Calif. county’s ambulance response times delaying FFs on scene up to 25 minutes

I’ll dispense with the lame joke about how they are just Falcking around.

ALAMEDA COUNTY, Calif. —In a recent and strongly worded letter, the managers of two Bay Area cities demanded improvement from Falck, the private ambulance company tasked with responding to emergencies in Alameda County.

The officials from Livermore and Pleasanton alleged poor performance and delayed response times that were “outside of those dictated” by Falck’s contract. In sum, the letter reported that ambulances were late to about one in every six medical emergencies in their cities.

“The expectation of our community is a quicker ambulance response when 911 is called,” the letter read.

About 90% of the complaints at my former employer were about response times, not patient care issues. People don’t much care what we DO as long as we show up quickly.

The accepted “standard” response time in EMS is 8 minutes and 59 seconds. This is based on the inaccurate and obsolete premise that that is the maximum time a person in cardiac arrest can survive without CPR. There was never any data to support it, but so called “experts” in EMS latched on to it and set it as a standard.

One of the ways that private services under municipal contract use to meet that standard is by sending fire department first responder to stop the clock. The fire service organizations that represent fire fighters and fire chiefs latched on to this starting in the mid 1980s for one reason. Jobs. At the time smoke detectors and fire sprinkler systems were cutting the number of fires that needed to be responded to and some cities were talking about cutting back on fire department staffing.

So the two organizations which I won’t name came up with the idea of fire first response to medical calls. Note that the people who came up with the idea were not the same people who were going to be getting up at all hours of the night to go to medical calls for which they were poorly trained. If they were trained at all. Thus was born the fire service “Stare of Life” where in the fire fighters stood around while the officer got on his radio to ask for the ETA of the ambulance.

Although firefighters are often the first responders on a scene, they are not technically allowed to transport patients to the hospital — even in emergency situations. Because Falck has an exclusive contract with the county, only their ambulances are permitted to conduct such transports.

According to Woerner, that often creates a situation in which firefighters end up waiting on the scene 15, 20, or even 25 minutes for an ambulance to arrive, even with critically injured patients.

“In my world, it’s not acceptable,” Woerner said of Falck’s delayed response times.

Be careful what you ask for, you just might get it.

Some observers think a better system would be the “alliance model,” a public-private partnership where the county EMS agency contracts with the fire departments, which in turn manages the ambulance system. The system is used successfully in Contra Costa County , and San Diego just recently reached an agreement with Falck to take over billing and staffing in a similar model.

San Diego had a previous incarnation of this type of system with a different private ambulance service. I forget which one and it might now be out of business. Then again San Diego has always had weird EMS delivery models.

But I digress.

“Response times are only important and influence clinical care and patient outcomes in a small fraction of cases,” spokesperson Troy Espera wrote in a statement.

This is 100% accurate. It’s also 100% irrelevant. Why?

Because as stated above all people who call for an ambulance care about is that someone gets there fast.

Although Oakland only represents 30 % of the population, 50 % of the call volume in Alameda County comes from the city.

I’ve never been to Oakland and with luck will never go to Oakland. I know little other than it’s baseball and football teams have fled to other areas. One other thing I know is that Oakland has a lot of poor people. Poor people utilize, some say abuse, EMS for a bunch of reasons that I won’t go in to. It’s not just Oakland, but every city of any size anywhere in the country.

All sorts of alternatives have been tried to sending ambulance that essentially function as taxi cabs, but if anyone has found one that works I’ve not heard about it.

{Hayward Fire Chief Garrett} Contreras

“Our residents shouldn’t have to have an understanding on how this all works,” [Hayward Fire Chief Garrett] Contreras said. “The expectation the public has is that when there’s a problem, we’re going to fix it. So let’s fix it.”

Hate to break it to you Chief, but you are not part of the solution, you are part of the problem.

Thus has it ever been, thus it seems it will always be as time goes by.