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Does Chicago have a shortage of ambulances? (more)

Apr 1

Posted by Admin in Fire Department News | 38 Comments

Some recent articles about the controversy in Chicago with EMS responses and the availability of ambulances;

This from CBSChicago about a memo to dispatchers:

The CBS 2 Investigators and the Better Government Association have been warning about an apparent shortage of Chicago ambulances and paramedics. The result: dangerous delays for patients needing emergency care.

So far, it seems the city is trying to cover the problem up instead of fixing it. In the meantime, the response times for ambulances are just getting worse.

“Anybody available downtown that can take a run,” a dispatcher’s voice crackles through the scanner speaker.

These are the types of calls paramedics say happen every day. “It’s clear they have no ambulances and it clearly validates what we’ve been saying that they need more ambulances,” said paramedic field chief Pat Fitzmaurice.

But now, city officials apparently don’t want the media or anyone else with a scanner to hear some of those transmissions asking for help. They are asking dispatchers to watch what they say.

CBS 2 and the BGA obtained a copy of a memo written by a supervisor at the Office of Emergency Management. It called shout-outs for any available ambulances: “not an acceptable practice.”

The memo instructs dispatchers to, “Avoid terminology like we have no ALS (advanced life support) ambulances available,”….particularly when they have to send a basic life support ambulance to the scene and a fire engine with a paramedic on board. Basic life support ambulances do not have paramedics and the same equipment as advanced life ambulances.

Dispatchers should use ambulance numbers to instruct staff in the field on what to do in those cases, the memo said, adding, “Hopefully we can get the message across without highlighting the fact that no ALS unit is available.”

The memo also concedes that, “We all realize that certain times we are inundated with runs and lack of resources.”

This is from EMS1.com:

A city-issued memo obtained by CBS Chicago asks dispatchers to watch what they say, calling shout-outs for available ambulances “not an acceptable practice” and instructing dispatchers to “avoid terminology like we have no ALS ambulances available” so as not to highlight the fact. Written by a supervisor at the Office of Emergency Management, the memo also states, “We all realize that certain times we are inundated with runs and lack of resources.”

Better Government Association CEO and President Andy Shaw said the city should be addressing it.

A spokeswoman from Chicago’s Office of Emergency Management said the memo is an “informal internal document” that serves as a reminder to dispatchers to use “approved protocol and professionalism.”

CBS has continued coverage of long response times, including incidents where it took 16 minutes for an ambulance to respond to a woman struck by a postal truck while crossing the street, 22 minutes for an elderly patient complaining of chest pains, and 26 minutes for an ALS response to the home of an elderly woman having trouble breathing.

A spokesman for the Fire Department said the 26-minute response time was “unacceptable” and the incident is under investigation. In a written statement, the Fire Department said it is conducting a review of its ambulances to ensure deployment meet the needs of Chicago.

Also from EMS1.com:

The head of most EMS operations is the communication center. The responsibility is huge. It is the first point of contact for the community when reporting medical emergencies.

[Dispatchers] coordinate the system’s resources, trying to match the appropriate unit to the appropriate incident. Dispatchers use various forms of technology to help make those decisions: software, GPS, dispatch algorithms, among others. The system has to be able to send the appropriate resources at the right time to avoid going to a zero-level condition. Sometimes that’s unavoidable, but regulating the system to minimize a zero-level condition can help reduce the possibility.

How does Chicago keep track of their resources? It seems a little strange that a dispatcher doesn’t know where the units are at any given time. While Chicago is a big system, other similarly sized systems seem to be able to tell which ambulance should go where at any point in time. Is this a sign of a larger issue? If there are ways to increase the effectiveness of system operations, throwing more ambulances at the problem isn’t necessarily the fix.

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Does Chicago have a shortage of ambulances?

Feb 9

Posted by Admin in Fire Service News | 15 Comments

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

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