Closest ambulance goes?

[DrParasite]

Question for y'all:

Does your EMS system follow the rule of closest ambulance goes, or do they have an area that is covered by just one agency (who is responsible in a given area, regardless of how many calls they get until they request mutual aid)?

In NJ, as a general rule, EMS is very municipal oriented. Every town has it's own EMS agency, or contracts out to a non-municpal EMS agency (hospital based, private, non-profit/volunteer, etc). Regardless of if there is a closer ambulance by location, the home agency will handle all calls in their boundaries, and they can either stack calls or request outside mutual aid.

Where I used to work, our station was 1.3 miles from the town & county line. Along that that road were several developments and high occupancy lowrises, on the other end of the double yellow line. for the local AHJ to respond, it was at least a 3 mile trip. If they were busy, their mutual aid was either 6 miles or 3 miles away, depending on who was called. we were still 1.3 miles, but since we were in another town, and another county, we rarely went. and if they needed a 2nd or 3 ambulance (or heavy rescue) for an MVA, we had crews staffed 24/7, but were rarely called if the MVA was on their side of the double yellow line.

So with the discussion about closest ambulance in Flint Michagan, and how many of the public want the closest unit to go, and not the contracted provider, I was curious how it worked in everyone else's neck of the woods.

 

[JPINFV]

1 contracted service, contracted mutual aid/backup services. The problem is two fold. First off, the individual cities can always require additional equipment above and beyond what the state mandates (for example, there is no mandate in California that every ambulance has a defibrillator (manual or semi-auto), but the cities can require it of their contracted ambulances. Also the 911 ambulances may have access to county dispatch frequencies that non-911 ambulances don't have).

Second, given the general volume of ambulances in major cities, it's impossible to track all of them and when they are ore aren't available. We're talking about hundreds upon hundreds of ambulances.

 

[DrParasite]

I should also mention, in my home town, there is a a stretch of state highway that is another town. that means the local EMS agency leaves their station, heads up the highway, enters another town/another agency's response area, than reenters their hometown a mile up the road.

We also have some "limited access highways" where the only way to get on is by entering another town, or going down the highway, leaving your town, making a U-turn, and reentering the original town by heading in the highway in the opposite direction. had this happen to me when I stopped at an MVA recently.

 

[DesertMedic66]

1 contracted agency for the whole county. Within the county there are 3 divisions of the same company.

We have 3-4 fire departments that transport only people in their cities (we run mutual aid for them).

For all of our main response area we will use all of the units in our division. If we don't have anymore units in our division then we call for mutual aid from the fire department. They can either send one of their ambulances or they can deny mutual aid. Then we will have units from the 2 other divisions come to take calls/cover the city. (all of these ambulances are ALS).

If we have a pending call that we don't have any units and fire denies and the other divisions units are too far away then we will send a BLS ambulance of our own. If we don't have any available from all 3 divisions then we call the purely IFT companies to see if they can take it. If they can't, and this has happened before, then the fire department (assuming they are on scene) will transport a patient in the engine if it is possible. If its not possible then the patient/911 caller has to wait until a unit goes available or finally comes into our area from one of our other divisions.

Confusing :unsure:

 

[JPINFV]

...but it doesn't really explain why AMR Rancho responds to Mt. Baldy except for the fact that Mt. Baldy Village is on the exact opposite side of the Riverside/LA county line.

 

[DesertMedic66]

...but it doesn't really explain why AMR Rancho responds to Mt. Baldy except for the fact that Mt. Baldy Village is on the exact opposite side of the Riverside/LA county line.

Is Mt. Baldy village in San bernardino county? I don't know that area at all.

 

[CANDawg]

Where I'm from, the closest ambulance is dispatched generally. There are specialized teams that respond to certain types of calls (i.e.: there is a team that responds to most of the calls involving the homeless in the downtown core), but for the most part dispatch will send the unit that is available and nearest.

The system works well since there is only one service (publicly run third service), and all trucks are ALS. Once you start throwing competing services and BLS/ALS trucks in, it starts to get a little bit harrier. I'm not sure which side of the line I fall on.

 

[JPINFV]

Is Mt. Baldy village in San bernardino county? I don't know that area at all.

So it is... and so is Rancho. It still doesn't make sense for AMR to run it in contrast to Schaefer, which covers the road leading to Baldy as well as a good chunk (if not all of) Glendora Ridge Road.

 

[DesertMedic66]

So it is... and so is Rancho. It still doesn't make sense for AMR to run it in contrast to Schaefer, which covers the road leading to Baldy as well as a good chunk (if not all of) Glendora Ridge Road.

It's all county based for AMR. If its in San bernardino county then AMR goes to it (unless it's big bear or Rialto where the fire department transports). If its in another county then AMR can't take it. There are political issues when it comes to responding to a call that is in a different county.

If the roads to the village are in LA county, for example, but the city is in San bernardino county then AMR will cover the city only. So if there is an accident on the road itself then it will be the contracted LA county company/fire.

For where I am at it literally comes down to what side of the road the call is on. If its a TC on the east side (from the double yellow lines) then fire will transport. If its on the west side of those lines then we take it. If it is unclear as to where the actual call is then both a fire ambulance and my companies ambulance will be sent to the call until it is determined who gets the call. It's stupid.

 

[TRSpeed]

So it is... and so is Rancho. It still doesn't make sense for AMR to run it in contrast to Schaefer, which covers the road leading to Baldy as well as a good chunk (if not all of) Glendora Ridge Road.

If Baldy is in San Bern county then AMR will technically be closer to respond since the road up is in San Bern county. Why would a LA county ambulance be faster to respond. AMR doesn't just cover Rancho.

Edit. I didn't check the EOA coverage areas but if the roads leading up to Baldy are in LA county, then I understand what you are saying.

Schaefer and AMR units can be anywhere at a different time especially because of system status management.

 

[NYMedic828]

In NYC, FDNY ultimately controls every 911 ambulance. Hospital based companies are dispatched by FDNY, and NYC charges a hefty premium to allow those companies to play in their sandbox to begin with.

That said every unit has GPS built into the vehicle and we are dispatched by the closest appropriate unit for the assignment. The GPS sucks quite often and people will get on the radio and tell dispatch they are closer.

 

[rwik123]

In NYC, FDNY ultimately controls every 911 ambulance. Hospital based companies are dispatched by FDNY, and NYC charges a hefty premium to allow those companies to play in their sandbox to begin with.

That said every unit has GPS built into the vehicle and we are dispatched by the closest appropriate unit for the assignment. The GPS sucks quite often and people will get on the radio and tell dispatch they are closer.

How does hatzolah work in NYC? I never fully understood it.

 

[socalmedic]

If Baldy is in San Bern county then AMR will technically be closer to respond since the road up is in San Bern county. Why would a LA county ambulance be faster to respond. AMR doesn't just cover Rancho.

Edit. I didn't check the EOA coverage areas but if the roads leading up to Baldy are in LA county, then I understand what you are saying.

Schaefer and AMR units can be anywhere at a different time especially because of system status management.

its literally a flip of the coin on who will get that call. baldy is berdu county, however the road up to there is in LAco. berdu co fire has a BLS engine which will respond, LAco usually gets requested for closest ALS. and if its winter AMR may have an ambulance up there for the ski resort. if its summer schaefer may get the call or one of the LAco AMR rigs may get the call.

 

[socalmedic]

in my county the closest ambulance will get the call. we are all in CAD with AVL.

 

[NYMedic828]

How does hatzolah work in NYC? I never fully understood it.

They are their own entity separate of the 911 system.

The only way you get hatzolah is by calling hatzolah directly. 911 has no affiliation with hatzolah, thank god for that. (no religious pun intended)

 

[Shepard]

In my county most 911 ambulance is contracted, with the exception of two or three FD-based ambulances that are backed up by contracted ambulances. All 911 dispatching is on one main dispatch, and the closest ambulance or engine or apparatus goes. We have mutual aid agreements, but there is a "no-zone-whoever-is-closest-gets-it" policy here. Not just limited to amb. but includes fire.

 

[DrParasite]

in my county the closest ambulance will get the call. we are all in CAD with AVL.

directed to you and any other county based, so if you have an area on the county line, will you only pull from your county, or will your dispatch center call the next county over and say "I have a call in town on the county line, do you have a closer unit?"

 

[socalmedic]

directed to you and any other county based, so if you have an area on the county line, will you only pull from your county, or will your dispatch center call the next county over and say "I have a call in town on the county line, do you have a closer unit?"

yes and no, my county is unique to the countys around it, in that to the south all ambulances are BLS where as we are all ALS. we will auto-aid for closest ALS, be it fire engine or squad, but our ambulance will still get dispatched to transport. we will run into the south to fill in for a missing BLS ambulance if they have none available, but that is rare. to the west is the pacific ocean... no aid there. to the east there really isnt much there, we have an ambulance on the county line, but the next closest ambulance is 45 min or so away, so we will give any call to the other county which is about 1/2 the distance. north is still AMR with the same medical director so we share calls near the county line, they are on AVL as well so it is easy to tell who is closer. they have an ambulance closer to the county line than we do so they take more of our calls then we do of theirs.

hope that helped.

 

[medicdan]

I'll throw a wrench into this discussion... How do you feel about individual facilities or entities entering into their own contracts for ambulance coverage-- separate from the city or county EMS system. The perfect example of this is nursing homes... who call private contracted ambulance services for everything... How do you feel about these contracted ambulances responding from several towns or dozens of miles away, while competent ambulances sit in the town?

Do you think these nursing home runs are "below" the city EMS? Are the extended response times justified because the patients are in a "healthcare setting"? We all hope this isn't happening for cardiac arrests and the like, but we all know it does.

Thoughts?

 

[Christopher]

I'll throw a wrench into this discussion... How do you feel about individual facilities or entities entering into their own contracts for ambulance coverage-- separate from the city or county EMS system. The perfect example of this is nursing homes... who call private contracted ambulance services for everything... How do you feel about these contracted ambulances responding from several towns or dozens of miles away, while competent ambulances sit in the town?

Do you think these nursing home runs are "below" the city EMS? Are the extended response times justified because the patients are in a "healthcare setting"? We all hope this isn't happening for cardiac arrests and the like, but we all know it does.

Thoughts?

Wait, your nursing homes don't call 911? Sign me up! Just kidding.

Non-emergent transfers? Emergent transfers? No reason transfers? Our skilled nursing homes call 911 for all of these. I wish they used contract ambulance services more.

Why shouldn't they contract with a provider for non-911 issues?