MORE LEGISLATURE STUFF - Rethinking Emergency Rescue Reality

CATSKILL -  They call themselves the “Joint Task Force on EMS Response Staffing Configurations,” which in Joe Average terms has to do with the number of workers needed to keep ambulances running smoothly.

A recent White Paper produced by the group is therefore deeply relevant to the discussions being led by the Greene County Legislature linked to potentially creating a unified county ambulance system.

Those talks have been ongoing for several months, prompted by an appeal from mountaintop government officials for county lawmakers to take the lead in addressing persistent issues in emergency medical rescue.

Hilltowners said the existing network, largely operated by municipalities, is unsustainable due to oppressive costs and manpower shortages.

The Joint Task Force lasers in on those two elements, drawing conclusions that may change the current thinking about where this new countywide system, if established, should place primary attention.

In the local talks, response time to the scene of a call is overwhelmingly hailed as the top priority, aiming for as swiftly as humanly possible.

There have been local voices, though, saying response time is not the end-all, be-all factor, especially as it entails staffing configurations and the dollars needed to provide efficient and affordable coverage.

The Joint Task Force sees the matter similarly, being composed of people from various national and international organizations including EMS physicians, firefighters and emergency dispatchers.

Their report is titled, “Rethinking Emergency Medical Services: Applying Evidence and Data to Redesign Response Models for a Resilient and Sustainable Future,” sounding right up Greene County’s alley.

It states, “the current emergency medical services delivery model places significant emphasis on short response times and advanced life support (ALS) staffing,” meaning on-board paramedics.

Greene County offers ALS service through its flycar system and in the towns of Catskill and Windham, and it is agreed no one wants to go backwards in current response times.

There is, though, a major problem with patient transport, not provided by the flycars, placing the burden most heavily on municipalities.

Local conversations have centered on combining the two, trying to arrive at the proper number of workers and ambulances that solution would require, a number ranging from 9 to maybe 12 or more ambulances.

Each ambulance, in addition to the vehicle expense, would result in more staffing, more payroll, more health benefits, etc.

It is a vexing question for Greene County, given its varied landscape with dense populations in valley and river communities and much more scattered distribution in rural, mountaintop towns and villages,

The Task Force report states, “contemporary evidence-based research has revealed response times have little to no impact on patient outcomes for the majority of EMS responses.

“Only 6.9 percent of patients accessing EMS require potentially lifesaving interventions,” the report states, an eye-opening low percentage.

Cutting to the chase in their “Conclusions” section, the Task Force states, “EMS systems across America are facing an unprecedented staffing and economic crisis.

“Some systems are failing while others are facing difficult decisions and insurmountable hurdles.

“Many of the reasons for the staffing and economic crisis are unrealistic public expectations based on beliefs that are not supported by contemporary evidence-based data,” the report states.

Strongly recommending that, “significant community education should be undertaken by local community and EMS leaders,” the Task Force report arrives at a surprise determination.

“Right-sizing expectations and EMS delivery based on scientifically proven EMS system redesign - specifically regarding ambulance staffing and  reasonable response times - may have a significant impact on EMS system sustainability in many communities across the country and help preserve an over-taxed, stressed EMS workforce.

“EMS system leaders should analyze response data in their local community and critically evaluate the acuity of patients requesting 911 EMS response,” the report states.

The ultimate goal is, “assuring patients with high acuity medical complaints receive a rapid response, including closest medical response resources with ALS support, and low acuity patients receive alternative responses,” the report states.

Local EMS pros say that distinguishing whether or not an ambulance is needed to drive a person to the hospital, rather than being mandated, regardless of the call, could dramatically ease overall system strains.

But there are presently no options. “There are required State protocols and regulations,” legislature chairman Patrick Linger says.

“We know there are patients who are transported to Hudson [hospital] simply because they need a ride to Hudson,” Linger says.

“If there is a waiting list to get into the Emergency Room, the ambulance has to wait and that is a significant call volume,” Linger says.

Acknowledging that response time is considered Priority #1 by many local EMS personnel, Linger says, ‘my point is that response time isn’t as important as having ambulances to respond in the first place.

“We’ve already lost agencies along the way to the current discussions. There’s no longer nobody there to pick up the slack,” Linger says.

“If we lose any more agencies, somebody isn’t going to get an ambulance when it’s called. We don’t want that to happen,” Linger says.