Hello, 9-1-1? Our EMS is Dying!!

Gentle readers, it isn't the murder rate in Philadelphia that will pre-occupy the thoughts of newly-elected mayor, Michael Nutter. It is the city's ability (or lack thereof) to provide a vital service to the community that needs fixing, first and foremost.

Captain America, quoting the "paper that shall not be named here," started the blogging earlier this week:

Once again Philly Fire is in the news and the EMS situation is on the front page. As usual the news isn't good. Today's article in the XXXXX XXXX is about the city's failure to use private ambulances. As usual the Main Stream Media is way off base and their ignorance of the subject invalidates their coverage.

Lets start of with an overview: In Philadelphia, the Fire Department is the Marine Corps of the city's operating departments. Whenever something goes wrong, you can call 911 and you will get a firetruck to help resolve the situation. We respond to an estimated 280,000 calls a year and that number keeps going up.

Many years ago the Fire Department began operating the city's ambulances kind of by default. What began as an after thought evolved over time into a landslide. Today between 220,000 & 240,000 of our calls are for emergency medical service. Over the years 911 has degenerated from an emergency lifeline to the first choice of any citizen who needs a ride to the local emergency room. This was never the intent of 911. Remember the slogan "To stop a crime or save a life" call 911? Those days are long gone. Now the system is completely overloaded and unable to function properly under the crushing workload of everyday operations.

(snip)

Now the chickens have come to roost. People are dying because the system is melting down. Too many calls and not nearly enough ambulances. There are some tough decisions that will have to be made and soon. The talk in this article about private companies is a red herring. The Fire Department can't depend on outside resources to accomplish it's primary mission. That's why private companies aren't used. Also private companies are only far too willing to work in areas where there are plenty of paying customers with lots of insurance. They don't want to venture into the badlands to pick up the shootings and stabbings. The PFD makes no distinction as to where a call comes from we respond to everything, all the time.


The most recent death made national news (yet another black eye for the City):

Deadly Delays Plague Ambulance Services
Not Nearly Enough Ambulances to Go Around, Officials Say


By ANNE-MARIE DORNING
Jan. 18, 2008

Deborah Payne, Rotan Lee, Ricky Badway and Danny Rumph all have something in common. They're dead. And they died after waiting anywhere from 19 minutes to more than an hour for an ambulance in Philadelphia.

The latest incident occurred just a few weeks ago, in the early morning hours on New Year's Day. According to a Philadelphia Fire Department timeline, Payne dialed 911 at 2:30 a.m.

And so Payne and the firefighters waited. And waited. According to the fire department timeline, an emergency vehicle finally reached Payne about an hour after her first call, only to break down. Payne died while waiting for a second EMS vehicle to arrive.

It's a story Candy Owens said sounded sickeningly familiar. On Mother's Day in 2005, Rumph, Owens' 21-year-old son, was playing a game of pickup basketball at the Mallery Recreation Center in Philadelphia when he collapsed at 10:30 p.m. His friends dialed 911. They also called Owens.

"It was horrible. I watched my son die. It was the worst experience of my life," Owens said. According to Owens, it took an EMS crew 41 minutes to arrive, traveling halfway across the city.

The national standard for response time by emergency vehicles is eight minutes and 59 seconds or less. But according to a city controller's report released last month, one-third of Philadelphia's ambulances took 10 minutes or longer to respond in 2006. And there are just 28 ambulances in full-time service for a city with a population of 1.5 million.

Demand Up, but Supply Scarce

Philadelphia City Controller Alan Butkovitz said he ordered the study of the EMS system because of some troubling information.

"We know that since 1999, demand for ambulance services has almost doubled," he said. "We had been hearing about problems from paramedics for years now."

Butkovitz said his report showed that although the recommended average number of runs for an emergency unit is 2,500 to 3,500 a year, several vehicles in Philadelphia have handled more than 8,000 runs a year. And those vehicles are subject to break down more often because they are in use almost constantly. The report also found that "poor morale among many paramedics is fueling discontent and increasing turnover." In fact, the paramedic turnover ratio is now more than 50 percent.

"Here's the deal. People wait a long time every day. Pretty much every day somebody is having a delayed response. Somebody is waiting a long time. And somebody is getting a fire truck and going without an ambulance every day," said Dave Kearney, a 20-year EMS veteran who is now a firefighter and secretary of the Philadelphia Fire Fighters Union.

Kearney said the members of a typical Philadelphia EMS crew get their first call as they walk through the door at 7:30 a.m. and they might get back to the station "once that day."

Private Services Out of the Loop

Unlike fire departments in many other major cities, the Philadelphia Fire Department has no agreement to call on private ambulance companies when its ambulances are already tied up and delayed answering new calls.

The fact that a system the size of Philadelphia's doesn't have such a back-up program — known as mutual aid — surprises Jim McPartlon, president of the American Ambulance Association.

"In any progressive and quality EMS system, response times should be adhered to and if that can't be adhered to they should have mutual aid." he said.

In Payne's situation, a private ambulance company was just blocks away.

"What if a 9/11 happened here? Would they seriously not put out a call to private companies and just try to do it all themselves?" said Butkovitz, the city controller.

In the 1990s, a growing number of large ambulance companies, such as American Medical Response, started competing with fire departments for the often lucrative emergency response and patient transport market. Fire departments had traditionally handled all 911 calls, and after treating and stabilizing a patient, they left the transport up to an ambulance service.

The "ambulance wars" heated up when fire departments in some communities started fighting back, taking over the entire paramedic business from private companies.

Fire officials insist they are best situated to provide the most effective and professional response.

"If somebody is breaking into your house, do you want the security guard from Wal-Mart showing up to help or the police? Do you see what I'm saying? Do you want to take your chances with some fly-by-night ambulance company?" Kearney said. (TM - That's a cheap shot, Kearney! More on that below!)

But that's not the way Owens sees it. She said she would have taken the chance on anybody if they could have saved her son.

As for a mutual aid system, Ayers said that "nothing is off the table" but added that there are "legal issues and union issues" that have to be worked out.

The TrekMedic (a 28-year veteran of the EMS) continues (and seethes):

OK,..first, you'll notice that Captain America makes the statement about the chickens coming home to roost.

With all deference to C/A and the PFD, here's why that is happening:

In 1991, the Commonwealth of Pennsylvania enacted ACT 45, the ambulance service licensing law. The Commonwealth was divided into more than a dozen administrative regions, acting under the authority of the PA Department of Health.

Philadelphia became its own region, due to its overwhelming size and population. Who became the agency authorized to carry out ACT 45? That's right, the Philadelphia Fire Department. The PFD only recognizes itself as the sole provider of 9-1-1 based pre-hospital care in the City. It treated private ambulance services, and the 12 or so community volunteer ambulances that existed in Philadelphia, some pre-dating the PFD's EMS program. I should know; I got my start at the now-defunct Wynne-Brook Community Ambulance, which served Overbrook and Wynnefield for 3 decades!

What transpired over the next 17 years? Private ambulance services operated in Philadelphia much like any business. The Philadelphia Regional Office of Emergency Medical Services became another government-run boondoggle, not unlike the recently-scandalous Licenses & Inspections Office.

Private ambulances learned the byzantine workings of PROEMS and found ways to circumnavigate the Commonwealth's rules and regulations in favor of higher profits.

In that respect, Mr. Kearney is justified in his remarks.

The solution to the problem? Its been brushed off by that "union issue" remark. Of course! Philadelphia is a union-dominated city and the IAFF Local 22 isn't going to allow non-union labor to operate in their playground, no matter how many dead bodies they push out of there way to make their point!

Here's the TrekMedic solution:

1. Get PROEMS out of the hands of the PFD and into the hands of the City's Department of Health! Pre-hospital care is a HEALTH issue, not a fire prevention issue. Let those brave men and women do their jobs - putting out and preventing fires and saving lives!
2. Get EMS out of the hands of the PFD, which has treated the service like a bastard step-child from Day 1 and also bring it over to the Department of Health. See #1 for the rationale.
3. Make private ambulance services adhere to the same rules as the City's EMS service and reward those who do with mutual aid contracts. Those who don't should be blacklisted by the City. And keep a close scrutiny over who owns the private services (trust me when I say the Russian mob has a great deal to do with this in NE Philly!)

Relations like this work in places like New York City (where my parent company's operations cover approximately 25-33% of the FDNY-EMS calls) and Phoenix (a comparable-sized city) where the largest private service, Southwest Ambulance, is held under the same exacting standards as the Phoenix FD's units.

Stop the madness and start saving lives!!!