Results of Volunteer Chief/Captain Survey

16 Surveys were returned, 15 agencies participated (one agency returned two questionnaires) 4 (25%) completed by Fire Chief, 10 (63%) completed by EMS Captain/Assistant Chief, 1 (6%) completed by Director of Operations, 1 (6%) completed by Quality Improvement Director.

The oldest department-based ambulance service started in 1941, the youngest in 1997. The median year for starting ambulance service is 1967. The smallest department responded to 17 calls in the first quarter of 1999, the largest went to 246 medical emergencies. The average number of responses for all agencies is 95 during the first quarter. Annually, the smallest department went to approximately 70 emergency request for service, while the largest went to nearly 1,000. Of 1,420 calls during the first quarter, less than 2% were turned over to mutual aid ambulance. Approximately 11% of emergency responses were for motor vehicle accidents, 44% were medical, and 8% were stand-by events, the remaining 37% of calls were not categorized.

Most agencies thought the New York State Department of Health EMS Office and the various regional councils were helpful.

Only two hospitals were rated extremely helpful, while 10 hospitals received no-help ratings. Only three hospitals had more than half of the respondents offer an opinion regarding helpfulness.

Among private ambulance companies, Monroe received ratings of "extremely helpful" and "no help." A majority of responses regarding both Monroe and Rural Metro-Rochester were "not applicable." All three ambulance companies had their largest block ratings as "very helpful."

None of the three air ambulance services received "extremely helpful" or "no help" ratings. All three medevac services had the majority of scoring in the "very helpful" or "helpful" categories, although at least half the respondents reported Mercy-Flight Buffalo and Guthrie as "not applicable" to their agencies.

All EMS support organizations included in the survey received "no help" ratings, while only one received an "extremely helpful" rating. Interestingly, not every agency uses 911 communications, although it did receive the greatest number of "very helpful" ratings. Also notable, is the Red Cross (another volunteer agency) receiving the largest number of "no help" ratings despite its mission to help victims of disasters.

Law enforcement agencies, on the other hand, are regarded favorably by all respondents.

Eleven departments reported average response times. The shortest average response time was 3 minutes, 30 seconds; the longest reported was 10 minutes; the average of the averages was 6 minutes, 23 seconds. Only four agencies reported fractile response time reliability and all four claimed 90% or higher performance.

In regards to acceptable response time intervals, the average BLS was reported at 7 minutes, 30 seconds, with a range of 2 to 15 minutes. The acceptable response time for ALS averaged 9 minutes, 19 seconds, also ranging from 2 to 15 minutes.

A majority (62.5%) of respondent agencies report no first responder personnel respond to the scene before the ambulance. However, 25% of agencies reported defibrillator-trained staff routinely arrive before the ambulance. The remainder (12.5%) report non-certified personnel or FR/EMTs are sent to medical emergencies before the ambulance.

The three most important factors for the success of a volunteer ambulance service are: recruiting, retention, and meeting member needs. According to the respondents, the least important factors to success are financial management and fund raising.

Interestingly, the areas reported as needing the most improvement are the same: recruiting, retention, and member needs. The areas reported to need the least improvement includes one of the least important (financial management) as well as two others: quality management and customer service.

The only clearly identified positive impact on patient care reported is the addition of more volunteers. Every other system change is regarded as having no impact or a negative effect on patient care.

Only 31.5% of agencies reported an outside organization performs quality improvement activities for the department. Of those outside quality improvement, an equal number reported the feedback was valuable as reported feedback had little value.

Youth programs are available in 37.5% of respondent agencies.

Chief/Captain Comments
Specific for Genesee Valley Rural Health Network 
Livingston County

Please describe how some of the agencies could assist you better in three of the most important challenges you face as a leader of a volunteer department?

Give better feedback on the way we treated the patients. Did we do well? Is there something else we should have done?

The camping area in Letchworth Park would receive more rapid care if Perry Ambulance and Wyoming County ALS were dispatched instead of Rural/ Metro stationed in Lakeville, as occurred on 08/19/99.

County Health department and County EMS: Better communication of information from DOH, REMAC, etc. to volunteers. Faster response to questions and concerns. Better working relationship between EMS coordinator and County Emergency Management director-fire and EMS. EMS coordinator who will advocate for volunteers without intimidation of superiors. 

County EMS coordinator is little to no help - lack of leadership and has no control over the EMS providers in Livingston County. The coordinator should take a more proactive approach and be a problem solver.

County EMS and Public Health need to actively work with the volunteer agencies to develop a county wide recruitment / retention plan.

An EMS Agency lacks Hare traction splint, Kendrick extrication device (KED), orthopedic (scoop-style) stretcher, etc., yet financial resources of Rural Health Network were used for fax/copier which is superfluous for OPC reports. CFP's fax is adequate. 

We don't get to Strong that often, but when do, we can kiss our equipment (backboards, MAST pants, etc.) goodbye.

Hospitals: Better feedback re: quality of care and patient care issues. Also patient outcomes.

The Office of Emergency Management (fire coordinator) and the EMS coordinator do not communicate with each other. Ten of twelve ambulance services are fire department ambulances. Many problems would go away if they worked together.

The state DOH regulates ambulance service. County health department just serves as another layer. As most EMS agencies in this county are operated by fire department and EMS is really emergency service. It should fall under the office of the Director of Emergency Services. Hospitals should give feedback on patient's diagnosis and outcomes. Useful for training, QA and QI.

There are more and more regulations initiated by all services and many times, it has been discussed that the end results all point to practically forcing volunteer ambulances out of business. 

An EMS unit receives $180,000 per annum from BOCES for a lease for a school. None of that income has been given to CFD for recruitment, training or retention of volunteers who will be needed for EMS for students at that school.

Could MLREMS please stop the pilot programs? And could they also look a little further south of Henrietta when they implement a new policy? After all, it is the Monroe Livingston Regional EMS Council.

Increased availability of continuing education programs for volunteers in Livingston County.

County medical director should get involved in the decision making process with the county and the EMS providers. Right now the medical director's involvement is very limited.

Not listed, but tax breaks for volunteers both EMS and fire. May help retention problem.

Some feedback from hospitals, paramedics, and air transport could helps us know what to do differently or better next time.

Please describe how quality improvement could be made more valuable for your department.

We receive QI/QA information form OPC and at present feel it is adequate.

Feedback would help tremendously. 

This is done through group and does nothing to help. 

What has been the impact of Medicare's refusal to directly reimburse for paramedic intercept (fly car) services?

Residents in our community are now afraid to call for an ambulance when they have a medical emergency because they know we have to call for ALS and they have to pay.

Let me show you some newspaper articles!!

Very negative impact. Our elderly are being forced to choose quality health care in an emergency situation based on financial resources. Many refuse ALS when it is truly needed.

It causes a hardship for the patients because of a bill that goes directly to them. A bigger problem occurs when the service is needed again and the patient refuses ALS because of the bill. 

Some elderly patients refuse ALS (paid) service because of direct billing fear. 

Many patients refuse fly care services because they feel they can't afford it. Some of these patients truly need the paramedic intervention. Time is wasted trying to convince them.

Many public complaints. 

How would you redesign the EMS system in your area?

The financial resources of the Rural Health Network and the Livingston County Department of Health would be utilized to assure all EMS vehicles have the capacity of cellular telephone communication with the medical control at Strong Medical Hospital. Color codes, similar to those being utilized in Monroe County, would be available to the Livingston County 911 center for North Noyes Memorial and Wyoming County Community Hospital and to EMS agencies so that our patients can be informed of any anticipated delays in care upon their arrival at the destination hospital.

Get rid of the proprietary services and place EMS (BLS and ALS) under municipalities - just as police are. If the volunteers can't supply the service, then the municipality should be required to hire the appropriate personnel. 

I would put the EMS coordinator's position under the direction of the Emergency Management director. All but two ambulance (volunteer) services in this county are fire department ambulances. I feel that as long as these two entities are regarded separately it will continue to be a struggle to keep fire and EMS working together toward the same goals.

Decrease the number of minutes before a call is mutual aided. Improve volunteer recruitment and retention. Increase the number of proprietary ambulances staged in the county with funding from the county or state for idle time. More medical director and county coordinator involvement.

The EMS office should take a more active role. EMS should be taken away from the Public Health office and placed under the Emergency Management Office. There is absolutely no support for Public Health other than superficial lip service.

Would have paid volunteers to cover part of the time to relieve such few volunteers. I believe it would make a tremendous difference and not have so many burnouts. 

We have so few volunteers that I would supplement with paid. We cannot convince the town officials that it could work. Money is the big object. I would also like to incorporate the fire department with the EMS department.

Chief/Captain Comments
Specific for Rural Health Community Services
Steuben County

Please describe how some of the agencies could assist you better in three of the most important challenges you face as a leader of a volunteer department?

Give better feedback on the way we treated the patients. Did we do well? Is there something else we should have done?

Rural/Metro Corning's management views Volunteer EMS as a threat and does not look at the big picture of providing EMS vs. profits. Their billing techniques have seriously damaged EMS's reputation. 

Seems to me that NYS/DOH requires an EMT on every run to be from a certified agency. County mandates an ALS unit be dispatched for all calls but the very basic. It would seem that a reduction in the basic ambulance requirements could provide faster response, more volunteers and still provide ALS coverage for the more severe cases.

Could help sponsoring training.

Some training with all EMS in county to keep everyone current. Sometimes to do a monthly training may help.

Dispatching - 911 needs to stay in the cities where it belongs and works, and leave us alone. The first step towards it (control dispatching - which is new to us) only inhibits us - our response time, location details, nature and details of the call. 

I feel dispatching is the biggest problem. There are so many areas where communication is not possible.

Help with callout.

It will help when 911 system is installed. We are not affiliated with fire department so cannot use Steuben County Services to be called out. We can not get any reliable pagers. Callouts are a real problem.

There are more and more regulations initiated by all services and many times, it has been discussed that the end results all point to practically forcing volunteer ambulances out of business. 

Interfacing with ALS units. We are an ILS unit. I think the rules for interfacing should be different between a basic and an ILS unit.

Not listed, but tax breaks for volunteers both EMS and fire. May help retention problem.

The county needs to target areas of long response times and assist agency in developing a plan to resolve, i.e., paid service back-up, paid staff, etc. 

Numbering at homes and roads. Many roads have same names in two different areas.

Please describe how quality improvement could be made more valuable for your department.

We review certain calls with St. James EMS and our medical director. I think a bi-monthly meeting and discussion between us would be useful.

Our QI program works well for us now. We could offer to help other groups to develop and implement a QI program. 

Address needs of volunteers. 

Feedback would help tremendously. 

This is done through group and does nothing to help. 

QI is just one more paper chase. Our best QI is that our medical director reviews every PCR and makes comments on them. This seems to have more impact than any other way.

Woodhall does their own QI. We seem to do okay. I would like to see the hospital follow up by telling us the outcomes of the patient that we bring that are listed in the "critical stages".

What has been the impact of Medicare's refusal to directly reimburse for paramedic intercept (fly car) services?

Residents in our community are now afraid to call for an ambulance when they have a medical emergency because they know we have to call for ALS and they have to pay.

We ask patient if they would like ALS and tell them there is a charge for service from ALS.

Patient refusal of ALS. Cannot afford. Most are on fixed income. Government is aware of status, local and state, but refuse to fix it.

Detrimental to patient care. Our ALS has been refused at the door because the patient thought there was going to be "another" bill. Once it is explained to them that our ALS is part of the ambulance and there will be no bill, they allow treatment. 

Many of our residents are complaining.

Patients suffer. They feel they can't afford the charge and want to refuse the care needed. 

People are refusing ALS.

Very negative effect in this area. Whenever possible we travel to Hornell.

How would you redesign the EMS system in your area?

Our department has few EMT's. I would place every medic on a set schedule to cover calls. Put ALS on automatic dispatch to all medical emergencies, i.e., chest pain, trouble breathing.

Get rid of the proprietary services and place EMS (BLS and ALS) under municipalities - just as police are. If the volunteers can't supply the service, then the municipality should be required to hire the appropriate personnel. 

Improve the relationships between the volunteers and the paid services.

Very good.

I would bring the EMS system under the director of Emergency Management Services. Appoint a deputy coordinator or two for EMS. Hire a secretary to cover EMS paperwork. Then reevaluate the system. Maybe county paid EMTs of ALS technicians placed in key areas as needed to supplement volunteers. Maybe consolidating some groups.

The EMS system overall is fine. Problem areas of response times needs to be actively addressed. 

If it ain't broke-don't fix it.

I would employ a full EMS coordinator to oversee EMS classes, certification communications and set a standard operations countywide with one dispatch center with countywide SOPs. We also need to get more volunteer ALS in Steuben County.

For the most part we do okay. It would be nice to have Steuben have their own "stems" since Steuben is mainly volunteer units. Or even to be more like Allegany County-all under one roof so-to-speak.