WEITZMAN: COUNTY POLICE AMBULANCE BUREAU
IN NEED OF MAJOR UPGRADE
Audit of Police Emergency Medical Service Finds
Bureau Ill-Prepared to Meet Growing Demand for County Ambulances

Nassau County Comptroller Howard Weitzman warned at a news conference today that the Nassau County Police Department’s Emergency Ambulance Bureau is not adequately prepared to meet the growing demand for ambulance services in the county. 

“Nassau’s police ambulance bureau already handles the majority of the county’s ambulance calls, and that number is growing as Nassau’s voluntary ambulance providers have found their resources increasingly strained,” Comptroller Weitzman said.  “Unfortunately, our audit of the police department’s ambulance bureau found serious deficiencies in technology, equipment and in the training and supervision of ambulance personnel, as well as a critical lack of record-keeping, that will hamper the department’s ability to meet the growing demand.”

“Incredibly, we found that the police ambulance bureau does not maintain statistics on response time, and therefore cannot even say how quickly it responds to medical emergencies.  When it comes to medical emergencies, quick response is the whole ball game.  If the police ambulance service does not know its response time, they cannot act to correct potential deficiencies that could cost lives,” the Comptroller said. 

In order to address these deficiencies, Comptroller Weitzman called for the immediate implementation of a program to monitor and assess response times, improved staff training and supervision, and technology upgrades aimed at improving response times.  “The bureau may need additional EMT staff as well, but that decision will require better information on current response times and an assessment of future needs,” Comptroller Weitzman said.

In Nassau, most emergency calls for ambulances – more than 60 percent of total emergency ambulance calls routed through the county's Police and Fire Emergency Reporting System (county 911 and FireComm) -- are handled by the county police (see chart, last page).  The numbers do not take into account additional direct responses by volunteer services, which are not included in currently available figures on ambulance responses in Nassau. 

“That’s another problem we found,” comptroller Weitzman said.  “The system is so confusing and fragmented that nobody is even sure what the total number of ambulance responses in the county is.” 

 “Even with that uncertainty, all indications are that Nassau County ambulances will respond to an increasing number of emergency calls every year as the county’s volunteer fire departments are less able to meet the demand,” Comptroller Weitzman said. 

The trend of increasing reliance on county ambulances is growing, the Comptroller said, for several reasons:

• Long Island’s aging population;
  
  
• Fire department ambulance calls far outnumber fire calls; and
  
  
• Many volunteer fire departments report shortages of EMT volunteers, with many having to hire paid personnel to fill the need.
  

 “Our police EMTs must be able to respond effectively to this growing number of ambulance calls, and they must have up-to-date technology and training,” Comptroller Weitzman said.  “It is equally critical that the police department maintain adequate statistics on response times and other measures of effectiveness, so that they may correct problems that could hamper quick and effective responses. 

“Unfortunately, at the moment Nassau County is in the awkward and dangerous position of not knowing what its average ambulance response time is, or whether it meets state and national standards.  This is a serious situation that requires immediate attention,” Comptroller Weitzman said.

Although the Police Department, in response to the audit findings, said it is working to improve its data collection and analysis system, the Comptroller said, “I would like to see a greater sense of urgency.  Monitoring ambulance response times, and acting to improve them where necessary, must be given the highest priority.”

According to a National Institutes of Health (NIH) publication, emergency medical service providers should aim to respond to top-priority medical emergencies within nine minutes from the time of call dispatch.  “Nassau’s police ambulance bureau simply cannot say whether it complies with this recommendation,” Comptroller Weitzman said.  

Moreover, New York State Health Department regulations require emergency service providers to have written protocols governing how much time may transpire between receipt of a 911 call and dispatch of an ambulance.  Nassau’s bureau, however, currently has no such policy.

In addition to the lack of record-keeping, the audit also found that:

• the police ambulance bureau does not utilize Automatic Vehicle Locator (AVL) technology.  AVL uses a global positioning system to identify ambulance locations,

enabling dispatchers to send the nearest available ambulance to the scene, reducing response times.  The North Shore Hospital ambulance system, by contrast, uses such technology.

• Police may not be adequately trained in the latest emergency procedures.  The department had stopped providing training for officers to maintain their first responder certifications.  New York State requires that such certifications be renewed every three years.  As a result of this audit, the police department has decided to resume recertification training.  Also, only three of five EMT instructors at the Police Academy are certified by the state Department of Health to provide such instruction.
  
  
• The bureau’s Medical Control Unit, which operates 24 hours a day, 7 days a week, has only one supervisor.  As a result the unit, which provides instructions to ambulance technicians prior to the ambulance’s arrival at the hospital, is unsupervised at times.  Auditors also found that two of five EMT supervisors were actually assigned to other duties, leaving about one-third of field work hours unsupervised.
  
  
• Since 2002, when the department entered into a contract with a new billing vendor, revenue collection for ambulance services has increased significantly.  “In general, the department has improved its bill collection procedures over the past few years,” Comptroller Weitzman said.  “Our audit suggests measures that could further improve the county’s success rate in collecting such bills.”   Auditors found that more than half of the money owed to the department for ambulance services, some $2.6 million, cannot be collected because insurance information was not obtained from the patient.  This could be remedied if the county entered into agreements with local hospitals permitting it to obtain patient insurance information directly from the hospitals. 
  
  
• Nassau must count on patients to remit insurance proceeds for ambulance services to the county rather than receiving reimbursement directly from insurers.  The audit recommends that the county become a “participating provider” with major insurance companies.  Such a change would allow reimbursements to be sent directly to the county, rather than to the insured patient.

The complete audit report can be read by clicking the report title at the end of this page.

Police Dept. Emergency Ambulance Bureau Report (.pdf file)

Corrective Action Plan (~132kB - 3 pages pdf file )

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