Deployment In Busy Urban Systems

[HellsBells]

I work in a Large Urban area, 1 million plus residents in the city with about 45 ambulance running at peak hours.

We operate under a flexible deployment strategy, where we have certain stations that must be manned at all times. (ie. a call goes out from a demand post, the nearest non-demand unit will be called in to cover the area). For me, working from a non-demand post it seems like we're forever driving back and forth between stations in between calls. It get particularly annoying during nights, when I just want to catch a few hours sleep.

So... My question to all you guys in the big citys, does this sound similar to where you work? Are there any deployment strategies out there that work better? Does anyone work in systems that practices curbside deployment? I'd really like to hear what works, or doesn't work for all y'all.

[AnthonyM83]

We're pretty much all moving around all the time. Often time it creates a domino effect...the busy areas have two or three 24-hour shift ambulances in line (plus the rovering units until about midnight)...after that you're left with limited rovers and two calls can mean everyone has to move up (unless all cars are in station and they can absorb the hit, so to speak).

[Richard B the EMT]

Here in the FDNY EMS, we have the ambulances "staged" from what we call "CSL" , or Cross Street Location. Basically, the majority of ambulances dispatched by the NYC 9-1-1 system sit on a street corner until they get an assignment. This was designed by some computer program, taking into account population density, expected traffic flow, and computer models on where the next call is most likely to come in from, with the nearest ambulance assigned. They even have direction of where the ambulance is parked at the CSL, midnight to 0800 pointed north, 0800 to 1600 east, and 1600 to 2400 south. I do exaggerate some here, but not by much.

Presuming to now attempt to answer your question, figure my district, the Q1 (the Rockaways/Broad Channel areas), with 4 BLS and 2 ALS ambulances. Due to call volume, or delays awaiting ED beds, everybody is on an assignment.

Dispatch knows the Q1 is potentially going to have a call, and no additional ambulances usually in the district to handle them. They will redeploy, temporarily, units near the Q1 from the Q3 (Howard Beach/South Ozone Park areas) or the K4 (I think that's the nearest Brooklyn district, from near the Kings Plaza Shopping Mall, in Flatbush/Marine Park/Mill Basin areas). Yes, this will result in the northern areas, like the Q3 or K4, having their ambulances depleted, but if a call comes in for those areas, they shift over more ambulances from whatever the next nearest district.

Figure it's something like having nearby fire companies "relocate" to cover firehouses temporarily empty due to the locals fighting multi alarm fires.

I know it is not perfect, but it seems to be working.

Almost forgot, here, I'm talking about a section of one of the 5 boroughs, or counties, that comprises the "Greater City of New York, New York". We use, each of the three 8 hour tours, about 225 ambulances, to provide for a population of 8,000,000 residents, and a transient population, each 24 hours, of an additional 2,000,000 people.

I have unconfirmed information that, in calender 2007, the 9-1-1 system responded the EMS to one point three MILLION calls.

[Leener77]

I work for EMSA in Tulsa where the population is about 400,000 (I think anyway) and we also cover 3 smaller cities which surround Tulsa (Bixby, Jenks & Sand Springs) we have about 22 different places throughout the 4 areas which we can post. Granted we don't ever cover all posts but we have different levels which determines which posts we use. So depending on how many ambulances we have out and/or how many calls we're getting......there are times we are constantly moving around from post to post. There are also times you could get put at a post for hours at a time (which most people don't mind considering how busy we usually are). In 2007 we ran over 150,000 calls (Between Oklahoma city & Tulsa) Tulsa is quite a bit busier then Ok City. I work 12 hrs shifts at night from Fri-Mon so we tend to do about 6-10 calls a night on an average night. From what I understand summer is much busier then winter so I have yet to experience how things work in the summer. We may end up moving around more during the summer months. The constant back and forth from post to post can be very frustrating especially at night when sometimes you just want to sit for a little bit. It's rare we even get a break on the weekends. I'd say one shift a weekend we get an actual 'break'........so you just eat when you can and sometimes it's on the way to a call........lol!

[HellsBells]

So Richard with your "CSL" deployment I take it that any downtime you have between calls or ER visits that you go back to patrolling a street corner and dont return to your hall? Furthermore, I guess I should ask do you even get much down time in you're shifts? With an annual call volume of 1 million I imagine you stay quite busy.

[Niftymedi911]

Our county has a population of 850,000 full time residents and during the seasonal months (Jn-April) we have nearly 3 million residents. We have 28 24 hour trucks that are stretgically placed within the county at the various FD stations. We do have a stand-by policy (Post as some refer to them) in place. Each truck has a zone (8:59 response time limit) that they respond in. If Medic 4 and Medic 14 that for instance cover zone 4 and 14 are out, Medic 20 (zone 1, there are 4 trucks in zone 1, 3 trucks can be pulled from zone 1 leaving 1 truck to keep zone 1 at 8:59 response) is placed at station 4 to keep the 8:59 response time goal. We also have 3 12 hr 911 response trucks for peak times within the heart that also have stations (but no assigned zone). They commonly used as needed to cover zones. We also have a 6 truck interfacility transfer divison that solely does transfers. The ultimate goal was to take the load off the 9-1-1 trucks and earn that extra income. In Lee county, there were over 9500 interfacility transfers between the 5 county hospitals.

After every call unless needed for coverage, we return to our assigned station and wait for the next call. Well not wait, but recline... you get the picture. We cover over 1100 sq miles of our county with those 31 trucks. We also have 2 helicopters and 1 Critical Care transfer truck. (MedStar operations)

We answered 74,452 9-1-1 calls, 9,500 interfacility transfers, and transported 1100 patients by helicopter.

[Dustdevil]

I'd be interested in following the retention and retirement numbers of the post-merger FDNY EMS as time progresses. I want to see how many, who stared after the merger, actually stick around long enough to retire, and what the average turnover rate is. I'm talking those who are strictly EMS, not those who go on to the fire side after starting in EMS. It currently sounds like a recipe for high burnout. Anybody that stays in that system long enough to retire probably burned out long before they got there.

[Richard B the EMT]

We sit on a street corner, we even have a signal indicating "we're on the street corner". One unit out of my "house" sits on a corner where there are no buildings for a couple of blocks in all directions. We go more than a few blocks from the CSL, we have to change the status signal to indicate "available in the district", such as going for coffee, and another signal indicating "at the House" for whatever reason.

Dust, that information is available, just that I don't know who to ask to get it for you. Yes, we have people who use FDNY EMS as a stepping stone to become fire fighters.

A mention here: As the FDNY at the time of the merger in 1996 was predominantly white males, with the number of EMS personnel who were minority and/or women was supposed to reflect somehow for equal opportunity in hiring. Again, someone else has the "stats" on that, and I don't know them off hand.

[HellsBells]

Wow, I thought flexing from station to station at 3am was a pain in the ass. I can't imagine having to stage on a street corner all shift. I think my bitterness would grow exponentially.

Actually, I remember reading an article about a service in Ontario where management tried to employ curbside deployment. The union shot it down, arguing it was an unacceptable environment to work in. I'll see if I can find the story.

[p3medic]

Look up whole body vibration, and you'll see why idleing on a street corner is a bad idea.