Ambulances Slow to Respond in Tulsa

Ambulances Slow to Respond in Tulsa

News Feb 14, 2013

Feb. 14-- EMSA reported that its ambulances were delayed in responding to at least 80 calls so far this year, a situation city officials say is not an isolated or temporary problem.

Ambulances were delayed to calls involving heart attacks, breathing problems, car accidents, seizures, suicidal patients and other serious medical conditions, records show.

Ambulances were called during that time for at least two patients -- both 59 years old -- who died from cardiac arrest, records show. It is unclear what role, if any, emergency response played in those cases. One victim was pronounced dead before an ambulance arrived.

EMSA CEO Steve Williamson said the reported delays are not actual delays but are situations in which ambulances might be delayed beyond the response time required by city ordinance.

Public safety is not being compromised, and EMSA has a medical director who closely monitors such issues, he said.

He said the data are based on messages EMSA sends to the Fire Department as a "heads up" and that the data are being "misinterpreted" by city officials.

The map displays addresses where EMSA dispatchers said ambulances were delayed arriving to medical calls since Dec. 31, 2012 through Feb. 4, 2013. EMSA later said the data represents possible delays, not actual delays.

Fire Chief Ray Driskell said he has been asking Williamson for months to help the Fire Department obtain better data and information from EMSA. The department has 490 emergency medical technicians, more than 100 certified paramedics and 16 trucks staffed with firefighters who have advanced lifesaving training, he said.

"I'm here to help EMSA," said Driskell, whose son works for EMSA. "I want to try and improve what's going on."

Driskell said that during a recent busy weekend that prompted attention to the issue -- Jan. 26 and 27 -- EMSA did not communicate about the call overload until it had already occurred.

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"They just said, 'We're going to be delayed,' " Driskell said.

That message often comes verbally, with an EMSA dispatcher in the city's dispatch center leaning over and telling a Fire Department dispatcher about the delay, he said.

Tulsa city councilors plan to discuss the reported delays at a committee meeting Thursday, in part due to a spike in calls during the last weekend in January.

"I'm hoping to have a better understanding of why these delays are happening and what we can do to improve. I've heard numerous complaints," said City Councilor Karen Gilbert, who asked that the issue be placed on the committee's agenda.

Mayor Dewey Bartlett said he has heard no complaints from citizens about ambulance response times.

"What we don't want to do, in my view, is to jump to conclusions. ... We have to see the rest of the story," he said.

The Emergency Medical Services Authority is a government agency that oversees a private contractor to provide ambulance service to more than 1.1 million people in Tulsa, Oklahoma City and area cities.

A Tulsa World investigation of EMSA that began in 2011 uncovered numerous administrative problems with the agency's billing and spending practices, which sparked a recent critical state audit and earlier city review. EMSA's board meets later this month in Stroud to discuss the audit and related issues.

To date, investigations by the World and other entities have not raised concerns about delayed responses by EMSA. The agency announced Tuesday that its dispatch center has been re-accredited by the International Academies of Emergency Dispatch. EMSA said it has held the accreditation since 2000.

Agencies on demand

A city ordinance requires EMSA ambulances to respond to 90 percent of the most serious calls in Tulsa within 8 minutes and 59 seconds. The ordinance specifies longer allowed response times for less serious calls.

EMSA has specified all response time requirements in its $150 million contract with its contractor, Texas-based Paramedics Plus. EMSA has not fined Paramedics Plus in the last four years for failure to comply with the overall response time, records show.

Tulsa firefighters also respond to medical calls, often arriving before ambulances because there are more fire trucks available to respond to such calls. Firefighters provide medical care until ambulances arrive to continue treatment and transport patients.

When EMSA dispatchers expect ambulances to be delayed during times of peak demand, they send a message to the Tulsa Fire Department. Williamson said EMSA began sending those messages to the Fire Department at the suggestion of EMSA's medical director.

Records show that the messages -- which arrive via email to Driskell and other fire officials -- state "EMSA is delayed" to the call. They note the address and a few details about the patient.

The messages show that EMSA reported being delayed on 85 calls between Dec. 31 and Feb. 4.

"EMSA delayed and sending all calls to fire for response," states an entry in the data regarding a call Jan. 1.

Seven of the entries note that other agencies were called to help EMSA with the demand.

"Mutual Aid -- No EMSA Units, No Sand Springs Fire Units," states another call on Jan. 26. That call was from a Sand Springs resident with an unknown medical issue.

Williamson sent an email with the subject line "crazy day today" to Driskell and other officials at 6:26 p.m. Jan. 26.

The email says EMSA received 16 calls at 9 a.m. that day and 18 within the next hour. It refers to a patient in the 3300 block of East Archer Street who "was coded an arrest and TFD did pronounce the patient but an EMSA unit did respond and arrive on scene and remained for approximately 25 minutes."

Records do not list the name of the 59-year-old man, and it is unclear how quickly an ambulance arrived or whether advanced life saving techniques would have made a difference. Another case involved the death of a 59-year-old woman in east Tulsa but fewer details are available.

Williamson said he takes the welfare of people who call EMSA seriously. He said he once summoned an ambulance for his late wife and understands the need for urgency in all cases.

The last weekend in January was a particularly busy time for EMSA, possibly due to the flu and normal variations that occur in medical calls, he said.

The company can exclude from EMSA's on-time calculations calls in times when demand is particularly high or during certain weather conditions, as determined by a weather expert, Williamson said.

Emails obtained by the World show that Driskell has been asking to meet with Williamson about the matter for nearly two years.

"Over the past 3 weekends, I have noticed a consistent issue of 'delayed responses from EMSA.' I have many concerns with this," states an email from then-Deputy Chief Driskell to Williamson on March 18, 2011.

Driskell said he met with Williamson on Monday after saying it was "imperative" to meet about delays. He said EMSA and TFD officials discussed the need for better communication, better equipment and how response times are tracked.

"I think he was receptive to the concerns of the Fire Department," Driskell said.

Williamson said the concerns are based on a misunderstanding about ambulance response times.

"It's not a system just built on levels of service," he said. "If we only required them to have 20 ambulances out or 30 ambulances out, you couldn't require the response times that we do."


Response time requirements

A Tulsa city ordinance requires EMSA ambulances to respond to calls in the city limits within the following time limits 90 percent of the time. EMSA is allowed to exclude from these requirements calls received during certain peak demand times and "unusually severe weather conditions." Calls are listed by priority, with 1 being the most serious and 4 being a scheduled medical transfer.

Priority 1: 8 minutes, 59 seconds

Priority 2: 12 minutes, 59 seconds

Priority 3: 60 minutes, 0 seconds

Priority 4: 20 minutes, 0 seconds*

EMSA is required to respond to calls outside of Tulsa and Oklahoma City in cities that it serves -- the "non-beneficiary cities" -- within the following time limits 90 percent of the time. The requirement excludes calls during peak demand times and severe weather.

Priority 1: 11 minutes, 59 seconds

Priority 2: 12 minutes, 59 seconds

Priority 3: 60 minutes, 0 seconds

Priority 4: 20 minutes, 0 seconds*

(--after agreed-upon pickup appointment)

Source: City of Tulsa ordinances

Ziva Branstetter 918-591-8306

Copyright 2013 - Tulsa World, Okla.

Tulsa World, Okla.
Ziva Branstetter
A leading healthcare Software-as-a-Service (SaaS) and data provider taps a marketing veteran to support Its rapid growth.
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