public's money is being spent you need to be able to justify the added costs. You could say "let's have EM docs out on ambulances, they have more training, so they should save lives." And why not have doctors on the fire trucks, having them their earlier would be even better.

I can tell you the number of calls where you need a doctor in the first ten minutes, almost the same number as needing a medic there that soon.

 

[MedicFL]

I think the data actually pushes for BLS in trauma. The less done in the field the higher the survival rates. I forgot what study but there was a study in an Urban setting that pts with penetrating traumas who waited for EMS had a 27% less chance of surviving than if they were transported by PD or family member on scene, some even came by cab. Oh and in real Fire Departments a rescue company is much like a truck company, they are not an ambulance which I don't know why many departments in FL insist on calling ambulances rescues. I don't think ALS first responders are the answer. Look at the state of NJ they have NO ALS ambulances in the state they have paramedic intercepts, a BLS truck responds and only calls for a medic if they need it and are often times intercepted in route by the medic who jumps on with all his ALS gear. I do agree that more medics in the system does often times "water down" the quality. I work with a Department that has ALS everything including towers and I asked one of the three medics on the truck when the last time he started an IV was and he said "about 3 years ago". Now this Medic gets floated out to a Medic Unit for the day because of staffing, you cant tell me that his skills are up to par with a guy that runs transports every shift..

 

[cavalier329]

do you have a link to those stats? I really want to read up on that for a proposal im putting together.

Thanks!

 

[leviathan]

While I disagree with the thought that a lot of medics dilutes the quality of the service,

I will disagree with your disagreement, because:

...three Paramedics responding to an unknown medical call and the patient starts showing signs and symptoms of Hypovolemic shock everyone’s running around setting up life packs, spiking bags and setting up two 16g IV lines

sounds like frantic paramedics who do not have enough experience with acutely sick patients to do the important things, like get them to a trauma receiving hospital ASAP.

 

[cavalier329]

I HATE when medics think they are doing something beneficial to a trauma vic by hanging around on scene to draw blood and hang a bag of saline

i mean, come on...in the time that it takes a sub-decent medic to finish all that I couldve been to the ED, had the pt headed up to CT, and back in service.

 

[jbar]

Though I will say that not a bad thing to have a medic on bad trauma if they can keep their scene time as short as an EMT. The worst trauma we had when I was an EMT was a women hit by a bus. Our scene time was 5min, to assess and backboard and my medic started 2 blood pumps with 16ga enroute to the hospital. That's how you do it, do the IVs on the road.

 

[cavalier329]

I agree. I got questioned on my turn around for a ped struck because it was 15 minutes from the time we got dispatched to the time we called out at the hospital

I was sort of insulted they questioned me haha. I told my capt that I would be sure to waste some more time next time. I think she got pissed.

 

[TarHeelEMT]

Back to the Fire/EMS discussion:

That's all weird to me, because here in North Carolina, it's actually illegal to have a dual fire/EMS system. There are some fire departments that also have an EMS branch by the same name, but they are very strictly separated and run out of different state offices entirely.

Personally, I don't think fire and EMS should be together - especially as EMS matures. Paramedics are becoming true healthcare professionals, and I think that being associated with fire departments is a stumbling block that prevents them from being respected (and paid) according to their merits.

 

[MadMack]

Back to the Fire/EMS discussion:

That's all weird to me, because here in North Carolina, it's actually illegal to have a dual fire/EMS system. There are some fire departments that also have an EMS branch by the same name, but they are very strictly separated and run out of different state offices entirely.

Personally, I don't think fire and EMS should be together - especially as EMS matures. Paramedics are becoming true healthcare professionals, and I think that being associated with fire departments is a stumbling block that prevents them from being respected (and paid) according to their merits.

Florida is a different animal from the rest of the country, especially when you get into my county, Palm Beach, where its a mandated ALS county. Meaning that every ambulance, everywhere has to have at least one Paramedic and one EMT. Fire has always been dual role in this county, and we produce some of the finest and best paid Paramedics in the country. As far as being paid what we're worth, starting salary for a probationary Paramedic/Firefighter with County Fire Rescue is $50,262, most municipalities are only 2,000 3,000 less then that for first years. You also get pension and outstanding benefits. Salaries increase dramatically if you step up to Driver, Engineer, Rescue Lieutenant, Lieutenant, Captain, EMS Captain etcetc. You run 24/48 shift schedules, and with that a lot of our Paramedics work in local Hospitals as ALS, EKG, Medical and Trauma Techs or run their own businesses. I personally think the way Fire and EMS are blended in this county should be the model for how a system should work.

Like I said, its very different here from the rest of the country, which is why we don't let anyone who isn't ex-military challenge our state exam without being a graduate of a Florida Paramedic program. Granted, not all our Paramedics are awesome, some are pretty sub-par, but then again, every field has to have a lowest bracket.

As far as respect goes, we're a very young part of the healthcare field, we've come an extremely far way in a short amount of time. Most docs I've worked with are very informative and always willing to help, because as ED docs they realize that its going to be me and my classmates out in the street taking care of the patients before they get to the ED. Some docs look down on us because we're not MDs, but these are the same docs who **** on their nurses and PAs. My biggest issue has been with RN's, some of them seem to have a burning hatred of Paramedics in general because of the freedom we're allowed in our scope of practice. But again, these are generally the same nurses that sit around bitching while their HIV patient in septic shock is being ignored.

What it comes down to is this: the respect we get is a direct result of the quality of work and professionalism of the Paramedic.

 

[MedicFL]

Florida is a different animal from the rest of the country, especially when you get into my county, Palm Beach, where its a mandated ALS county. Meaning that every ambulance, everywhere has to have at least one Paramedic and one EMT. Fire has always been dual role in this county, and we produce some of the finest and best paid Paramedics in the country. As far as being paid what we're worth, starting salary for a probationary Paramedic/Firefighter with County Fire Rescue is $50,262, most municipalities are only 2,000 3,000 less then that for first years. You also get pension and outstanding benefits. Salaries increase dramatically if you step up to Driver, Engineer, Rescue Lieutenant, Lieutenant, Captain, EMS Captain etcetc. You run 24/48 shift schedules, and with that a lot of our Paramedics work in local Hospitals as ALS, EKG, Medical and Trauma Techs or run their own businesses. I personally think the way Fire and EMS are blended in this county should be the model for how a system should work.

Like I said, its very different here from the rest of the country, which is why we don't let anyone who isn't ex-military challenge our state exam without being a graduate of a Florida Paramedic program. Granted, not all our Paramedics are awesome, some are pretty sub-par, but then again, every field has to have a lowest bracket.

As far as respect goes, we're a very young part of the healthcare field, we've come an extremely far way in a short amount of time. Most docs I've worked with are very informative and always willing to help, because as ED docs they realize that its going to be me and my classmates out in the street taking care of the patients before they get to the ED. Some docs look down on us because we're not MDs, but these are the same docs who **** on their nurses and PAs. My biggest issue has been with RN's, some of them seem to have a burning hatred of Paramedics in general because of the freedom we're allowed in our scope of practice. But again, these are generally the same nurses that sit around bitching while their HIV patient in septic shock is being ignored.

What it comes down to is this: the respect we get is a direct result of the quality of work and professionalism of the Paramedic.

You are wrong on who can challenge the state test. ANY RN, MD, Dentist or DO with a valid state EMT card and challenge the state exam. Anyone who hold a paramedic cert from another state may challenge the state exam. No military member who's training is not within the last year can challenge. Military medics or 91w's are only trained to the NREMT-I standard. The SF medics recently lost the ability to take the NREMT-P class. TO be a flight nurse in FL you must be a PM and RN I work partime on a bird and my partner took the FL PM test without ever going to paramedic school just about a year ago..

 

[emtcsmith]

I have become less and less for "ALS Engine" since it seems like the idea is that these type of responders will be the solution for a EMS service shortage. Paramedics need to be used for ALS patients, BLS patients need to be transported by BLS units. The next big issue is that an "ALS Engine" puts undo strain on the apparatus. Yes these units are going on CFR runs but in my ideal system Fire would only have to assist EMS in lifting/rescue/etc incidents.

In this urban type of environment the idea system would be a paramedic responder and large force of BLS transporting units.

 

[MadMack]

You are wrong on who can challenge the state test. ANY RN, MD, Dentist or DO with a valid state EMT card and challenge the state exam. Anyone who hold a paramedic cert from another state may challenge the state exam. No military member who's training is not within the last year can challenge. Military medics or 91w's are only trained to the NREMT-I standard. The SF medics recently lost the ability to take the NREMT-P class. TO be a flight nurse in FL you must be a PM and RN I work partime on a bird and my partner took the FL PM test without ever going to paramedic school just about a year ago..

I was thinking of reciprocity, not the ability to challenge the test, my mistake.

 

[docB]

In this urban type of environment the idea system would be a paramedic responder and large force of BLS transporting units.

Interestingly that "roaming medic" model is also used effectively in some rural areas.

One thing about EMS (and fire and schools and sanitation and etc. etc. etc.) is everyone thinks their place is unique and needs a system just like theirs with whatever special tweaks it has. Unless they hate their system and then it needs whatever they think it needs. One thing that is true with EMS is that it is always hampered by being at the intersection of lots of divergent personal, political, interagency and economic interests.