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Not enough ambulances in Boston?
By adamg on Tue, 11/21/2017 - 8:42am
WFXT takes a look, includes the story of a two-year-old in seizures for nearly 20 minutes until an ambulance arrived in East Boston - which has just one BEMS ambulance serving it.
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Comments
Also a factor is because they
Also a factor is because they're already swamped with overdose calls. Add the severe congestion of traffic more than ever before (driver's can't even move to the right if an ambulance is coming because the congestion is so bad). Is there also a shortage of EMT's or just ambulances? EMT's have to put up with so much shit it's sad.
Perhaps look into motorcycles
Perhaps look into motorcycles that can cut through the Boston traffic, can reach patients quicker and can determine if an ambulance is truly needed.
http://www.ajemjournal.com/article/S0735-6757(06)00443-8/abstract
Also they would be a lot cheaper than adding more ambulances.
Worth Looking
This recommendation is certainly worth looking into.
Now that the election is over
We need a plan to close at least 25 schools. The city is bursting at the seams, but we just keep pouring money into BPS while it continues to shrink and overhead skyrockets. At the same time, we have about the same number of first responders as we did a decade or more ago.
Unless there is a magical pot of money out there somewhere, we are going to need more cops and EMS to serve our growing population and the only source of that money I see in the budget comes from BPS overhead.
More cops?
Are you out of your mind?
Are you being facetious?
I hope?
I believe the population has grown from about 550k to 650 k without any material difference inBPD staffing.
Are you?
You seem intent on using fairyland just so stories to justify gutting education.
Nothing propels the crime rate sky high like gutting education.
Gutting education
Care to cite some numbers about gutting education in Boston?
Basically all the staffing increases in Boston over the last many years can be explained by BPS which shrinks about 1% each year.
When there is eventually only one student, we should still spend 1 billion a year on BPS?
When you cite actual facts about education
Rather than libertarian stink tank bullshit about utrained, unqualified, unpaid teenagers reading text books at 30 kids for ten hours a day being "better" than actual teaching by actual professionals, maybe then we will talk.
Or, maybe, you can just move to Oklahoma or Kansas and enjoy the level of education that surrounds you - it is the end product of your theories.
Better click those ruby slippers some more
We're not in Kansas Swirls. In Mass we have charters that do as well or better than publics pretty much across the board.
That's not your ruby slipper theory - that's Mass reality (and I'm sure you can cite me the rare exception - which around here gets shut down).
About a dozen years ago Boston had roughly 500 kids per school
Now we have 425.
At what point do you think it's time to cut?
(and a portion of that is parents moving their kids to charters - but of course you know what's better for their kids than they do because of that giant magical armchair you sit in with the ivory towers sticking out of it)
Kids
Isn't it possible classes were too big in the past and they should have hired more teachers but did not? Now that there are less students, things are where they should be?
Actually
While we have slightly fewer teachers now compared to 10 or so years ago, the number of students has dropped by an even greater percentage so student/teacher ratios have declined and in fact are among the lowest in the state.
And just because you close schools, you don't lise teachers. Just overhead. Transportation, principals, vice principals, nurses librarians and do on can be much more concentrated. Plus maintenance and capital expenses.
Even a BPS study indicated we could cut about 10% in expenses and maintain services. That's about what I'm thinking is doable without harming education quality.
Admit it
http://www.universalhub.com/2017/dorchester-charter-school-proposes-new-...
You hate special education and disability students and are secretly happy every time a late ambulance saves you school tax money.
Yeah but no
Putting charters aside, BPS needs ever more of the city budget with more or less flat enrollment. We're talking about cost per student here, nothing to do with charters.
ooohh - what's that - GROSS
Swirly is putting words in my mouth again. Disgusting.
Data!
https://www.boston.gov/news/mayor-walsh-releases-2018-recommended-budget
"The Boston School Committee approved a $1.061 billion budget for the Boston Public Schools (BPS) , which is projected to increase to $1.081 billion once collectively bargained cost increases are added, the largest appropriation in BPS history. That represents a projected $40 million increase since last year, and a $143 million increase since Mayor Walsh took office. Funding directed to schools (including district and charter schools), will increase by almost 4 percent, a $25 million increase over FY17, even before employee collective bargaining increases are negotiated. In total, with this budget, staff levels at BPS will have increased by approximately 250 since Mayor Walsh took office in 2014."
Gutting. LOL.
Gutting would be gutting say
Gutting would be gutting say two dozen schools. And because you're not cutting students you'll need all the teachers and when you add on increased transportation cost all you've cut is administrators.
We spend about 34% of the city budget on education. That's bottom 14% in the state. On a per pupil basis we spend about $2k less than Cambridge.
World class city.
The budget's gone up at least 3.75% a year
In the past 4 years (and I ignored the reserve for that figure.) That beats inflation. The debate about how much the BPS should be given in the budget is one thing. The fuzzy math wherein increased funding is somehow a budget cut baffles me. Noting the percentage of the budget spent on education compared to other municipalities means nothing. Maybe for 86% of municipalities, places like Worthington or Freetown, they don't have the need for some of the spending that Boston does. For example, how much does Sandisfield spend on police? How much does Hardwick spend on fire?
Also
only about 8% of the population is in public schools and we actually spend another $125 million plus on charter school tuitions, so we actually spend more like 37 or 38% on schools. As you point out, Boston does many things that cost money over what other towns spend. Revenue per capita in Boston is among the highest in the state, much due to commercial taxes other towns don't have. As you note, apples and oranges.
Most towns have 10-15% of the population in the schools. When you see off the chart per pupil spending like in Cambridge and the cape schools, that's because you have 5% or fewer kids in schools to afford that.
Bottom line, our school infrastructure was built for 75k or more kids. We now have about 53k. Start closing (don't sell the real estate though, lease it in case we need it for something else)
about cost savings through school closures
BPS educates 56,000 students in 125 schools, which is about 74% of school-age children who live in Boston. BPS is 34.3% of budget. It's a reasonable expectation that your grade-school kid, K-6, can go to school in your community or choose a school which requires more travel because you're not satisfied with the choices in your community. This is consistent with BPS policy--limited district school choice.
Walsh wants to fund universal pre-K, which will require space for an expansion in the number of students served.
A Walsh-ordered McKinsey analysis declared BPS had surplus capacity of 40,000 seats. Their analysis used an inappropriate methodology, and their conclusion was wrong. I wish Walsh had asked for the approx. $600,000 fee back. BTU took a look at the report.
I haven't seen a new official number of surplus capacity by I have heard an estimate of about 10,000 seats.
Closing schools does not deliver the cost savings many people expect. Here's a Globe article on the topic from April 2016, "School closings bring pain, and not always savings"
Here's an article on the impact of school closure on a community, "Ghastly Impact of Closing Schools on Students and Communities/"
It's clear that Walsh wants to restructure schools in two ways; grade alignment and school closures. These are education management initiatives unlikely to yield educational benefits or significant cost savings. And they would be disruptive, and that disruption is likely to fall on the people who live in neighborhoods who have no political clout. They would lose their community grade school and their kids would travel farther to get to school each day.
I agree on one point. Don''t sell the real estate. I think Walsh has acknowledged as much.
One big difference
We largely don't have community schools - and many of the problems cited in other cities are from closing certain community schools.
Looks like the other communities got about 2/3 of expected savings - McKinsey said $2 million per school - so we would expect between $1.3 million and $2 million - or about $40 million.
And that's before we look at the hundreds of staff (non-teaching) added over the past 10-15 years doing who knows what. Students down 10%, staff up 10%? And no expansion of teaching positions? Strange - and the first place I'd look.
Menino had a habit of "parking" staffing in the schools - added a hundred or more janitors just to lay them off a couple of years later, one year when there were additional dollars available they literally created new positions to use the money. Then if times get tough - these people get laid off so the more permanent staff gets their raises/bennies etc. Political budgeting - uggghh!
What cost savings?
Closing a school saves less than 2/10ths of 1% of BPS budget. If you take McKinsey estimate as accurate, it'd save 0.18% of BPS budget.
Home-based school assignment weights geographical proximity. This allows kids from the neighborhood a preference to go to the schools nearest their homes if that is their want. Closing those schools has the effects the research found.
If it was me, I wouldn't close 10 schools to save $20m in a school budget $1,080m
Then what do you cut?
Fixed costs are now up to about 21% of the budget and that grows about 1% every 2 years.
Public safety is I think about 20%. Schools 34%.
That's 75%. Heathcare is about 7% of the budget.
EVERYTHING else is 18%. 1% of the budget eats entire departments.
So don't cut the schools. You can't cut fixed costs. Good luck cutting public safety.
Now find $50-100 million in the rest of the budget to keep meeting the growth of fixed costs.
Your choice sir/madam?
Raise Taxes
You raise taxes.
Won't happen
Try telling the 92% of the city that doesn't use the schools you have to raise taxes to pay for an already over bloated system and an override won't pass.
We've never had an override and the publicity of a budget that can't make ends meet with revenues growing twice the rate of inflation while not adding personnel won't play well.
Rock meet hard place.
Salary freeze for everyone earning 120,000K and up.
Median income in Boston is 55K. Median in the Commonwealth it's $70.6K. The compensation for white city employees is both top heavy and well in excess of median income.
Come one Stevil...
We don't need more cops, I like the overtime just the way it is!!
As an epileptic myself
20 minutes of untreated seizures (without a rescue medicine on hand) can be deadly.
It can cause Status Epilepticus which basically means the brain keeps seizing until you end up in a coma and possibly die from it.
EMS motorcyles are an interesting idea
Most people would be amazed at some of these ambulance calls. Mosquito bite, Poison Ivy, stubbed toe, loose tooth and diarrhea. A patrolman friend once said on the police radio, "I'll bring the toilet paper."
Most medical calls bring not just the ambulance, but a ladder truck and a police cruiser. They like to get the "runs up" no pun intended, for budget purposes. In many cases, the caller just wants company. When the hospital gift shop still sold cigarettes, we would have one woman call nightly for "cramps." Full EMS, police and fire response nightly so she could get a ride for her Marlboros. Barbara openly admitted the ambulance was a taxi service, $1000 per call in those days, paid by Medicare. Probably more now.
An EMS motorcycle might be more effective for the minor calls and deliver the cigarettes.
Bicycles in DTX
Bike EMTs and Cop/EMTs are common in downtown crossing. They have fat panniers loaded with their basic supplies and can deploy rather quickly in the ped-only and heavily trafficked areas in the central core.
I've also seen EMTs on foot during the worst of the passing out crisis, when I was reporting unresponsive addicts at least once a week. Finding one was much quicker than calling 911 from a cel phone. There was an orbiting ambulance backing them up.
The motorcycle idea is interesting, as it extends the distance and capabilities of the responders (can carry more than a bike, generator lighting systems and sirens, etc.)
Not to
say that people don't call EMS for dumb reasons, but diarrhea can be fatal due to dehydration and/or internal bleeding.
Growing up I had an elderly neighbor get long-term diarrhea after a struggle with pneumonia that required multiple courses of increasingly hars antibiotics. He had a heart attack from dehydration and passed away in his bed.
Complete Fish BS
Most people would be amazed at some of these ambulance calls. Mosquito bite, Poison Ivy, stubbed toe, loose tooth and diarrhea.
in many cases, the caller just wants company.
When the hospital gift shop still sold cigarettes, we would have one woman call nightly for "cramps." Full EMS, police and fire response nightly so she could get a ride for her Marlboros. Barbara openly admitted the ambulance was a taxi service, $1000 per call in those days, paid by Medicare.
Once again, in your never ending need for attention, you make up stories and peddle them as some sort of direct "insider" knowledge. -
If you want to establish credibility, Identify the municipality where these occurred. The year(s) during which they occurred. I am particularly interested in your story about "Barbara" who you represented as calling 911 nightly to go to the hospital to get cigarettes (surprised you didn't say Newports being the bigot that you are) - what was the name of the hospital she was going to?
Fish, I don't expect you to ask these questions - asking primarily to show that you are at minimum a prevaricator but more accurately stated, a complete liar.
"Surprised you didn't say Newports"
I spit coffee at that, and I wasn't drinking any.
I agree with Fish. You never
I agree with Fish. You never noticed the over the top response to things where it is not required?
Heck, even a firefighter I know admits this.
I know of some people that refuse to call for ambulance because of the over the top response they know will be coming.
Maybe you never worked in situations where you are exposed to all kinds of personalities. Work in healthcare sometime, it will open your eyes. People like "Barbara" are out there, you just haven't noticed.
Rollies are the new Newports.
Rollies are the new Newports.
Motorcycles are incredibly
Motorcycles are incredibly dangerous, especially if they're being driven like ambulances - veering through stopped traffic, crossing red lights, etc. EMTs don't get paid enough as is, let alone if they're now risking permanent brain damage and death.
A couple of things. If you
A couple of things. If you think fire and police responses to medical calls are to "get the runs up" your knowledge of police and fire procedures is lacking.
Second thing. Barbra's nightly call to 911 wouldn't have gone on for long. The flagrant abuse you described would end when it was clear there was no medical reason to transport.
Which brings me to my last point. Medicare will only pay for ambulance transport when there is a medical reason for the ambulance ride. Maybe they would have paid for the first ride but after that they would have checked the E.R. report and found no medical problem the bill would be denied. Also it's pretty rare for medicare to pay $1000 for an ambulance ride. That would have to be a high level of paramedic care. A ride for "cramps" would be about a $200 payment.
Insurance, including Medicare, generally will not pay for
an ambulance ride to the ER unless the patient is admitted to the hospital. Even then, they payment will be a very small percentage of the actual bill.
Very ignorant of the system, John. Not a clue.
Your name calling and skepticism aside, you're clueless. Obviously no first responder experience. "Barbara" was indeed labeled a "chronic caller". Still, we had to respond each time. HIPPA and morals prevent me from sharing more about her. Same as a bank with a faulty alarm. Until the branch manager got around to calling an alarm company, and they showed up days later, an alarm was treated as an armed robbery. There is no such thing as a routine call in police work and we treat things seriously.
Barbara's ambulance calls were strictly for cigarettes. She told me and we laughed about it. I had no way of stopping her. We weren't the feds so couldn't prosecute Medicare fraud and she wasn't falsely reporting a crime so no MA Law applied. She just had "cramps."
$200 wouldn't get you in the door of the ambulance. Once the oxygen mask goes on, blood pressure cuff comes out and you're plugged into the computer, you are near $1000. You can't hire a limo for $200 an hour but you can hire an ambulance? Who is transporting you, Alan Alda and Lorrainne Swit on MASH?
Liars gotta lie
Fish - poor attempt at a dodge…you told a bullshit story and when called out on the lie, you changed the subject.
No one asked you to disclose anything about "Barbara."
You were asked to Identify the municipality where these occurred, the year(s) during which they occurred
and the name of the hospital she was going to?
As a former cop, I am sure you are familiar with the Reid Institute…you are familiar with the Reid system, aren't use you?
Early in Reid training you are taught how to spot liars when they are challenged about the core facts regarding the story they are telling. Basically they do several things to dodge answering questions…first, they slightly acknowledge a peripheral issue included in their story so as to sound as if they are responding.
Next liars typically will raise a new issue which they say prevents them from responding on point. Third they quickly shift their response to a new set of facts (unrelated to the question) thus changing the subject. During their answering, liars like to sprinkle in andedotal examples of issues that re-enforce their new facts. By the time they are finished with answering, they have completely ignored what they were asked by changing the subject.
You are a textbook example of a liar - notice what you attempted to do -
First you attempted to sound as if you were acknowledging the subject by citing "Barbara" was indeed labeled a "chronic caller." Yet the original premise of your previous comment was imbedded in a number of examples of non-emergency ambulance misused. Barbara was simplycited as an example in the various abuses you claimed are routine occurrences.
Your switch was to try and make Barbara as the central issue in your claim by saying we had to respond each time. HIPPA and morals prevent me from sharing more about her. Your switch occurred at this point - you tried to change the subject to Barbara instead of validating your original claims about ambulances by answering the questions about where and when these abuses were occurring. The reason being, you made up the original claim.
Next you introduce your new facts by equating Barbara's privacy concerns to being like a bank with a faulty alarm.
You then start talking about false bank alarms and armed robberies. For validity you add in There is no such thing as a routine call in police work and we treat things seriously.
An like most liars, you circle back and repeat the original lie: Barbara's ambulance calls were strictly for cigarettes. She told me and we laughed about it. You then try to reenforce the original lie by introducing new dynamics such as I had no way of stopping her. We weren't the feds so couldn't prosecute Medicare fraud and she wasn't falsely reporting a crime so no MA Law applied.
Fish, you are indeed slippery but neither particularly bright or skilled at perpetuating internet deception on a social media cite.
Seek help, you need it.
At the risk of sounding pendantic
It was Loretta Swit who played "Hot Lips" on MASH
I have 24 1/2 years as a fire
I have 24 1/2 years as a fire and ambulance dispatcher. Certified Emergency Medical Dispatcher and Certified Emergency Fire Dispatcher. The city I work for does about 25,000 fire and ambulance calls per year.
There are people who abuse the system but transporting someone to buy cigarettes at a hospital nightly would not happen.
I wouldn't expect you to know about medicare's payment system. I have a relative who is a medical coder/biller at a hospital north of Boston.
Medicare pays a fraction of what insurance companies pay for services. My insurance will pay $1000+ for an ambulance ride. Medicare does not.
Weird ambulance anecdote
I was driving southwards on the JWay on Sunday and there was an ambulance with its lights on but no-one in the back (no interior lights were on) that was driving about 25 MPH. It would proceed through the various red lights and then traffic would resume flowing past it until the next light. It ended up at the Faulkner I think.
So this ambulance was I guess going to pick someone up at the Faulkner but was it really an emergency to get to a hospital? Or just someone who didn't know what the hell they were doing?
To me the implicit deal with emergency vehicles with lights and sirens is you put on your lights and we get out of the way. However, you proceed at safe speeds to wherever you need to go and don't hold up traffic driving like Hans Moleman.
Re: Weird ambulance anecdote
Parkwayne, I'm not an EMT but I have seen empty ambulances use lights and siren if called to a small hospital to transfer emergency or violent patients to a different facility. For instance, if Faulkner couldn't handle a massive heart attack and wanted MGH, or if they had a violent inmate that they wanted to return to the Shattuck. A lot of prisoners will fake an illness to get out of the cell, then they go wild at the hospital. There are always a few yahoo first responders but most won't abuse the lights.
I know police are often criticized for briefly putting on the blue lights to run a red light, as if they were impatient. Often times they are on the way to a "hot call" but want to arrive silent. The law allows first responders to run a light after a complete stop (I know that doesn't always happen) but to flick the lights on and then quickly turn them off is sometimes a strategic decision. If there is a robbery or assault in progress, going in full steam will alert the suspect to run. If you recall the old police TV series "Adam-12" which was very factual, the officers were often told to arrive "silent" but would still use their lights (red in LA) to get through traffic, then shut them down.
"So this ambulance was I
"So this ambulance was I guess going to pick someone up at the Faulkner but was it really an emergency to get to a hospital?"
It can be. My company gets interfacility calls regularly, and some of those are stat (emergency) transfers. Some smaller hospitals (including Faulkner) just aren't set up to handle certain kinds of emergencies - they may not have, say, a trauma surgeon or neurologist or a cath lab for heart attacks - so the best they can do is stabilize a patient (who, in an emergency, is transported to the closest appropriate facility) and send them out to a larger or more specialized hospital. If John Smith is, for example, in a car accident, he gets taken to the nearest ER. If that's a community hospital and John Smith has a major brain bleed that needs a neurosurgeon, an ambulance will be sent to pick him up and take him to say, BMC or MGH. In that case the ambulance goes lights & sirens to the community hospital.
Your surrounding small cities
Your surrounding small cities and towns use the excess capacity of private ambulance services if needed. Boston could too. With today's technology, finding one nearby isn't a problem and the ambulance traveling home from a Boston hospital run could chose to be available or not based on their own dispatcher. Uber Ambulance essentially. They're in it to make money and it sounds like the demand is there.
Could too?
Boston does use private ambulances when BEMS is flat out. Still not enough.
Polling. Polling. Polling
Polling. Polling. Polling for Privates on BAMA. No Privates available.
Every day.
Many factors
The main one being supply and demand. Keep building housing, attracting much more residents to the City than it can handle. More people equals more ambulance calls.
Traffic. More people equals more vehicles. More vehicles creates more traffic and gridlock.Also Uber and Lyft create more traffic. I counted 8 ride sharing cars going inbound on Bennington Street the other morning. More people riding bikes, more Hubway stations taking up spades on public streets.
Boston is paying the price of overdevelopment and the notion that everybody needs to live in the City. Getting an ambulance will become the least of our problems.
If this were really an issue
If this were really an issue then there would be some correlation between population density and mortality among major cities in wealthy nations, but if anything the reverse is true.
EMS dispatch hangs up on
EMS dispatch hangs up on Relay calls, and doesn't know where Boston City Hall is.