Pam Zekman from CBSChicago did a piece the other night on the state of the Chicago FD ambulance fleet and EMS responses:
If you have a life-threatening condition will the city get an ambulance to you in time?
CBS 2?s Pam Zekman and the Better Government Association investigated and found they may not. That’s why paramedics say the city needs more paramedics and ambulances.
Take the case of Lynn Ramos. She was crossing Washington Street in the Loop last month when she was struck by a 2-ton postal truck. Fire engines with a paramedic on board arrived in about four minutes to extricate her from under a wheel of the truck. In recorded calls, one of them can be heard asking a city dispatcher why an ambulance hasn’t shown up yet. Ambulances housed closer to the downtown were not available. The vehicle that was available was five miles away and took 16 minutes to get there — 10 minutes longer than state guidelines suggest. The injured Ramos was suffering from a punctured lung; one fractured leg and the other broken in two places; a fractured pelvis and ribs.
The delay never should have happened, says Paramedic Field Chief Patrick Fitzmaurice. “We don’t have enough ambulances,” he says.
The city says it meets state standards by getting a fire engine with a paramedic and advanced life support equipment to the scene within six minutes to stabilize a patient until an ambulance arrives.
“It may take 10 to 15 minutes for an ambulance to show up after that,” said another paramedic, who asked CBS 2 to conceal his identity. ”And, depending on what’s wrong with the person, those minutes are critical.”
He’s one of more than a half dozen paramedics who tells CBS 2 that’s not good enough for people suffering from life-threatening conditions.
A stroke patient, for example, needs to be taken to a stroke center where their condition can be assessed and drugs given to eliminate the deficits they may suffer, he says. A gunshot victim, accident victims with internal injuries “need a surgeon to repair what their problem is,” says the other paramedic. “Time is of the essence.”
An audit by the city’s inspector general highlights the problem. It found that the city’s medical response times did not meet the standards recommended by the National Fire Protection Association. The NFPA says advanced life support equipment should get to a medical emergency within five minutes from the time it is dispatched 90 percent of the time. The inspector general found the city only met that standard 58 percent of the time.
“Taxpayer money for critical services are at the core of what we pay our taxes to do,” Inspector General Joseph Ferguson said. “And to the extent that our office looked at it, it appears that it is being done at a much lower level than what the fire department was claiming.”
Ferguson says the fire department first told his office they use the NFPA standards but then said they did not. And the report criticized the methods the fire department used to calculate its performance, saying, “No one has any idea truly how well it is performing a core mission.”
Andy Shaw of the Better Government Association says. “… peoples’ lives will be imperiled if they don’t get the right ambulances and the right trained personnel to the scene quickly enough.”
And that’s a daily struggle for dispatchers, paramedics like Fitzmaurice say. “There are times they literally just get on the radio and say, ‘I have no ambulances. … Can anybody go?’”
In a written statement, Fire Commissioner Jose Santiago disagrees there is an ambulance shortage. “The Fire department takes its calls for medical assistance very seriously and does not have a shortage of ambulances,” he said. Santiago also said the department plans to hire more paramedics this year, “after a temporary delay due to our updating testing requirements.”
“We are fully staffed every day with a mix of paramedics working straight time and overtime, the majority of which is voluntary. This allows us to respond quickly to start care and transport patients,” he says. In response to questions, a spokesman said the department would hire enough paramedics to reduce the $7 million it had to pay in overtime last year.
And the department is already tracking the response times of ALS ambulances to see how they can be utilized more efficiently and whether they need to move the headquarters for some of them to meet increased demands.
This from Bill Post:
This is a problem that most of us have known about for a while already however the ALS Engines and Trucks have been arriving on the scene much sooner which is the reason for the ALS fire company program. If you look at the video and the story you will see that one of the EMS field supervisors was willing to go on camera to confirm the story. That is unusual as he is an employee of the CFD . If you’ll notice the second CFD employee in the report chose not to be identified.
thanks Dan & Bill
#1 by Bill Post on February 20, 2014 - 3:01 AM
Contrary to what some people may think or assume, Chicago’s BLS ambulance program which officially began on June15th 2000 ,was not specifically recommended by the Study of the Chicago Fire Department that was done by the Tri Data Corporation that was released in 1999.
That study also known as the “Comprehensive Review of the Chicago Fire Department” had only recommended adding “at least 6” additional ambulances but never mentioned BLS ambulances. The BLS ambulance program was developed from another source.
At the time of the study Chicago’s Fire Department operated ambulance fleet was an all ALS fleet with 59 ambulances in service..
While quite a few public ambulance services do run with separate ALS and BLS ambulances in their fleets’s several don’t which includes both the Dallas Texas and the San Antonio Texas Fire Departments which are all ALS.
There are also a few Fire Departments which only make ALS removals and only use their ambulances on ALS runs.
The best know one in the nation is in Seattle Washington because they began strictly as an Emergency Cardiac Care program and is best known for having the high save rate of “witnessed cardiac arrests” in the nation. To this day they only used their ambulances for ALS emergencies and the system used in MIlwaukee Wisconsin is very similar where the Fire Department provides first responder service but if it is not an ALS or life threatening emergency then one of three private ambulance companies contracted by the city removes the patient.
#2 by Dennis on February 19, 2014 - 6:05 PM
no Brendan, adding 10 more ALS and eliminating the BLS will help out the citizens greatly. Having been on a BLS ambo I can tell that out of 22 runs I would do a day 3/4 could be ALS if the protocol was followed by dispatch. But in addition to adding the ALS, the city also should start back screening calls as well. Not sure if IDPH has anything to do with that but I’m sure the attorneys do. So let me ask this..if you call 9-1-1 for a arm pain and they send a BLS ambo and it turns out you are having a heart attack would you still be happy with getting that BLS ambo or would you rather have a ALS ambo. Just like the fire side always prepare for the worse. I would rather have a over qualified ambo picking me up instead of a under qualified.
#3 by Brendan on February 19, 2014 - 4:12 PM
Those 10 new Ambo’s need to be BLS answer all the BS the city decides to send a unit to. 60 ALS ambo’s for a city this size is plenty.
#4 by John on February 11, 2014 - 9:53 AM
As far as dispatching BLS to ALS is concerned, any person calling in who has a previous medical problem automatically get ALS. Back pain(in a person with diabetes) is ALS and that is from the Medical Director and CFD set rules for the alarm office. Just a little info as to why a BS call is dispatched ALS. We could talk about this forever with BLS and ALS, but that is the rules. Also, people know how to play the system and call in saying they have chest pain. Crews get there and the person has a “cold”. That isn’t dispatch fault, its the caller knowing the “game”.
#5 by NJ on February 11, 2014 - 8:40 AM
Bill,
Thank you for your elaborate post. As usual you do a fine job, especially breaking down the details of statistics etc.
Your info on NY was helpful. It is more complicated because NY has many different aspects to their system including large numbers of private volunteer EMS’s that run thousands of calls per year too. The bottom line is that Chicago is waaaay poor in the number of ambo ‘s dept. As the piece rightly pointed out, very often transportation is the key. Having a medic on scene for 15+ min is often insufficient. The patient needs the hospital fast.
There are several factors IMO in Chicago that play a role. Primary, is that due to the ratio of BLS to ALS rigs, the vast majority of BLS calls are dispatched to ALS rigs. Second, as I stated before, Region XI SMO’s call for ALS far more than many other regions and systems do.
As for the dispatch, it is only as good as the people doing it, regardless of the system.
#6 by Bill Post on February 11, 2014 - 4:50 AM
NJ, I found out what the NOC is. If they are using a complete protocol such a Pro Q A the answers to the specific questions should be able to assist in determining as to whether the run should be dispatched as an ALS or a BLS run.
While I don’t know what the exact breakdown of types of runs have been in Chicago , I have heard for quite a while that in most cities the BLS incidents really out number the ALS incidents but that also depends if the different fire or ems departments are using the same standards or the same protocol determenating criteria and that criteria can still vary from city to city even though ideally speaking it really should be standardized.
Since you brought up the New York City system their statistics are much easier to come by then Chicago’s for both fire and ems runs.
In New York City only about 35% of their EMS runs are considered to be ‘life threatening” emergencies according to the classification system that they use. In New York City the EMS calls are divided into 8 categories which they call “segments”. If the call is classified as a Segment 1,2 or 3 it is considered to be “life threatening” with Segment 1 being the most urgent while if it is classified as a Segment 4 through 8 call then it is not considered to be “life threatening”.
New York City as you may know runs a much more complicated system then Chicago does and it is what could be called a “mixed system”. Here’s why. Not all of ambulances that the 911 system dispatches are New York City Fire Department Ambulances. As of mid 2012 only about 64% of the 911 dispatched ambulances were from the New York City Fire Department. The remaining 36% were supplied by several private hospitals which run their ambulances as part of the 911 Emergency system in New York City.
Even though those ambulances are provided by several private hospitals they are dispatched and run as if they were public ambulances and the 911 system in New York City will dispatch the closest ambulance that is part of the system whether is from the Fire Department of one of the private contributing hospitals.
Another thing that is different about New York City’s Ems system is that the ambulances run on 8 hour shifts or “tours” , like the police department does. Because of that less ambulances run on the “first tour” or the midnight shift. On the second the third tours is when most of the ambulances run. So New York City really runs with about 370 ambulances during the day and evening tours and on the midnight tour they run with about 255 ambulances on duty. Those were the numbers of ambulances that they were running with in 2012 and included both the Fire Department and the Hospital Ambulances.
While 600 isn’t the correct number of Ambulances that New York City runs with, I do know where you got that number from. The New York City fire department was running 636 Ambulance “tours” or shift crews a day while the Hospital Ambulances were running 359 “tours” or crews a day in 2012.
So that high number was the amount of crews that they would use in a 24 hour period and not the number of ambulances that they were using.
You are correct however that based on population per capita if Chicago was running it’s ambulances according to New York City’s per capita ambulances then Chicago would be running with about 123 ambulances as Chicago has about 1/3 or about 33% of the current population of New York City. Of the 370 Ambulances that New York City was running with in 2012 133 of them were ALS and 237 were BLS. That figure includes both the Fire Department and the Hospital Ambulances. If Chicago was using New York City’s formula( like you were suggesting) then 44 of the ambulances would be ALS and 79 of them would be BLS.
I am not advocating that I am just presenting the numbers so no one should say that I am advocating that.
Another interesting fact about New York City’s ambulances is that the fire department has only been running public ambulances since around 1996. Before 1996 New York City’s Health and Hospital corporation had run the City Ambulances as a “third service”.
Even though the New York City Fire Department runs and is responsible for about 64% of the 911 or public ambulances the ambulances do not run out of the fire stations. All of the ambulances are based at designated intersections or street corners around the city when they are on duty.
New York CIty does run with about 35 ambulance stations however they only use the stations when they change shifts , clean up and get resupplied and do light maintenance otherwise the ambulances are on the streets at their designated intersection’s.
Around 2004 New York City did open two New Fire stations with ambulance stations that were “built in” to the fire stations but as I just mentioned they are only used for changing shifts ,paperwork and light maintenance. Since then several additional new EMS stations were built separate from fire stations. Several of the EMS stations are located in some former fire stations however.
Currently New York City doesn’t run with any ALS fire companies and only the Engine companies and Squads (rescue/pumpers) run as first responders. Truck companies are not normally dispatched as first responders and if the Engine in a double company station is not available then they will dispatch the next closest Engine to the medical emergency as opposed to using the Truck (Ladder) company as the first responder.
This was meant for informational purposes.
#7 by Bill Post on February 10, 2014 - 4:55 PM
NJ , I have question for you. What is an NOC? What do the initials stand for.
What set of triage protocols is the CFD currently using to determine the type of medical run is being dispatched?
For example are the Protocols the one that are issued from the National Academy of Emergency Dispatch that is based in Salt Lake City or are they another set of protocols that are issued from a another company or agency?
I assume that what ever protocols that the Chicago Fire Deparment is using is hooked up to the 911 center computer consoles so that the call is classified based on answers to the relevant questions that asked?
Thanks
#8 by Max O on February 10, 2014 - 1:20 PM
The question is will Rahm actually put more ambo’s in service? Come on Rahm do it for the Children.
#9 by 0.02 on February 10, 2014 - 12:38 PM
Bottom line is more ambulances are needed. You have over half the ALS fleet doing over 5,000 runs a year and the top 5 are over 7,000 runs. There are BLS ambulances that are doing 15+ runs a day too. It’s to the point now that almost everyday the office is telling a fire company to put their medic in the back of the BLS ambulance because there are no ALS available. An example is at engine 101 there is a BLS and an ALS ambulance and they are doing about 50 runs a day together. Bottom line is more ambulances are needed.
#10 by NJ on February 10, 2014 - 9:06 AM
There are a couple of problems with the BLS rigs. One, in many cases it is hard to determine what is ALS (and Region XI goes way overboard, IMO with what NOC’s need to be ALS) on the phone. Feeling weak can be a cardiac event, in certain cases.
Second, is that the OEMC dispatchers often do not put out the NOC as what the caller actually says. They run through their protocols and choose the worst sounding thing in their medical history. Thus, many real BLS calls are dispatched to ALS.
Finally, in the busy areas of the city, the BLS rigs are pretty busy. They’re not usually sitting in quarters. They are few and fare between, and are not adequate even if utilized to relieve the ALS rigs to any significant degree.
Once final point. FDNY, runs about over 600 ambo’s (best available info). Their response times are slightly over 6 min. If you do the math for their higher population vs Chicago’s we should have about 120 ALS ambo’s and over 50 BLS.
#11 by Midwest Medic on February 9, 2014 - 8:42 PM
A way to (try to) combat this would be to utilize BLS ambulances more effectively. Psychs (who haven’t made a suicide attempt by lethal means), falls that aren’t accompanied by loss of consciousness, “my hand has hurt for six months,” flu-like symptoms, and the myriad other non-critical calls all get BLS rigs. It doesn’t necessarily change the shortage, nor does it mean that 911 callers (who are notoriously bad at describing things or occasionally lying) will provide good information for dispatch to get it right all the time. But it does mean that, combined with the paramedics in place on suppression companies who respond to calls already and would be on scene in case the call info was bad, ALS ambulances would be more likely to be available for things that get called in with “ALS sounding” complaints. The overuse of paramedics is not a uniquely Chicago issue, of course, but that’s another conversation entirely.
#12 by Chuck on February 9, 2014 - 7:29 PM
Casey, it doesn’t matter what type of call, it just matters that they’re not there PERIOD. And the further out in Chicago you live, especially North and Northwest, ambulances are REALLY at a premium. If 46, 47 and 39 are dragged south or southeast, that leaves Ambulance 2. And if they get dragged southeast into the City, then the people that actually PAY for the ambulances are really screwed. No help coming for them quickly, to be sure.
#13 by Bill C. on February 9, 2014 - 5:33 PM
UNFORTUNATELY, IDPH defines an EMERGENCY as decided by the CALLER, NOT by the actual PROBLEM .
THIS is WHY all these ” my hand hurts” “oh its been about 3 weeks now” , get dispatched as emergencies .
IDPH definition seems to be bogging down possible telephone triage prospects.
#14 by Kyle on February 9, 2014 - 4:27 PM
There would not be a shortage or delayed arrival time if there was a way to weed out the non emergency calls. What would be interesting to see is when there is an actual life threatening emergency and the closest transport paramedic is out on another call, what type of call are they on?
#15 by NJ on February 9, 2014 - 3:34 PM
He is very definitely correct. 15+ min run times for the ambo’s are not uncommon.