Some recent articles about the controversy in Chicago with EMS responses and the availability of ambulances;
This from CBSChicago about a memo to dispatchers:
The CBS 2 Investigators and the Better Government Association have been warning about an apparent shortage of Chicago ambulances and paramedics. The result: dangerous delays for patients needing emergency care.
So far, it seems the city is trying to cover the problem up instead of fixing it. In the meantime, the response times for ambulances are just getting worse.
“Anybody available downtown that can take a run,” a dispatcher’s voice crackles through the scanner speaker.
These are the types of calls paramedics say happen every day. “It’s clear they have no ambulances and it clearly validates what we’ve been saying that they need more ambulances,” said paramedic field chief Pat Fitzmaurice.
But now, city officials apparently don’t want the media or anyone else with a scanner to hear some of those transmissions asking for help. They are asking dispatchers to watch what they say.
CBS 2 and the BGA obtained a copy of a memo written by a supervisor at the Office of Emergency Management. It called shout-outs for any available ambulances: “not an acceptable practice.”
The memo instructs dispatchers to, “Avoid terminology like we have no ALS (advanced life support) ambulances available,”….particularly when they have to send a basic life support ambulance to the scene and a fire engine with a paramedic on board. Basic life support ambulances do not have paramedics and the same equipment as advanced life ambulances.
Dispatchers should use ambulance numbers to instruct staff in the field on what to do in those cases, the memo said, adding, “Hopefully we can get the message across without highlighting the fact that no ALS unit is available.”
The memo also concedes that, “We all realize that certain times we are inundated with runs and lack of resources.”
This is from EMS1.com:
A city-issued memo obtained by CBS Chicago asks dispatchers to watch what they say, calling shout-outs for available ambulances “not an acceptable practice” and instructing dispatchers to “avoid terminology like we have no ALS ambulances available” so as not to highlight the fact. Written by a supervisor at the Office of Emergency Management, the memo also states, “We all realize that certain times we are inundated with runs and lack of resources.”
Better Government Association CEO and President Andy Shaw said the city should be addressing it.
A spokeswoman from Chicago’s Office of Emergency Management said the memo is an “informal internal document” that serves as a reminder to dispatchers to use “approved protocol and professionalism.”
CBS has continued coverage of long response times, including incidents where it took 16 minutes for an ambulance to respond to a woman struck by a postal truck while crossing the street, 22 minutes for an elderly patient complaining of chest pains, and 26 minutes for an ALS response to the home of an elderly woman having trouble breathing.
A spokesman for the Fire Department said the 26-minute response time was “unacceptable” and the incident is under investigation. In a written statement, the Fire Department said it is conducting a review of its ambulances to ensure deployment meet the needs of Chicago.
Also from EMS1.com:
The head of most EMS operations is the communication center. The responsibility is huge. It is the first point of contact for the community when reporting medical emergencies.
[Dispatchers] coordinate the system’s resources, trying to match the appropriate unit to the appropriate incident. Dispatchers use various forms of technology to help make those decisions: software, GPS, dispatch algorithms, among others. The system has to be able to send the appropriate resources at the right time to avoid going to a zero-level condition. Sometimes that’s unavoidable, but regulating the system to minimize a zero-level condition can help reduce the possibility.
How does Chicago keep track of their resources? It seems a little strange that a dispatcher doesn’t know where the units are at any given time. While Chicago is a big system, other similarly sized systems seem to be able to tell which ambulance should go where at any point in time. Is this a sign of a larger issue? If there are ways to increase the effectiveness of system operations, throwing more ambulances at the problem isn’t necessarily the fix.
#1 by "J" on April 10, 2014 - 5:47 PM
One factor over looked is the fact that the immediate need for a 3rd Fire Candidate class can now be delayed and possibly put off for a class from a new list of applicants. With the elimination of the “BLS” core of firefighters needed to man the 15 taxis (somewhere in the 120+ range in manning numbers when daley days and furloughs are considered) it gives the chiefs and manpower people more flexibility in placing often needed EMT’s on the BLS fire companies.
On another note…My hat goes off to all the guys and gals who were thrown into the program when they were first hired (even though it wasn’t even on the radar when they applied for the job) and made the program work…for those on the outside looking in they risked a lot on their future by working in this program often with others who were incompetent and unqualified.
I had never had to ride an ambulance in my career but always appreciated the professional level many of them performed at the positive attitude they maintained.
In closing candidates on the Chicago Fire Department can be Candidates again. This is huge for the citizens of the city because the field training that so many new hires had been shorted on because of the ambulance details will be be back and their officers will be able to fully mentor and train them.
#2 by Dennis on April 9, 2014 - 11:12 PM
I do not believe that the 15 BLS ambos will all be converted to ALS. I believe it will be just 5 additional ALS ambulances. 200 more paramedics is still not enough when currently the fire department is short close to 350 paramedics with just 60 ambulances covering 4 platoons.
#3 by Drew Smith on April 9, 2014 - 10:25 PM
My point is that the law allows for 1 and 1. While most EMS systems require 2 paramedics that is the prerogative of the system’s medical director (MD or DO) and the provider (such as a FD or private amb) could negotiate a change in policy with that single person rather than IDPH. If the provider is subject to a collective bargaining agreement that contains staffing levels then that’s a whole other story. Regarding 1 and 1 versus 2 paramedics, in the EMS system my FD belongs to the policy is not two paramedics assigned to the ambulance but rather that there must be two on the scene and two during transport. While the practical effect is that there are two assigned to the ambulance it would be possible to meet the requirement otherwise.
#4 by FFPM571 on April 9, 2014 - 8:37 PM
The new contract states… 15 BLS ambulances upgraded to ALS 200 paramedics to be hired by September… http://www.chicagotribune.com/news/politics/clout/chi-emanuel-firefighters-reach-contract-deal-20140409,0,6612933.story
#5 by Dennis on April 9, 2014 - 8:08 PM
Jim, Most FF’s do not want to be on an ambulance. Anyone hired after 2008 must have and keep their EMT-B status but anyone before 2008 can drop their EMT-B status. Guys come and go in the EMT-B program because they get burned out from doing 20+ runs on and ambo and then also miss fires at their companies. Hence why some guys drop it after a year. Yes it is a 5% increase in pay for the EMT-B but it only matters for the pension in the last 4 of the last 8 years on service.
Fleet Guy, The BLS program was not put in place to make up for anything about the buggy drivers. The buggy drivers were long gone before the BLS program was put into place. The commissioner at the time was Trotter who was a single role medic and he wanted something to take the weight off the ALS ambualnces. The program is a total failure. The only way for anything to improve is educated the public about the ambulance service and to go back to screening calls.
Also ” obamacare ” does NOT cover BLS transports because they are a non-Emergency, non-life threating condition transport. Just because Chicago goes lights and sirens in transport doesnt mean it’s an emergency.
#6 by NJ on April 9, 2014 - 10:53 AM
Fleet guy, how would upgrading all rigs to ALS help the supposed lack of coverage for BLS? Many many ruins with the ALS ambos are BLS and logged as such, so if you are correct, upgrading rigs doesn’t help, unless they ALS everyone regardless of need.
#7 by Jim on April 9, 2014 - 10:28 AM
Dennis,
Why would someone drop their EMT or Paramedic status? Aren’t you providing a better service to the residents and such increasing your worth?
#8 by Joe on April 9, 2014 - 9:51 AM
@Fleet guy. I’m going to need a citation from a real and reliable source on your Obamacare claim. BLS service is still covered under private insurance, medicare, and medicaid. None of the aforementioned will pay for an ambulance transport if they deem the condition non-emergent. Yes, BLS transports are less likely to be deemed emergent, but BLS transports are today and will continue to be covered by insurance. The service level of the transport agency is irrelevant.
#9 by Dennis on April 9, 2014 - 8:16 AM
Chuck, They are detailing guys almost everyday to ALS ambulances. In the 19th Batt. alone one day last week 3 guys were pulled and put on ALS ambo’s. Also as of last year there is no more sign up program. The one time pay is gone, and no more signing 5 year contracts. If guys want to opt out the can at anytime unless their still under the old 5 year contract. I was one of the first who got the pay but did not sign a contract because there was no contract to sign.
#10 by Fleet guy on April 9, 2014 - 4:24 AM
Let’s not forget there are 9 ALS equipped ambo’s down at SLD now at the ready for use. ie the taste, a blizzard ect they are number 70-79 all they need is manpower. So this conversion from bls to ALS is going to happen. The city will win a manning victory in the public eyes with the conversion. FS&R will lose 20 ff/emt jobs a day that means 20 less ff/emt on overtime. the bls program was put in service FS& R lost BC buggy drivers but got the BLS program. Also other reason this change is coming soon Obamacare does not pay for BLS service.
#11 by Chuck on April 9, 2014 - 3:08 AM
If the City starts detailing FS&R FF/PM’s to ALS ambulances every single day, that will have multiple NEGATIVE effects. There will have to be multiple rehires of that rank, which, if they cannot FIND ENOUGH individuals willing to be rehired to cover the ALS engine and truck vacancies, will force those companies which still DO have EMT-P personnel available to not only run more(if that’s humanly possible, at this point,) but run further and further away from their still district, and will cause a mass exodus of personnel from the ALS program when the chance to opt of the program comes around. And then where will this city be?
#12 by Dennis on April 8, 2014 - 7:39 PM
Also here is what is currently in the contract for the ALS ambulances:
1 paramedic and 1PIC or 1 AC in each of the 60 or more ambulances on average on a daily basis over a one week period(monday-sunday), but no less than 57 ambulances on a daily basis: provided that if due to exceptional cicumstances on a given day 57 or more ambulances cannot be mantained in service or if 60 or more ambulances per day by weekly average cannot be maintained in service, the union shall be notifed in either or both instances and the union and the employer shall meet and discuss the reason and take steps to avoid a repetition.
Also in this section it states:
To meet necessary manning requirements and operational needs, the employer may detail cross-trained dual certified personnel from fire apparatus or ambulances. Such personnel detailed to an ALS ambulance shall act as the paramedic/driver and the EMS paramedic assigned or detailed to that ambulance shall act as the PIC.
#13 by Dennis on April 8, 2014 - 7:25 PM
Ok here is what the contract states. June 1, 2014 the manpower opens up for negoations. If before then the union agrees to discuss switching the BLS to ALS then once the union and the city agree to discuss that then it also opens up all manning. So in effect the city can say hey we will switch the BLS to ALS but we want to elminate the 5th guy on all companies. Thats why I believe nothing will happen till after June 1st because then the manpower requirement is open then to negoations. Yes our contract expired on June 30, 2012 but there are still sections that have different expiration dates.
#14 by Jim on April 8, 2014 - 6:31 PM
Chuck,
Why do you think the city would be foolish to tie minimum manning and more ambulances together? In the court of public debate, I would bet that the city could spin that they want to increase the number of ambulances while reducing the number of firefighters on some companies.(No reduction in total manpower) If they were to show the amount of runs the ambulances are doing compared to fire runs, that would get the public on the city’s side. Most people are concerned with ambulance services rather than fire services. I’m not saying it is right but facts are facts.
#15 by Dennis on April 8, 2014 - 6:16 PM
Drew Smith, the EMS system that chicago is in along with Ingalls and Christ and maybe others require any ALS ambulance to be staffed with 2 paramedics. Now if it is a new start up ALS service then the local system may grant a 1 year waiver to the department to have the ALS ambulance staffed by 1 paramedic and 1 EMT-B. I highly doubt that Chicago will put 1 paramedic and EMT-B on an ALS ambulance but they may apply for the 1 year wavier for the newly formed ALS ambulances if it is deemed that the city has too few single role medics. Now they may also require the FF/PM’S to be detailed to the ALS ambulances until they get enough single role medics (which they’re doing now anyway). Adding more ALS ambulances will not have any effect on the runs, the shortage, or the wait times. The only clear cut way to fix any of this is to go back and screen the 9-1-1 calls. Someone with a runny nose, the chills, a stomach ache, her period, and many others do not need an ambulance.
#16 by Drew Smith on April 8, 2014 - 2:55 PM
There is no waiver from IDPH needed to staff an ALS ambulance with one paramedic and one EMT. The law already states that is the minimum: http://www.ilga.gov/commission/jcar/admincode/077/077005150F08300R.html
TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER f: EMERGENCY SERVICES AND HIGHWAY SAFETY
PART 515 EMERGENCY MEDICAL SERVICES
g) Personnel Requirements
3) Each ambulance used as an Advanced Life Support vehicle shall be staffed by a minimum of one Paramedic or Pre-Hospital RN and one other EMT Basic, Intermediate, Paramedic, Pre-Hospital RN or physician on all responses.
#17 by 0.02 on April 8, 2014 - 2:47 PM
The manning clause expires in June 1,2014. What that meant was neither side could talk about it before then. And yes there is a possibility of manning being connected to ambulances. The city has been trying to reduce manning in double company houses from 10 to 9 between both rigs.
#18 by Midwest Medic on April 8, 2014 - 2:31 PM
Chuck, just for informational purposes, the state of Illinois already allows any ambulance in it to run “one and one.” The two paramedics on a rig concept is either Chicago’s choice, or they are being forced by their resource hospitals (they have three) to run with two paramedics on every ALS ambulance.
#19 by Chuck on April 8, 2014 - 2:22 PM
.02, where do you get June 1st? The City and the Union have been in “negotiations,” as you put it, for over 2 years – the current contract, if you can call it “current,” expired June 30th, 2012. And there is NO WAY the City will tie more ambulances and minimum manning together. If they do, they’re stupider than they already look now. And they could get the 15 in service rather quickly, by asking the State of Illinois for a temporary waiver (lasting a year,) to go 1 EMT-P and 1 EMT-B for manpower.
#20 by 0.02 on April 6, 2014 - 8:37 PM
There is most likely going to be a paramedic class soon. There are interest letters going out to medic candidates and currently medics are working almost 24 on 24 off because they are so short handed.
#21 by Bill Post on April 6, 2014 - 7:16 PM
For informational purposes Chicago’s BLS ambulance program wasn’t recommended by the “Tri Data Study” of the Chicago Fire Department that was commissioned by the city and released in 1999. The BLS ambulance program was somebody else’s idea.
While the trend has been for fire departments and Ems systems around the country to put BLS ambulances in service to handle the non life threatening Emergencies not all fire departments run a “2 tiered system” and Dallas Texas still runs with an all ALS system. Phoenix Arizona within the last few years had gone from an ALS/BLS ambulance system to an all ALS system with one paramedic and one Emt assigned to each ambulance.
Midwest Medic does make some good points.
The Chicago Tri Data study at the time had only recommended adding 6 full time ambulances to the fleet which was based the CFD averaging about 227,000 EMS call per year which is what the average was in 1998. At the time the CFD had only 59 ALS ambulances in service.
The report had further stated that if the call average were to increase to 250,000 calls per year (as the run numbers had been increasing upwards during those years) that 12 additional ambulances would be needed in Chicago. That was based on mathematical formula based in average ambulance “Unit hour Utilization rate” of .42 which considered to be the “ideal” rate for a large city ambulance system which was based on the experience of managers of high performance EMS systems around the country through “trial and error”.
As that was based on averaging the ambulances the hours that they could be available against the amount of Ems calls that the system would average in a year it also meant that there would be individual ambulances that would exceed that average as the .42 was based on a system wide average.
As there at least one third of the ambulances exceeded that average it was also recommended as possible solution to have what is known a “power shift” ambulances.
To simplify it the report had suggested the possibility of running extra ambulances during the busier hours (which in most places tend to be from the mid afternoon to late at night). The part time ambulances are also know in some places as “power shift” ambulances.
A number of cities do run “power shift” ambulances during the busier times of the day and evening such as Dallas Texas , Phoenix Arizona, Philadelphia and New York City just to name a few.
While it’s true that New York City runs most of their Ambulances on 8 hour shifts (like the police operates) so they always run less ambulances during the midnight shift, in both Dallas and Phoenix the fire fighters and most of the Paramedics work on 24 hour shifts similar to Chicago so some type of an arrangement would have to be worked out for the power shift or the “over time” ambulances. That is a possible solution to the problem however it would complicate things for the Union and the city to work out an arrangement like that as the “power shift” ambulances wouldn’t be in service for a full 24 hours.
Around 1986 when the Chicago Fire Department was only running with 49 ambulances in service a local EMS study was made for the Chicago Fire Department that had recommended increasing the number of Ambulances to 60 (at the time) and having some of the ambulances go out of service for the “Midnight shift” while several ambulances would have been relocated. That local Ems study also had 2 of the ambulances change locations depending on the time of day it was.
Mike Mc and anyone who maybe interested ,from June 1976 (when the CFD only had 36 Ambulances in service) Ambulance 45 would regularly relocate from their current quarters to Engine 5’s house (near downtown) until November 1981 during between the hours of 8 am and 6 pm during the day when the loop was more crowded. Ambulance 28 didn’t go in service until April of 1983 almost a year and a half later however by 1982 there were 42 ambulances in service with more to be be added within the following year or two.
The CFD also had relocated Ambulance 48 to Engine 104’s old house at 14th and Michigan during the day for the Holiday Shopping season from late November through New Years of 1982. So the Chicago Fire Department at one time did relocate ambulances downtown before more of them were put in service.
This was meant for informational purposes.
#22 by Medic on April 3, 2014 - 5:30 PM
Does anyone know if their will be another 100 medics in the next class after the one ends in June?
#23 by 0.02 on April 3, 2014 - 2:16 PM
The BLS rigs are not going ALS on June 1st. This is something the union and city have to negotiate over and this is tied to the minimum manning clause which can be talked about as of June 1st per the contract. In sure the city will try to get the union to give up minimum manning on fire rigs for more ALS ambulances and dropping the BLS ambulance program.
#24 by Jim on April 3, 2014 - 2:08 PM
Is there a source for this info?
#25 by Mike Mc on April 3, 2014 - 1:42 PM
Not a bad plan. By eliminating the BLS ambulances you can balance out the manpower costs of hiring the new paramedics. Not an exact balance, but close enough to justify the move. A lot of OIC and Commander positions that will open up.
Technically the same number of ambulances on the street. However, if they are all ALS, you should see the number of runs drop since more runs can be shared. The BLS ambulances never really absorbed as many of the runs as intended.
It will get the media off the mayor’s back, at least for a while. That is good for all concerned. Like it or not.
I always liked the idea of putting more ALS ambulances in the loop during the work week from 8:30 until 6:00. Keep pace with the popluation flux. Long runs if no one available. High visibility. Closer media attention. People see the first responder rig, followed by an ALS rig, followed by an ambulance, and it can give an unfavorable impression to the public. Can’t always be helped but you should try and minimize it.
Mutual aid with the suburbs in the outlying areas of the city would help. Not on a regular basis, just in the extreme cases when no ALS is available within a reasonable distance/time. A policy could be worked out for the FAO to execute. The suburban departments do this with each other all the time. Maybe the suburb sends you a bill. So what?
Separate but realted issue. The south side has to have another trauma center. That is something the mayor’s office can work on.
My full name is Michael M. McAuliffe, just a fan. If anyone wants to know.
#26 by NJ on April 3, 2014 - 8:32 AM
Is that a really new plan?
Are they going to renumber them to be sequential or just leave them as they are?
#27 by Josh on April 3, 2014 - 7:47 AM
Yes…All BLS ambos will be turned into ALS by June 1st….and yes there will be a medic class
#28 by Chuck on April 3, 2014 - 12:59 AM
300 letters went out, looking to hire 120. All 15 BLS rigs to become ALS.
#29 by NJ on April 2, 2014 - 11:07 PM
No. The new medics are just to replace retired personnel to cut down on overtime and rehires. No new ambos. No conversions of BLS to ALS.
#30 by Dylan on April 2, 2014 - 10:35 PM
CFD is starting up a Medic class sometime soon. The Mayor wants the class to graduate by June to get them on the streets. They are converting all BLS Ambulances to ALS and are putting out 5 more Ambulances I think.
#31 by Ed M on April 2, 2014 - 6:53 PM
Back in the mid 80s the 911 Dispatchers used to Triage the 911 calls, if they did not deem it an Emergency they would pass it off to a Central Dispatch System operated by a group of Private Services. This freed up the City Ambulances to cover the emergent calls, seemed like a pretty good system, and I am not sure if they still do it or not, but if not it might be worth revisiting. Just my 2 cents though.
#32 by chris on April 2, 2014 - 1:30 PM
They can track a snowplow and they can’t a ambulance
#33 by Midwest Medic on April 2, 2014 - 12:50 PM
There’s about a million ways to improve the “shortage” of ALS ambulances in Chicago. Using more BLS ambulances to handle calls (of which there are many) where ALS is not needed. Community paramedicine (to address system abusers, deliver patients where they need to be instead of just dumping them in an ER, and preventing preventable ER trips in other patient groups), paramedic chase cars in conjunction with increased BLS ambulances so that the paramedics can free up if they aren’t needed, and staffing one EMT and one Paramedic on ALS rigs (yes, it’s doable, and works nicely in many, many places) to better distribute existing paramedics. Those are just a few ideas. There’s a lot of good systems out there with far less resources than Chicago has. If Chicago can’t figure it out they aren’t trying.
#34 by Jim on April 2, 2014 - 12:48 PM
Does anybody think this is going to be a setup for the city to cut staffing on some fire companies while increasing the number of ambulances? I would bet the public as a whole would be very supporting of an argument like that.
#35 by Chuck on April 2, 2014 - 12:10 PM
Vehicle tracking? Please. City won’t spend $ on that.
#36 by NJ on April 2, 2014 - 10:26 AM
First off, CFD is way short on ambos. Rigs should not be doing over 7500 runs per year.
What they’re leaving out is why they can call for “available rigs to take a run” but they’re not officially in service. They chilling at the hospitals for long periods of time. That is an issue. However, it cuts both ways. On one hand they should be back in service when done, not 30, 45, 60 min later. However, on the flip side if they’re doing so many runs while staying OOS for the extra time, imagine how many they’d be doing without that.
Bottom line if CFD needs at least 15 more ALS ambo’s in addition to the current setup of 60ALS/15BLS. Simnple converting the BLS will not help much.
#37 by Crabby Milton on April 2, 2014 - 9:22 AM
I was thinking the exact same thing. We have the same crap in Milwaukee. There’s always money for nonsense and programs that have proven to be failure over many decades but not enough for public safety. We already have encrypted radio called OPEN SKY. That won’t completely hide the incompetence though.
#38 by Mike Mc on April 2, 2014 - 8:58 AM
You know what the real fall out of this is going to be … don’t you? The Mayor’s office will order that the radio transmissions be encrypted. Probably soon.