Carr proposes mayor-directed EMS improvement task force
James Carr, former executive director of NYC EMS, says response time is a symptom of broader problems the fire department cannot solve alone. He recommends a mayor-directed EMS improvement and modernization task force bringing together FDNY, OMB, OLR, labor, H&H, and hospitals to produce an implementation plan within 90 days.
Good afternoon.
My name is James Carr.
I served as executive director of New York City EMS from 1980 to 1988.
And this man's testimony was the best introduction I could possibly have.
I want to tell you that although there have been, I think, some changes in EMS in almost 40 years since I left,
Sadly, many of those challenges still remain today.
And I have to say that we talked about problems with response time, and response time is clearly a symptom, not an isolated issue.
It's a symptom of other problems.
The thing is...
The mayor has to take responsibility for this.
Happily, I no longer work for any mayors or anyone in the city government.
And I want to tell you that the things that have been talked about today, from the beginning of this meeting until today, until right now,
are things that some of which the fire department has control over, but many of those things the fire department does not have control over.
They need help, as this gentleman went through in a quite articulate manner.
The fire department can't address these challenges by itself.
I'm recommending a mayor-directed EMS improvement and modernization task force, bringing together the fire department, OMB,
OLR, EMS labor, health and hospitals in the broader hospital community to put together, to work together.
To focus not on finger-pointing, but to work together as a team to try to figure out the various issues and responses to the various issues that are necessary.
It's very clear.
You don't have to be a rocket scientist to recognize that they need competitive pay.
They need, dare I say, parity with the fire department.
In addition to that, if you want to deal with the increased call volume, you're going to need more staff than you currently have.
I'm talking about staff beyond the 45,000 that they currently have.
Yes, they're at 41,000 or whatever the number was, 4,150 or whatever.
But the goal is 45.
But the goal is 45.
That's fine.
But there's been a 41% increase since the 20-teens.
Did their budget increase, their budget for staff, increase by 41%?
I'll tell you the answer is no.
So the mayor has to put this, has to be the convening person who puts this group together, people who work for him, who have to collaborate with one another to address these issues.
And I'm proposing that within 90 days, the task force submit an implementation plan that establishes clinically appropriate response time targets, identifies the staff,
ambulance capacity, and operational improvements needed to meet those targets, and specifying the resources required and the agencies responsible for implementation.
The process could be measured by the percentage of patients reached within those targets.
And what I'm saying is you want an ALS unit 95% of the time in six minutes, not an average.
Of 10 minutes.
Because the averages cover up an awful lot of outlier calls.
The outlier calls are the things that we're talking about here.
The difficulty is that it's not one or two outliers.
It's tons of outliers.
The system-wide problem requires a system-wide management response, and New York City, I believe, has the data, the expertise, and the technology to improve EMS performance.
What is needed is a coordinated mechanism to turn that knowledge into action.
The objective is faster, more reliable access to appropriate care and better patient outcomes.
Thank you.