No Unit Available

[Guest ~~~]

Wow, just wow. I have heard about a shortage of emt's before, but nothing really like this. Any other thoughts?

Hit me at the part where the supervisor told one of the emt's that she shouldn't have wasted her time trying to help a woman with heart failure.

[Arctickat]

Well, now that those medics are out of a job, tell 'em to give me a call. I'll put them to work. They're heroes in my book.

[Bieber]

Occasionally we'll get down to having only three or for units available, and every now and then we'll have no available trucks--that never lasts for very long, though. Once they put out on the radio that we're at "status", everyone starts bookin' it to get available ASAP.

[Richard B the EMT]

All EMS personnel in large cities have variants of this. My old district was served by 4 BLS and 2 ALS units, covering an 11 mile by 1 mile isolated area, the Rockaway Peninsula. Some times, the Boro Command, or the Queens East dispatchers (on their own initiative), would redeploy "inland" FDNY units to cover, if and when it got busy, or Jamaica Hospital based units.

Laws got to be changed. A drunk, sleeping it off, or homeless person sleeping on the street, doesn't want any EMS bugging them, but a well meaning John Q. Public sees them, and calls 9-1-1. We have to respond. If we determine that they are alcohol impaired, we must take them, I know I'm not the only EMS crew person that had to drag a patient out from behind a lineup of cars in the driveway to the ambulance from their residence.

But an area of Detroit's size and population served, optimally, by only 44 ambulances, 22 on the road at any one time, but further cut down to only 18? NYC sometimes throws 18 ambulances, mixed BLS and ALS, to multiple alarm fires, heavy Multi Casualty Incidents, and obvious major incidents, along with one or more of the Major Incident Response Vehicles, each MIRV capable of care and transportation of 5 stretcher patients at one time.

18 ambulances? We'd jump over the nearest, and bring them in from further away, and other units would temporarily be responsible for larger areas then normal.

I recall 4 simultaneous MCIs, 2 in Brooklyn, one each in Manhattan and the Bronx. We handled them, but, while probably slowed down somewhat, still handled the "regular" caseloads.

If money is being misappropriated from ambulance purchase, maintenance of the existing fleet, and new crew hiring, the City and State attorneys should prosecute someone, just not the EMTs and Paramedics that are usually the only faces the public gets to see, up close and personal.

Sorry, but even someone who declares "No New Taxes", if the ambulance is delayed for them, would say "raise the taxes" to prevent EMS from NOT being around to rescue THEM.

Addendum: My area of NYC used to be served by 2 hospitals, but now it only has one, and that one also serves nearby Nassau County. Ambulances have to travel further to an ER/ED when the one local hospital gets jammed and slammed, so everyone is awaiting bed assignments in an ER/ED. Delayed in the hospital, then travel time back to Rockaway, over one of only 3 roadways in or out of the Peninsula.

[Guest ~~~]

All EMS personnel in large cities have variants of this. My old district was served by 4 BLS and 2 ALS units, covering an 11 mile by 1 mile isolated area, the Rockaway Peninsula. Some times, the Boro Command, or the Queens East dispatchers (on their own initiative), would redeploy "inland" FDNY units to cover, if and when it got busy, or Jamaica Hospital based units.

Laws got to be changed. A drunk, sleeping it off, or homeless person sleeping on the street, doesn't want any EMS bugging them, but a well meaning John Q. Public sees them, and calls 9-1-1. We have to respond. If we determine that they are alcohol impaired, we must take them, I know I'm not the only EMS crew person that had to drag a patient out from behind a lineup of cars in the driveway to the ambulance from their residence.

But an area of Detroit's size and population served, optimally, by only 44 ambulances, 22 on the road at any one time, but further cut down to only 18? NYC sometimes throws 18 ambulances, mixed BLS and ALS, to multiple alarm fires, heavy Multi Casualty Incidents, and obvious major incidents, along with one or more of the Major Incident Response Vehicles, each MIRV capable of care and transportation of 5 stretcher patients at one time.

18 ambulances? We'd jump over the nearest, and bring them in from further away, and other units would temporarily be responsible for larger areas then normal.

I recall 4 simultaneous MCIs, 2 in Brooklyn, one each in Manhattan and the Bronx. We handled them, but, while probably slowed down somewhat, still handled the "regular" caseloads.

If money is being misappropriated from ambulance purchase, maintenance of the existing fleet, and new crew hiring, the City and State attorneys should prosecute someone, just not the EMTs and Paramedics that are usually the only faces the public gets to see, up close and personal.

Sorry, but even someone who declares "No New Taxes", if the ambulance is delayed for them, would say "raise the taxes" to prevent EMS from NOT being around to rescue THEM.

Addendum: My area of NYC used to be served by 2 hospitals, but now it only has one, and that one also serves nearby Nassau County. Ambulances have to travel further to an ER/ED when the one local hospital gets jammed and slammed, so everyone is awaiting bed assignments in an ER/ED. Delayed in the hospital, then travel time back to Rockaway, over one of only 3 roadways in or out of the Peninsula.

I realize in major cities, even in some rural areas the shortage of emts and/or ambulances for care. I like how you mentioned raising taxes, I was thinking about a little motto: "Put down your chips, pay a bit more, you never know when a heart attack will creep up on you after 30 years of unhealthy eating." Although that's with the expection if they can start an IV, interp a ECG, give pain control. Also can't forget about the beta-adrenergic blocking agent. ( Good luck with getting beta blockers ) Which is common sense, people do not have that sort of stuff laying around. They don't look at the EMS in the same way untill they actually need it. Around here whatever fire district you live in has a ambulance fund. I'll take my town as an example, we have a population around 2,000 and everyone single one of the town members will get a donation envelope and more than half of those are turned down and the ambulances do not receive any donations. I believe it would be another story if they were currently be treating and transported by that fund and one of the EMT's asked for a donation.

Buuut on another hand can't forget about the family members with excessive reactions.. "No ma'am, your son just has a minor scrape on his knee. He's fine, but thanks for calling 9-11, not like we had any other more importants calls to respond to. Next time try using kneepads on him." - maybe that was a bit over exaggerating and what I really felt like inside. But I know someone out there has had calls like that. It's stuff like that holds units back. Luckily around here all of the fire department's ambulances are BLS and we have a county service that's ALS. If the dispatcher thinks they need ALS they will send out a small rescue truck with ALS personnel and the BLS ambulance. ALS personnel will go along with the patient to the hospital on the ALS unit. Which from the history of the area seems like it has helped.

Better planning always works as well.

Measure twice, cut once.

[MikeEMT]

This is an old video and there is more to it than just no units being available. This was a report on the poorly managed state of Detroit EMS. This was their attempt to get help and change and it failed. Neither medic was fired for this video, but the medic featured in it did resign last week.

[Just Plain Ruff]

In the area where I used to work, we had 1 maybe 2 ambulances to cover the entire county. When we had a bad wreck and both ambulances were out on that wreck, that's it, the county was uncovered and mutual aid was it. If more than 2 ambulances for the wreck were needed or another ambulance call came in, well, we just had to wait or the other patient just had to wait.

There were times when two nurses had to jump in the third ambulance we had in the garage and go on the call or we would start calling local crew members.

Luckily this didn't happen a lot but it did happen.

Unfortunately, we live in a world with finite resources and unfortunately, when you are the one requesting the resource that finite doesn't allow for, then you have to wait. It sucks, and causes bad press for the ambulance service but that's the name of the game and until more money is allotted for more ambulances, then this will continue to happen and even throwing more money at this problem will not stop the calls from coming in.

You just hope that you can provide for the population you serve. This is why prediction services such as SSM and other types of models are so popular.

[WolfmanHarris]

Demand for service in general and my region specifically is outpacing service growth even without the negative impact of economic austerity. I may make great political sound bite to call for across the board belt-tightening in tough economic times, but some services can weather that without impacting the general public better than others. With approx. 90% of costs of EMS (here at least) being wages and benefits, cuts would only result in less unit hours. Whether this is realized by cutting overtime, delaying hiring, or actual lay-offs the only end result can be delayed responses and increased staff burnout.

Thankfully I work in an area with a vibrant tax base and growth as well as a regional council that has so far been very supportive of funding growth in Paramedic services. However, even with planned growth call volumes are increasing and the time per call (including turnaround) is still increasing. This trend is not expected to reverse with the aging demographic and immigration so increasing funding is only part of the solution. My service is currently exploring major projects in Community Paramedicine that will initially start transporting low acuity patients to Urgent Care Centres and expand to programs that will see more treatment in place of LTC patients with follow-up in the home and eventually better treat and release within the community. These solutions are novel and potentially very effective but can only exist on the foundation of a strong core EMS system. Detroit and other severely economically depressed areas cant pursue better solutions for their patients when they can't even reach their true emergencies in a manner the public expects.

In the short years I've worked we have had a few days where call-volume has severely depleted our available units. While we are station deployed, our posts are hierarchical and as stations are emptied lower priority posts are moved in to cover these area. Below a certain number of units low priority calls (non-emerg IFT, non-emerg 911) are held and at six available units or below we switch to mobile deployment covering one of six major intersections in the region. I can think of perhaps a half dozen times when I've been working that volumes have depleted us to the point we go mobile though certainly on a regular day I can find myself extremely far from my home station covering busier areas. With the way our mutual aid agreements work we can call neighbouring agencies in not just to handle calls (this is done regularly in border areas of the region since the closest Ambulance regardless of service must legally cover the emerg call) but will actually start posting them in our area. I know of this happening once and it was combined with a call-out to begin upstaffing spare vehicles and the movement of medics assigned to HQ onto the trucks.

[Guest ~~~]

This is an old video and there is more to it than just no units being available. This was a report on the poorly managed state of Detroit EMS. This was their attempt to get help and change and it failed. Neither medic was fired for this video, but the medic featured in it did resign last week.

How do you know this? Do you know the EMT that resigned? I know the video is old by the upload date, not trying to slam you or anything.. just curious

[MikeEMT]

How do you know this? Do you know the EMT that resigned? I know the video is old by the upload date, not trying to slam you or anything.. just curious

This is how I know: http://www.ems1.com/ems-management/articles/1339321-Outspoken-medic-resigns-from-Detroit-EMS