The Investigation team of a local news station ran a story about ambulance response times in Hartford.
I-Team: Response times steadily increasing in Hartford, dispatch data shows
The hook call: A baby wasn’t breathing. 911 was called. The ambulance response was delayed. The baby, who was eventually transported in a police car (22 minutes after the 911 call), died.
How could this happen? The news team asked.
From this one shocking incident, they tried to look at the system. According to the I-team, ambulance responses in Hartford take an average of 11 minutes. The state and the ambulance companies say the ambulance response was 6 minutes and 50 seconds.
The difference it seems has to do with when the clock starts. Does it start when 911 is dialed or when the ambulance company is notified? In Hartford, the 911 calls goes into the police dispatch center. The dispatcher then takes down some preliminary information before kicking the call to the ambulance company. The state records the ambulance time as the period between when the ambulance is notified and when they arrive on the scene. Little comfort to the person who has dialed 911.
Still from the ambulance side, as a paramedic who has sat on the street corner and watched a fire truck go racing past, only to be dispatched two minutes later to the same call, it is hard to say the ambulance has to be held to the 911 call as the starting point. You shouldn’t be penalized for failing to respond to a call you know nothing about because the call hasn’t been sent your way. When I was in a rapid response fly car in Hartford, the company even gave me a fire radio so I could get a head start on critical calls by self-dispatching based on hearing the fire responders dispatched. I would call our company and tell them where I was going and for what, and they would say, we haven’t received it yet or its just coming in now.
That said, the I-team does raise an valid point. No matter when the clock starts, ambulance response times have risen in Hartford for five years straight.
Where the I-team falls short is in trying to decide the blame–between dispatch and the ambulance service. That’s not where the blame belongs. The I-team needs to look at the big picture.
After 30 years of being a paramedic, I am tired of these I-team stories that always seek to blame the ambulance companies or the 911 dispatchers for an ambulance being late. There is hardly a local TV news station in the country that hasn’t run one of these Ambulance Delayed stories.
I wrote the below post, Outcry, two years ago. I stand by it today. If the I-team wants answers, these are the questions they should be asking.
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An ambulance is late. Someone dies. There is public outcry. Calls for an investigation.
If you want to understand how this could happen, here are some questions you will want answered.
Who provides ambulance coverage in your town. It is a full-time municipal service with pensioned employees. Is it a volunteer service? Or does the city or town contract with an ambulance service?
How many ambulance are staffed and does the staffing change depending on the time of day?
If they contract with an ambulance service, what does the contract say? Are a specific number of ambulances required at certain times of the day? Are there response time parameters with fines if not met a certain percentage of the time? What is the track record of the ambulance service? Do they regularly meet their times or rarely?
Who dispatches the ambulances and who tracks the ambulances once they are dispatched? In what order are the first responders and ambulances dispatched and if the ambulances are dispatched after the first responders, how much later are they dispatched? Or are they both dispatched simultaneously?
Does the town have mutual aid agreements for coverage when all the town or city’s ambulance are tied up on calls and call volume exceeds the number of ambulances?
For a particular call, how long after the incident was called into 911, was the ambulance crew dispatched? If there was a delay, why was there a delay?
How many ambulances were on at the time of the incident? What were those ambulances doing? Were they all on calls? What type of calls were they on? All priority ones or were they dispatched for swollen feet, sore throats or constipation?
How many ambulances were at the hospital? How long had they been at the hospital? How long were they in the triage line holding up the wall while waiting to offload their patient? Are ambulances routinely tied up at the hospital waiting to clear triage and get a bed?
If the patient was eventually transported by a nonambulance, did the transport increase the patient’s chances for survival or decrease them? If it was a penetrating trauma requiring a surgeon to stop the bleeding , then transport in the quickest vehicle might have helped the person. But if it was a cardiac arrest with a patient requiring CPR and defibrillation, it may not have been a medically sound idea.
How much does the city or town pay for its police coverage? How much for its fire coverage? How much for EMS? In many areas, the answer will be millions for police, millions for fire and zero for EMS. While some cities and towns pay subsidies to the service, others pay nothing. EMS often supports itself only with patient billing. In many cases, the amount insurance–particularly Medicaid– pays is less than the cost of the service. In other cases, the patient has no insurance at all and is unable to pay a penny.
I’ve worked EMS over thirty years now. I have worked commercial and volunteer and overseen fire services. It is a rare day that there hasn’t been a time when each service wasn’t at level zero. Crews are constantly called out of the hospital — if they can get out — to take holding 911 calls.
These situations are not unique. They happen all over America, in big cities and small towns.
The bottom line is money. EMS is and has always been underfunded, especially compared to police and fire. Don’t blame the ambulance crews for the ambulance being late. The crews are nearly all underpaid and overworked.
Look in the mirror, American cities and towns. You get what you pay for. What are your priorities?
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Here’s two other posts I wrote on the issue of delayed ambulance response.