Emergency response times can vary widely-Dutchess County

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Emergency response times can vary widely

Where you live is a key factor

By Anthony Farmer

Poughkeepsie Journal

During a traffic accident earlier this year on Route 9 in front of Marist College, Alamo Ambulance Service paramedic supervisor Scott Spencer, right, and an unidentified New York State emergency medical technician stabilize an injured woman before transporting her to a local hospital.  

Lisa Hartley was at her Wappinger home with her three children one evening in July when her 11-month-old daughter stopped breathing and turned gray. The infant had become agitated, held her breath and passed out, Hartley said. ''Needless to say, we were horrified,'' Hartley said.

She dialed 911 and requested help. While waiting for the ambulance to arrive, her daughter, Logan, regained consciousness but was still not herself, she said.

Hartley was angered when the ambulance, from Alamo Ambulance Service, took 25 minutes to get there.

Alamo officials said the response was closer to 18 minutes and dispatch problems that led to the long delay have been corrected.

Hartley has since filed complaints with state and local officials regarding the response time and the state Department of Health is investigating.

''But not for divine intervention, this baby wouldn't have made it,'' Hartley said. ''There's got to be a better reaction.''

While longer than most, such lengthy responses to calls for help are not unusual in Dutchess County.

A Poughkeepsie Journal computer analysis of 73,000 emergency ambulance dispatches from 2001 to 2003 showed a combination of volunteer and paid emergency medical services (EMS) personnel working together responding to calls for medical help.

Residency important

And where you live has a direct bearing on how long it takes for an ambulance to arrive when you call 911 in an emergency.

Medical experts said how quickly help arrives is one of several key factors in surviving a life-threatening situation. Other factors include the level of training of those providing first aid and whether a hospital emergency room is nearby, said Dr. Craig van Roekens, director of emergency services at Vassar Brothers Medical Center in Poughkeepsie.

''The goal, of course, is to get to people as quickly as possible without causing a hazard to EMS personnel and other people,'' said van Roekens, chairman of the Hudson Valley Regional Emergency Medical Advisory Committee, which oversees ambulance service in the region along with the Hudson Valley Regional EMS Council. ''Time is not the only critical variable, but it is certainly one of the important variables.''

The Journal study found average response times in Dutchess County municipalities for 2003 ranged from under six minutes in the Town of Poughkeepsie to just over 21 minutes in the Town of Union Vale.

The response times are driven by a number of factors, including the availability of volunteer emergency personnel, the number of other calls being handled at a given time, and the distance to the scene of an emergency.

More municipalities and fire districts are hiring paid crews to augment or even replace volunteer crews, which simply don't have the numbers to handle the work load, especially during the daytime hours.

Mike Quinn, a member of the East Fishkill Rescue Squad, said there are times when volunteer squads don't have enough people available to answer a call.

''Sometimes there's nobody left; they're all out working,'' Quinn said. ''Things can get stretched pretty thin sometimes.''

If a volunteer crew can't be assembled, a mutual aid call is put out after 10 minutes, and another agency answers the call.

In general, the average response time in the county is up slightly from 10 years ago, the Journal analysis found, reflecting the area's growing population and increasingly limited volunteer pool. The average response time in the county went from just over nine minutes to just under 10 minutes.

While there's no national standard for response times, recommendations from various medical groups suggest response times between 6 to 12 minutes, depending on the level of care needed and on whether the area is rural, urban or suburban.

The EMS system locally consists of a patchwork of volunteers and paid emergency medical technicians and paramedics who are handling a much higher number of calls than a decade ago. The county's growing population, the implementation of an emergency 911 system five years ago and the booming use of cell phones are all causing stress on the system because of added calls, including those for nonemergency situations, officials said.

Besides Alamo Ambulance, Northern Dutchess Paramedics, based in Rhinebeck, Mobile Life Support Services, a private company based in Newburgh, and TransCare Hudson Valley, a new player in the area, are the other paid services in the county. Until July 2003, Sloper-Wilen Community Ambulance Service was also a paid provider, but after 50 years of service, it merged with Alamo.

25 have own squads

Twenty-five fire departments in Dutchess have their own volunteer rescue squads, and there's one volunteer ambulance corps. The volunteer agencies still respond to a majority -- 58 percent -- of calls in the county.

Regardless of where an emergency occurs in the county, paramedics are automatically dispatched to all calls where they may be needed. Paramedics have more extensive training than emergency medical technicians and are skilled at providing more- advanced care to patients who need it.

Most people expect quick EMS service when they dial 911 in an emergency. But when waiting for help to arrive, seconds seem like minutes and minutes seem like hours.

Most of the calls received are for emergencies that are believed to be life-threatening, including numerous conditions or injuries, from chest pains to difficulty breathing to someone being unconscious.

Generally speaking, those in the more densely populated areas can expect better response times while those living in more rural areas, where greater distances need to be traveled, can expect to wait longer.

Many take for granted all that goes into staffing an ambulance and getting it there in a timely fashion.

Stephanie Brozman, a Fishkill resident, saw first-hand how it all comes together.

In September, Brozman was experiencing shortness of breath and chest pains. Since she has a heart condition, she feared it might be a heart attack and her daughter called 911.

Members of the Rombout Fire Co. quickly responded and an Alamo ambulance was there just minutes later, Brozman said. Firefighters checked her vital signs and gave her oxygen until the ambulance arrived.

''The guys at the firehouse did a real good job,'' Brozman said.

She was also satisfied with the service provided by Alamo.

''They know what they're doing,'' Brozman said.

When she got to the hospital, doctors found she was suffering from angina and it was not life-threatening.

Recent focus

The issue of ambulance response has come into focus over the past year as Wappinger officials bickered with Alamo over the company's service in the town.

Town officials complained about long response times and in September terminated the town's contract with Alamo after months of debate.

Alamo maintained its average response times were in line with what the town had contracted for -- nine minutes or less for the most serious calls and 12 minutes or less for less serious calls. Ambulance officials said there are always unusual situations that result in longer response times, like handling multiple calls at the same time or responding to mutual aid calls in neighboring communities.

The town has since hired another private company, TransCare Hudson Valley, with a station in Wappinger, to provide ambulance service in the town. TransCare is headquartered in Brooklyn, but has three vehicles stationed in the town at all times, under their agreement with Wappinger.

But, not every town has a station. Some towns are served by stations in neighboring towns or ambulances on patrol.

In December, the Village of Fishkill and Town of East Fishkill fire department also ended their agreements for Alamo to provide coverage in their communities. The village cited alleged record-keeping problems, and the fire department complained that a ''fly car,'' an emergency vehicle with a paramedic, was sent, instead of an ambulance, which can transport an ill person. Each switched over to Mobile Life Support Services.

For the most part, it's still volunteers who are handling the majority of emergency calls in the county. But more and more, paid crews are being relied on to provide service, especially during daytime hours when the dwindling number of volunteers are simply not available.

The cost of this service varies based on the number of vehicles and personnel provided and the coverage period the municipality wants.

Paramedics are already available countywide for any emergency call requiring advanced life saving. The cost of those trips is borne by the patient's insurer. If the patient isn't insured, or unable to pay, the ambulance company must bear the expense.

With more two-income families and more local residents commuting longer distances to work, people have less time to volunteer. Stringent training requirements, totaling more than 100 hours, are also an obstacle to getting new people involved.

The shortage of volunteers is not unique to emergency medical services and extends to firefighting and coaching youth sports leagues.

The Town of Union Vale is just one place where the problem has become acute. Union Vale fire officials recently contracted with Northern Dutchess Paramedics to provide coverage during weekdays from 6 a.m. to 6 p.m. The town's volunteer rescue squad provides coverage the rest of the time.

While no one questioned the ability or dedication of the volunteer members of the Union Vale Rescue Squad, there just weren't enough people available to guarantee coverage during weekdays, Union Vale Fire Chief Dave Schmoke said.

''I'm not a big fan of doing that, but reality dictates it,'' Schmoke said of bringing in the paid service.

Having to cover some 36 square miles hinders response times, but having a paid crew on call during daytime hours, and based in the town, will help, Schmoke said. That wasn't always the case when relying solely on volunteers, he said.

''When we have people in town, we're not bad,'' he said. ''When we didn't have people in town, and we were not getting out, that was the issue.''

Can go unanswered

It's difficult to say how often, but it is not unusual for a 911 call to initially go unanswered in the county when a volunteer crew can't be mustered.

If a crew hasn't been assembled when an emergency call comes in, a second call goes out after five minutes. A third call goes out after another three minutes. If the unit has not started responding after another two minutes, another agency is called in to help.

But more municipalities and fire districts have made arrangements to fill those gaps.

And some are even looking to share services, like having volunteers respond to calls in each other's jurisdiction to maximize manpower, said DeWitt Sagendorph, Dutchess County Emergency Response Coordinator. Some emergency officials have talked generally about sending volunteer crews to nonlife-threatening calls to stabilize patients and letting paid services transport them to the hospital for care, he said.

''There's more and more of that being looked at and fostered throughout the county,'' Sagendorph said. ''But there's no one solution.''

Many in the field are watching the approach being taken in Suffolk County, on Long Island, to try to improve response times.

The Suffolk Regional EMS Council has instituted new protocols that require volunteers to phone in if they're able to respond when a call goes out for an ambulance. If two minutes go by without someone calling in, another call goes out and if another two minutes goes by, a neighboring agency is called to respond.

For life-threatening calls, the second dispatch call goes to the neighboring agency.

''It's all about the patient who's waiting for an ambulance,'' said Dave Brenner, chairman of the Suffolk EMS council. ''Time is medicine. The failure to administer this in a timely manner is crucial.''

When the new protocol was first proposed, it required certain response time goals. But that was dropped after feedback from the volunteer community, he said.

There's been a tremendous backlash from the volunteers, Brenner said. Many already don't feel appreciated, and the increased scrutiny only exacerbates that, he said.

Different viewpoint

But they need to think from the patient's point of view, he said.

''The only question patients have ever asked me is, 'What took you so long?' '' Brenner added. ''Anybody who thinks waiting 12 minutes for an ambulance isn't a big deal ought to try holding their breath for 12 minutes.''

The executive director of the Hudson Valley Regional EMS Council, which covers Dutchess and five other counties in the region, said the action in Suffolk has sparked interest around the state. But there are no plans for similar steps to be taken locally, Ray Barishansky said.

But people looking at response times and striving to improve them is best for all, he said.

''Heightened awareness about the EMS system will eventually be a good thing for the consumer, as well as the EMS system in general,'' Barishansky said. ''It has the potential to effect change.''

Edward Murray, president of Northern Dutchess Paramedics, said his paid crews have helped reduce response times in several towns in the northern part of the county where they have been hired to provide partial coverage. They are constantly working to meet a goal of responding within 6 to 10 minutes, he said.

''Unfortunately, given some of the geographic limitations we're dealing with, it is just that, a goal,'' Murray said. ''If you choose to live in a certain area, there are certain consequences that come along with that.''

Kevin Ronk, vice president of Alamo Ambulance, said a town can reduce its response times, but it comes with a cost. Adding more crews in a given area costs money for things like salaries and equipment, he noted.

''We'll put an ambulance on every street corner if you want,'' Ronk said. ''It becomes cost prohibitive.''

Hartley, the Wappinger mother, said she fears something will happen again with Logan or another child, and help will be slow in coming.

''I need to know if I have a problem beyond the scope of me being a mother, that there's going to be someone to help me,'' Hartley said. ''There really has to be a closer look at this.''

[DMA327 12]

GO mutual Aid? 18 minutes is a long time

But also depends on the area demographics

[WAS967 97]

10 minutes before the first call for M/A is a little rediculous. They complain that the cell phones are stressing the system, well use the cell phones to help the system. Call in and let dispatch know you are going to the scene/rig. I understand if the department doesn't have the money or infrastructure to have portables (especially with the size of some districts up there), but most people have cell phones. They may say that calling mutual aid within 2-3 minutes of the initial call is quick, but like someone said, try holding your breath for 12 minutes. Hell, in a lot of the county, it's quicker to drive to the hospital than to wait 20 minutes for an ambulance.