LEGISLATURE STUFF - 911 Call for 911 Service

CATSKILL - The proof will be in the proverbial pudding as Greene County Legislature members - now that they have it - ponder what to do with an extensive study on local emergency medical services.

Lawmakers recently received the 78-page report from Fitch & Associates, setting aside up to $100,000 for the independent review and its accompanying recommendations.

(Please see related story in “Better Than Hearsay” column regarding recommendations made by Fitch & Associates).

It will now be up to the legislature and a specially formed Ambulance System Policy Group how to move forward on the findings - or not.

Doing nothing would be unacceptable, according to legislature chairman Patrick Linger, who strongly backed bringing in the outside consultant.

Lawmakers approved the idea and investment after government leaders from mountaintop towns made an ardent appeal, last winter, to do something - anything - about struggling ambulance services. 

“We’ve been down this road before and came away without a solution to the problem,” Linger said at that time, referencing the work of a special Task Force established a decade ago for the same purpose.

A unified, countywide response and transport system was proposed, but did not get enough support from key municipalities to succeed.

“It failed back then. We don’t want to put that effort in now and have it fail again. We need to come up with something actionable to improve the system we already have in place,” Linger said.

Toward that end, the Fitch study states they were hired to, “assess the

county’s emergency medical services (EMS) resources and develop future options for a high-performing, sustainable EMS system. 

“The County was aware that the current EMS agencies were experiencing increased stress due to staffing and financial issues, which continued to impact the community.

“These are trends FITCH is seeing across the State of New York and the entire country,” the report states, noting, “emergency medical services are organized disparately in Greene County.

Each town and village [has] to either provide or contract for service. The system comprises ten agencies,” covering the county.

The report, in its Key Findings section states:

—“LACK OF PERFORMANCE METRICS CONTRIBUTES TO SYSTEM INEQUALITY. Currently, there are no common countywide response times or performance standards. Each agency is tasked to monitor its own standards and is not required to report them. 

“The system does not formally track or trend any aggregate performance metrics. This reliance on self-policing by the agency has led to inequities in service levels regionally and across the system as a whole.

—“GEOGRAPHY AND SEASONALITY CREATE STAFFING AND PERFORMANCE CHALLENGES. The geography of Greene County presents unique challenges for the system.

“Three distinct geographic regions exist: the mountain region, the valley region and the river region. Each presents unique characteristics that must be planned for in system design.

“Due to the region’s characteristics, each requires unique performance standards and operational expectations. Seasonality also presents challenges that affect the system as a whole.

“During the winter months, there is an influx of visitors for ski season. These visitors predictably increase demand during weekends and holidays of the ski season.

“It was reported that system resources could quickly become challenged by this increased demand for service despite its predictability.

“System design must account for these demands and other reasonable, predictable temporal events.

—“SILOED EMS AGENCIES INCREASE RISK. As each EMS agency participating in the County is independent, they are all unique in various

operational aspects.

“Each agency has its own policy and procedures, pay rates, quality

assurance program and operational expectations for staff. 

“Patient experience can vary from agency to agency based on the level of care provided, equipment purchased and utilized, level of experience and training of practitioners and protocol differences to a lesser extent.

“These disparities lead to a variety of patient experiences throughout the system. Variances in any EMS system increases risk to equitable service and clinical care.

—“NEED TO REGIONALIZE SERVICES. The EMS agencies in Greene County all work independently of each other, carrying their overhead expenses and direct labor costs. 

“Many also employ the same care providers. Having multiple agencies increases costs and inherent inefficiencies in operations.

“The Certificate of Need (CON) process in New York State establishes service areas, but as of now, these areas are not financially sustainable on their own.

“Implementing a localized EMS strategy would benefit the entire County and provide more cost-effective options.

—“SYSTEM LACKS A CULTURE OF SAFETY. It was reported that multiple care providers routinely work more than 72 hours per week, including more than 24 hours at any particular time.

“Numerous leaders and care providers reported this practice. With many agencies needing help to meet their specific staffing requirements, safety has taken a back seat to readiness. There is also a need for routine safety monitoring programs to be utilized.

—“DISPATCH SERVICES SHOULD BE EXPANDED. Greene County Emergency Medical Services (GCEMS) dispatch provides excellent

communication services.

“The Medical Priority Dispatch System (MPDS) is currently being utilized effectively. All 911 EMS calls should be initially received by GCEMS dispatch. 

“EMS agencies being dispatched by GCEMS should be required to accurately provide all status changes and unit “mark-ups” 100% of the time. 

“In addition, EMS agencies should be encouraged to provide real-time location data for accurate tracking and system management.”

No exact timeframe has been set by the legislature and the Ambulance System Policy Group for ultimately choosing a direction or to stay put.