EMS Subcommittee

Monday, March 28, 2022 - 9:00 am

 

 

Robin DeLoria - Chairman

 

Chairman DeLoria called this EMS Subcommittee to order at 9:00 am with the following in attendance: Clayton Barber (9:15), Robin DeLoria, Derek Doty, Noel Merrihew, James Monty, Matt Stanley (9:05), Ike Tyler, Meg Wood, Mark Wright, Mike Mascarenas, Dan Palmer and Max Thwaits.

 

Also present: Dina Garvey, Bryse Taylor and Matt Watts.

 

News Media present: Tim Rowland

 

 

DELORIA: Okay, Matt, Iíll turn it over to you since Rob isnít here, or one of you three, pick.

 

TAYLOR: So, we are going to have some resolution requests for staffing agreement renewals and contracts for providing equipment to agencies, but we have not gotten the actual contracts back from Dan Manningís office, yet. We met with him on Friday to make the last couple of changes we needed. Basically, it took the agreement for staffing, the agreement to provide equipment under the grant and our ALS intercept agreement with the agencies and put it into one contract.

 

DELORIA: Will those resolutions be on the table today?

 

TAYLOR: They are.

 

WATTS: I believe they were supposed to be, yeah.

 

MASCARENAS: Those are just all renewals, Bryse with the agencies that weíre already contracted with?

 

TAYLOR: Thereís 3 renewals with agencies that are moving off the first year of grant support and into the second with a paid salary of the employees there and then thereís a global ALS intercept contract that weíre sending out to the all the agencies that we interface with, with the medic cars.

 

WATTS: And also the equipment one.

 

TAYLOR: For Wilmington.

 

WATTS: Keeseville and Keene, as well.

 

DELORIA: Whatever became of the Lake Placid requests, is that tabled?

 

TAYLOR: Their only request, initially, was for liquid funds, which we canít distribute from the grant and there was no response of follow-up requests.

 

DELORIA: Understood, then.

 

TAYLOR: Iíll continue to attempt to arrange a meeting with them, follow-up on that and other grant support options for them.

Staffing gaps; we have a continuous listing for all the positions that are open. We hired, actually it was a move from Public Health, Dakota Olcott, heís an EMT on a grant project for Public Health. He moved under us and is full-time in Etown-Lewis. Nathan Thomas was the part-time employee in Newcomb that we have discussed giving hours under one of the medic car contracts. He is going full-time this week, so heíll be helping cover stations for call-outs, vacation time and heíll be in the medic car when thereís no stations to cover. I do have one more candidate who is currently a per diem with us for the last fly car position thatís open that weíre not taking hours from. I had discussions with him last week and weíll be moving forward, he needs to give his 2 weeksí notice to his full-time employer and heíll be starting in the middle of April. So, weíll have some much better public visibility with our medic cars out.

 

MASCARENAS: So, Bryse, weíre we able to meet our contracting obligations with our staffing?

 

TAYLOR: Yes, all of the contracting agencies are fully staffed we were able to quickly full the opening in Etown-Lewis when we had our resignation. So, the contracts are being fulfilled.

Etown-Lewis and Westport are in discussions about sharing a second EMS staff provider between the two of them. Their next board meeting is the end of this month, I believe then theyíll bring it to the Board of Commissioners and the squad members and then Iíll have discussions with Etown-Lewis about how they want to do that, if itís feasible.

 

TYLER: How do they do that? Are they sharing all three entities will share or two entities will share? Etown-Lewis and Westport?

 

TAYLOR: It would be similar to the contract they have prior to getting staffed by us, where they had one person that was stationed in Etown, but would respond to Westport calls. So, it would give Etown a full crew most of the time and they would split the crew to support Westport.

 

TYLER: Howís that charged?

 

TAYLOR: The fine details of who pays how much would be worked out between the squads themselves, it wouldnít be from us, based on number or calls answered or hours on the ambulance, Iím not sure.

 

TYLER: It just seems to me that if theyíre stationed in Etown-Lewis it would take longer to get to Westport, I donít know. Youíre right, I have to have that conversation with them, because if theyíre paying the same, they shouldnít be.

 

TAYLOR: I donít believe that you guys have overnight facilities in the fire department and Etown-Lewis does.

 

TYLER: No, we do now.

 

TAYLOR: Okay, so that would justÖ

 

TYLER: As far as I know, we better have, for $4 million.

 

THWAITS: Yeah, the previously contract they didnít, that would make sense.

 

MASCARENAS: So, theyíre looking to contract with us or is that something else?

 

TAYLOR: Yeah, it would be the County employee shared between those two agencies, because neither agency can absorb the full cost of an employee.

 

MONTY: So, wasnít the fly car, the thought process with the fly car was to fill in those gaps to cover; right? So, weíre looking to something in addition to the fly car?

 

TAYLOR: Yes, because the medic cars arenít on overnights, which is the timeframe that theyíre looking for.

 

MONTY: Why donít have the medic cars working around the clock?

 

TAYLOR: Thereís not typically a call volume to support that.

 

MONTY: But, thereís enough call volume to support putting somebody in a squad overnight?

 

TAYLOR: Thereís not really, but the alternative is them dropping all the calls in that timeframe, nights and weekends.

 

MONTY: We recently had a call dropped, next door here, we waited over an hour for an ambulance to come for a basketball player that hit their head and weíre local and that was at 6:30.

 

MASCARENAS: Yeah, I think for the County to cover any additional shifts we probably have to double our staff to cover the medic cars and if thatís something the County wants to do, we can do that, it would save the locals at the cost of the County.

 

DELORIA: But, with the data that you collect from the dropped calls you would kind of find out where the actual needs are, or are we actually creating needs because people have that need on weekends and nights and so forth. I would think that would be data you would use.

 

TAYLOR: So, theyíre trying to preempt the dropped calls on the weekends, because they have essentially 3 providers that cover all of their calls and several of them have out of town commitments that can take them away for the entire weekend. So, theyíre trying to be proactive in obtaining staffing coverage.

 

DELORIA: When you say overnights, whatís the timeframe, is that from 9:00 PM to 6:00 AM or, I mean how has that been planning out?

 

TAYLOR: So, typically shifts are 6:00 PM to 6:00 AM, 12 hour shifts, but every squad is a little different.

 

MONTY: I hear thereís been an issue with a couple of squads where members are shutting their pagers off and not responding. It maybe the situation why we waited an hour for somebody to come here, if it was my daughter, I would have taken her right over here to the hospital.

 

TAYLOR: This was in Etown that this happened?

 

MONTY: Yes

 

TAYLOR: Do you know what date that happened?

 

MONTY: I can get it for you, but it was probably a month ago, maybe 6 weeks.

 

DELORIA: So, you said those 3 agencies are in discussion on sharing positions and theyíre going to work out the schedules?

 

TAYLOR: Yes, that would be in collaboration with the two of them, if it works. The bottom line is the money has to come from somewhere and not everybodyís able to cover the costs.

 

DELORIA: Are those 3 agencies part of the medical billing where theyíre getting reimbursed for the cost?

 

TAYLOR: Etown-Lewis is, Westport is in discussions to become able to bill. Me and Ike sat with the Board of Commissioners and one of the Chiefs and the head EMT and had just over an hour meeting with the way to be able to enable them to bill.

 

TYLER: Hopefully this new legislation will help.

 

TAYLOR: I mean so, the reality of it is everything that weíre doing is in flux until after April 1st, because thereís a large change to Part 800, which governs EMS in the Governorís budget bill. If it doesnít pass April 1st then the executive orders expire a lot of our programs are going to be completely shut down, until thereís legislative change to Part 800. All the community para-medicine programs, mobile vaccinations, all of that will be completely shut down, if the Part F to Part 800, doesnít pass.

I also had a meeting with Keene, who is, they separated their ambulance from their fire department, so they can bill and get revenue recovery. They have a CON that covers the entire town of Keene. I am attempting to moderate discussions with them about combining their ambulance districts, so Keene and Keene Valley and they already, pretty much staff, so not a lot will change with that, but it would allow them to build a schedule with more resources to cover the gaps.

 

DELORIA: Are they receptive to that idea?

 

TAYLOR: Not initially. I am working on it.

 

DELORIA: You need more Robin approach; you negotiate their surrender.

 

THWAITS: I would say theyíre about 60/40, right now.

 

TYLER: How did that process go?

 

TAYLOR: They said it wasnít very challenging, it was time consuming and itís really much simpler, because they donít have to apply for a CON, itís a transfer of CON and thatís a much faster process through the REMSCO and through the State to get that done.

 

DELORIA: I find that hard to believe, but I will believe you when you say itís faster to do it through the State.

 

TAYLOR: No, no, no, itís faster than applying for a new one. Itís not fast, by any means, itís faster than applying for a new one.

 

DELORIA: Shorter application, only 26 pages instead of 38; right?

I will add, this is a good point to add this, when we went to the conference in Albany, Shaun and I sat in on the EMS debacle and Shaun lit right into them and he kept looking at me for my turn, you know, so we feel that we kind of set the record straight on why people are, these agencies are losing volunteers and whatís happening, whether or not it fell on deaf ears, I cannot tell you, but we didnít, we didnít filter our conversation with them.

 

TAYLOR: Yeah and itís a realistic and nationwide happening that EMS is moving away from volunteer. The certifications are becoming more stringent, thereís serious discussions that the paramedic being a degreed program, like a RN.

 

TYLER: Great

 

DELORIA: Understood, thatís what they want, but whether or not theyíre going to get that is another matter.

 

TAYLOR: Well, all of the large lobbying agencies for EMS, so, NAEMC, National Association of EMS Physicians, National Association of EMTs are all pushing for this agency.

 

DELORIA: We canít find truck drivers, where are we going to find paramedics? They want a physician assistance on every ambulance is what they want. So, when they heal them on the way down they can turn around and bring them back home.

 

TYLER: Thatís the issue, they donít care about us.

 

DELORIA: I donít know how weíll ever change that, but I think weíve got something good going here, if we focus on it and make it work. Itís supposed to be a ďPilot ProgramĒ and if get it running the way it should, it will be adopted as such.

 

TAYLOR: And I think the talks between Etown-Lewis and Westport, Keene and Keene Valley, really are kind of the beginning steps of the collaboration, Iíll say the first word, consolidation that this program was initially started to look into. It increases a pool of resources and spreads the cost and I think thatís the only way weíre going to have success moving forward.

 

DELORIA: Whatís the risk of, you know, our County CON being separated by this new legislation, where it doesnít really even warrant or justify our continued programming?

 

TAYLOR: Our CON isnít at risk with this. So, the programs that are at risk with this, are the Community Para-medicine Programs; which is something that weíve been investing a lot of man hours in to developing for the County, both to decrease the number of 911 calls that are unnecessary, as well, as potential for revenue recovery for the County. Mobile vaccinations; so a lot of the stuff that we did for Public Health support in the pandemic, with providing EMTs that could do vaccinations at clinics and pods and stuff like that. All of that stuff will get shutdown, until there was actual legislative change and right now itís bound up in the budget bill. So, thereís a lot of stuff thatís kind of in the air. We also have 3 different bills that are changing, whether fire departments can bill or not, how municipalities create ambulance districts, both like county all the way down to village. So, thereís a lot of stuff in the legislature right now, thatís making, predicting whatís going to happen in the future impossible.

 

DELORIA: Whatís your feeling on this EMS bill that passed the Senate and is before the Assembly?

 

TAYLOR: The one that allows fire departments to bill?

 

DELORIA: No, itís the consolidation where they can take two towns, villages, whatever and form a district. Because me, personally, I think thatís the most ridiculous piece of legislation at the table.

 

TAYLOR: Iím not a lawyer, just Iíll preface that with this, but, from the municipal laws that Iíve seen, itís not really changing much. The municipal laws already allow for everything from a county down to a village to form ambulance districts or contract with persons or companies to provide ambulance services in their area.

 

DELORIA: So, why is this supposed to be a fix to something? If we donít need it, we donít need it.

 

TAYLOR: I donít have an answer to that question.

 

PALMER: The reason you would want a district, per se, is because it pulls in those exempt taxpayers that are not paying now.

 

DELORIA: Okay

 

PALMER: The County has about $182 billion in assessed value and about $8 or $10 billion of that is exempt. When you form a district, you then pick up those exempt properties, it has the effect of lowering the tax rate.

 

TYLER: Would all tax exempt properties can be?

 

PALMER: Virtually all of them would fall into it, once you have a district, they are no longer exempt. Thatís like your water district, fire district, those are not exempt. So, thatís really the purpose of a district is to provide that you pick up that extra assessed value and essentially all it does is lowers the tax rate, because you now are dividing out what your budget is to.

 

DELORIA: Would that apply for the County, how weíre trying to get setup, as well?

 

PALMER: Yeah

 

TAYLOR: Yeah, the County could establish a countywide EMS District.

 

PALMER: The other thing a district does is it allows those towns that may not want to participate to, you can draw the borders around. So, if a town said, I donít want to be in, a district can get set up and formed and itís just that particular borderís left out.Right now, if we end up paying for an EMS itís going to go on the County levy and irrespective of where you are, everybodyís going to share that cost.

 

MONTY: But, the tax exempt.

 

PALMER: Except for the tax exempt.

 

MASCARENAS: Who are often big users.

 

TAYLOR: And itís hard to sell EMS to people, because a lot of the benefits are intangible and this program has had significant impacts, not only in the data. Like dropped calls have decreased by 99% since the start of this program, but ALS providers are working in their own districts and am to volunteer, because theyíre not traveling out of their district to work somewhere. Weíre retaining people in EMS that would have otherwise have left, because weíre offering higher wages and benefits and things that honestly, before now, were not ever seen. I worked 4 jobs before I came and worked for the County as a paramedic to make ends meet than I was able to work 2 jobs.

 

STANLEY: Welcome to living in the Adirondacks.

 

TAYLOR: But, how do you, the problem becomes, how do you explain to people the benefits that theyíre seeing, because their intangible and when people are hearing that theyíre going to pay more for a service, they want to know what theyíre getting out of it and thatís the sell that we have to do.

 

PALMER: EMS is not something that most people think about until they pick up the phone and dial 911.

 

TAYLOR: And itís a lot of the Sheriffís, everybody pays for it and theyíre available for everybody in the County, but some people donít use them.

 

PALMER: Right, thatís the way a lot of our services are.

 

TAYLOR: It doesnít decrease their availability of the need to have them and EMS is in the same boat. Anything else about all of that?

So, there are 2 upcoming EMT classes and AEMT class. One will be a day class, taught by Patty Bashaw, primarily focused on the deputies coming out of the academy, but there will be, itís open to the public, so there will be other people taking that class.

There is a nighttime class that will hopefully be held in Moriah. Dakota Olcott, who is our new hire, whoís a CIC, if he passes his test this morning. Heíll be teaching that one and then Pattyís doing an AEMT class and I donít have the schedule for that, yet, thereís been a significant amount of interest from some of the local squads to get some of their people that are interested to the next level.

 

DELORIA: Bryse, one of the bombshells that we dropped in Albany, last week, was the fact that the Public Health Law permits these courses to be pushed out online, as much as possible. Is anybody really focusing on that? Because it seems to me, if people from Newcomb, hypothetically want to take a course, theyíre going to drive one hour each way and naturally, if itís a lab or hands one thing, I can understand, but whatís the difference when itís somebody taking up space in this room or somebody taking up space on that television? Iím just wondering, are you guys, we should, the County, you on our behalf, should be pushing that in Albany.

 

TAYLOR: So, most of these classes are hybrid classes, so a mix of zoom and in-person. Thereís some stuff with EMS that you just canít teach virtually.

 

DELORIA: Understood, but thereís a lot of it that can be.

 

TAYLOR: There all hybrid now. I do know with some of the pandemic restricting decreasing, that thereís probably going to be a push to put it back, mostly in person or entirely.

 

DELORIA: I donít know, but thatís the ridiculous nature. If the law states, you can do this, why are they not doing it? It seems me that weíve got this monopoly of instructors that donít want to go out of their way to provide zoom capabilities for people taking these classes.

 

WATTS: Is it only that way because of the pandemic, right now?

 

TAYLOR: The hybrid classes? Absolutely.

 

DELORIA: But, the pandemic came after the legislation, thatís been on the books for a long time and nobody seems to want to do anything about it. It doesnít make any sense to me.

 

TAYLOR: So, thereís actually been a couple of programs that attempted district learning and they failed pretty spectacularly.

 

DELORIA: How long ago?

 

TAYLOR: 2014, I think was the last remote paramedic class with Hudson Valley.

 

DELORIA: It might be a good pilot to start up again.

 

TAYLOR: So, Bruceís program is interesting, because itís in-person, but itís distance learning between 3 different sites, to increase availability to people.

 

DELORIA: Right, but to my point, Essex County, 18 towns spread right from hell to breakfast, these people are really the ones that need access to remote learning, not what youíre saying, with probably most of the people taking those classes live within 15 minutes of the building where theyíre joining remotely with these other agencies, so I just donít think the focus is there and really needs to be.

 

THWAITS: Which they are doing with the paramedic program. Theyíre hosting out of our building, but itís being streamed toÖ.

 

WATTS: Glens Falls and Malone.

 

DELORIA: So, thatís 2 spots on that TV screen where people could be in Newcomb, Minerva, North Hudson, wherever, doing the same. I donít know, I think you should work on it.

 

TAYLOR: I am happy to follow-up on it. I do know that theyíre being planned and approved by the State as hybrid classes, but the push is going to come from the State. Itís not a local instructors issue, the pushes are coming from the State.

 

DELORIA: Understood, but we pushed that quite heavily down there in Albany, so wherever or not it fell on deaf ears, again, I donít know.

 

TAYLOR: So, Dakota Olcott is taking his test to become a CIC. This is another instructor in the County that can do CFR and EMT classes, which are the entry levels to the profession.

The AED distribution and training is actually separate. We have built a list of instructors that do CPR classes and weíre coordinating with the fire departments to get everybody trained and with that training, weíve refreshed the AEDs and 1st Aid bags and those will be getting distributed to the fire departments as they do their CPR classes.

 

WATTS: We just did a class this weekend and thereís another one coming up, next week, I believe.

 

TAYLOR: And weíre continuing to reach out to people to try and get it scheduled, everywhere.

 

DELORIA: Yup, thatís a pretty interesting product. I looked into that when Patty first brought it to the table. So, I curious to see how that whole software program works out.

 

TAYLOR: The scheduling software?

 

DELORIA: Yeah, yeah

 

TAYLOR: So, we sent a survey back into Personnel about the potential use of the Munis model, I believe the Sheriffs are using it. We have not heard anymore back, so we will continue to follow-up on that. From the survey they sent, it sounds like this can met our needs, it just has the unfortunate stigma of being in Munis; which has its own set of problems.

So, centralized billing; which we would like to return as revenue recovery support. Westportís possibly perusing, we discussed that they have to have their Board and squad meeting. We sat and discussed the best way to do that and Ike joined us for that. They seemed pretty receptive to it, but it a process, you have to form a LLC and separate and do the CON transfer, but Keene did it and I believe Schroon Lake recently did it and they said it was a relatively smooth process, just a little time consuming.

 

WOOD: Take the people out of it and then itís smooth.

 

TAYLOR: That applies to a lot of things in life.

And then the community of para-medicine program that were discussing is tied up in that bill. Weíve invested a lot of hours, we have potential telehealth providers to make the system work. Weíre in discussions with Elizabethtown Community Hospital and the surrounding health centers and we have a viable model thatís working other places in the State, particularly down in Cambridge Valley; which was the pilot program for all of this and thereís a lot of insurance changes with Medicaid and Medicare. ET3 is in pilot, which is what would allow Medicaid and Medicare to pay out for a treat in place or a transporting to an urgent care instead of the ER. But, all of thatís up in the air and influx until the budget billís voted on.

And then one thing that was not on the agenda, we have a budget line item and it was already approved for a senior account clerk, do we need to move a resolution to Ways and Means to begin the process of hiring or can we post that position?

 

PALMER: You can post it, if it was in the budget already.

 

TAYLOR: Do either of you have anything, Matt? Max?

 

WATTS: I think you covered everything.

 

TAYLOR: Any questions from anybody?

 

DELORIA: Max, AEDs, can you get us a price on them, is there anything on State Contract for AEDs?

 

THWAITS: I did look after last meeting. Theyíre not on State Contract. The last one we bought weíre refurbished, so I didnít know if you guys wanted to go that route. Theyíre cheaper, but theyíre certified.

 

DELORIA: Send me what you have on that. Kevin Boland is actually looking into that.

 

TYLER: How much do they run?

 

TAYLOR: Refurbished are between $1,800-$3,000.00, new ones are $5,000.00-$7,000.00, depending on how fancy you get. Theyíve come a long ways from when they first introduced and were $10,000.00-$15,000.00 apiece.

 

DELORIA: And do you have a line on where to buy those new, as well as refurbished?

 

THWAITS: Yes

 

DELORIA: Send that to me. Kevin dropped the ball on that, but heís busy, too, so Iíll push him along. Okay, does anybody else have anything? We stand adjourned, thank you, great job.

 

 

AS THERE WAS NO FURTHER BUSINESS TO COME BEFORE THIS TASK FORCE IT WAS ADJOURNED AT 9:30 AM.

 

 

 

Respectively Submitted,

 

 

 

Dina Garvey, Deputy Clerk

Board of Supervisors