Column: Entire Community Responsible for EMS Success

What's wrong with ambulances in Shelby County? Why do we have at best a 6 percent chance of surviving a sudden heart stoppage? Who's to blame? What can we do to improve our odds?

Rural Metro Ambulance Service is an easy target, but they get an ambulance to their patients in an average of 6.9 minutes. The national standard is 8 minutes.

The real culprit: all of us.

For too long we have tolerated an opaque, fragmented emergency medical services (EMS) system. We have not asked how it is doing. We have asked what it costs rather than what we need.

The agonizing wait for an ambulance that former Memphis mayor Wyeth Chandler's family endured two years ago was not the fault of the Bartlett ambulance service. In that case, Shelby County did not fulfill its obligation to provide a quick response. If Chandler had collapsed from a heart attack in Germantown, help would have been there in minutes. In unincorporated parts of Shelby County, residents have no such assurance. The citizens of Memphis and the towns pay to ensure that rapid response.

We must stress that word "obligation." EMS is just as important as fire and police service.

Much is at stake when someone suffers a heart stoppage or stroke because modern medicine can keep the heart muscle pumping and the brain cells connecting. Success in treating these emergencies often is a matter of time: time to get vital oxygen and blood flow to tissues before their cells die, and thus the patient dies too or is left severely impaired. Emergency ambulances and their crews cannot meet these demands alone. The entire community must work together.

Heart disease is our number one killer, and how well an EMS system performs when a person's heart suddenly stops is one of the best measures of system performance. For such patients, we need CPR applied within three minutes, electrical shock (defibrillation) applied within five minutes and a paramedic-staffed emergency ambulance available within eight minutes.

Any solution by the county or the towns that does not address all three of these requirements - early CPR, early defibrillation and rapid transport - will fail. Here is why.

Basic CPR can be started right away, by the person standing next to us or a police or fire department first responder. Immediate CPR increases chances of surviving two- to threefold; that chance decreases by 10 percent with every passing minute.

In Shelby County, there is only a 1 in 8 chance that someone will start CPR before EMS arrives. African-American patients have about a 1 in 16 chance. That is why we need an army of CPR-trained citizens. It will take strong commitment from government and community leaders to mobilize and train that army.

While CPR keeps blood flowing to a patient's heart and brain, we must use defibrillation to restart the heart. We now have the solution to this critical time demand - the automatic external defibrillator (AED). With an AED, a minimally trained bystander or professional first responder can set up and defibrillate in under two minutes.

An emergency ambulance must then rapidly transport the patient to the hospital, where medical teams face additional tight time constraints in using their tools to bypass the blockages that kill heart muscle or brain cells. Time lost in getting the patient to the hospital can be heart muscle or brain function lost.

Time is lost when patients or their families delay calling 911; when calls are transferred through a fragmented 911 system; when ambulances are not promptly available; when communication is incomplete; when emergency departments divert ambulances; when hospital procedures impede care. All these roadblocks must be ripped out of the EMS system.