City Council voices concern over ambulance response times

Posted November 21, 2012 at 12:00 am

By LESLIE COLLINS
Northeast News
November 21, 2012 

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Ambulance response times in the Northland continue to lag behind other parts of the city.

From January to October, the Northland performed the worst every month in terms of ambulance response times for life threatening emergencies.

Interim Kansas City Fire Department Chief Paul Berardi said challenges of the Northland are its geographical size, a growing population and fewer fire stations compared to other ambulance response districts.

Kansas City is divided into four ambulance response districts (ARD): ARD 1 (Northland); ARD 2, (Central); ARD 3 (East side); and ARD 4 (South side). For each ambulance district, city code requires that ambulances respond to life threatening emergencies in 9 minutes or less 85 percent of the time.

In January, KCFD met that goal 60.8 percent of the time in the Northland. By October, that number increased to 71.3 percent. In comparison, ARD 2 met the goal in October 86.4 percent of the time; ARD 3, 80.3 percent; and ARD 4, 76.8 percent. The three-month average from August to October was: ARD 1, 68.4 percent; ARD 2, 87 percent; ARD 3, 82.5 percent; and ARD 4, 73.7 percent.

According to a recent city audit, ambulance response times have increased citywide due to a change in 911 dispatch protocol beginning in December of 2011. The median ambulance dispatch time, which is the time between the dispatcher’s first keystroke after the call is answered and when the ambulance is dispatched, has ranged from 1 minute 9 seconds to 1 minute 36 seconds since December of 2011. Prior to December, the median dispatch time ranged from 24 seconds to 38 seconds. Dispatchers now ask a series of questions to determine the severity of the emergency instead of using a pre-alert system. When KCFD used a pre-alert system, an ambulance was immediately dispatched to the scene once an address and phone number were obtained.

Berardi stressed that during an emergency where seconds count, an ambulance is dispatched right away. Berardi also added that ambulance response times is not the only measurement of performance.

“It’s important to realize our patient outcome is one of the best in the country,” Berardi said. “We have one of the best cardiac patient saves in the country.”

However, City Council members are still placing emphasis on ambulance response times.

City Council member John Sharp said KCFD was on par with former ambulance operator Metropolitan Ambulance Services Trust (MAST) in terms of citywide ambulance response times until KCFD changed its dispatching protocol.

“We still have to address the dispatching issue,” Sharp said. “It shouldn’t take a minute and a half to dispatch. That’s just too long when that’s the average.”

While the Northland response times have improved, there’s still room for improvement, Sharp said.

“It’s (ambulance response times) not what people in the Northland have a right to expect,” he said.

During the Nov. 15 City Council meeting, City Council members passed a resolution directing the city manager to implement procedures to decrease the ambulance dispatching time to life threatening emergencies. The resolution details the dispatching time standards created by the National Fire Protection Association and also states that KCFD’s change in dispatching protocol added approximately one minute to the dispatch time. It further states that KCFD failed to meet citywide ambulance response times requirements for all 10 months of 2012 and failed to meet ordinance requirements in all four ambulance districts from January to September.

According to the resolution, the “Council is concerned about the increased ambulance response times to life threatening emergencies as indicated by the audit.”

City Manager Troy Schulte will work with the Emergency Medical Services Coordinating Committee as well as the KCFD to decrease ambulance dispatching times to life threatening emergencies. The City Council has asked Schulte to report back on the progress and procedures within 90 days.

Response time solutions

To improve overall ambulance service, KCFD is in the process of creating a strategic plan, which should be finished by the end of this year, Berardi said. One of the first steps of the plan is to develop a standards of coverage model, which could mean requesting more fire stations or EMS stations in the Northland, he said.

KCFD is also implementing several pilot programs, including the Basic Life Support (BLS) Transfer Ambulances Project. KCFD implemented the pilot program Nov. 11 and will continue to operate the program for a total of 90 to 120 days. The pilot program uses Basic Life Support units instead of Advanced Life Support units for non-urgent transfers from a higher level of care facility to a lower level of care facility.

From Nov. 12-14, KCFD received 41 ambulance transfer calls and used a BLS unit to transport 16 of the patients, with the remaining patients being transported by ALS.

“It’s obvious to us that we didn’t utilize them (BLS units) as best as we possibly could for those first three days,” said KCFD Deputy Chief Tom Collins. “That brought to our attention what do we need to do to fix that?”

Collins said KCFD will continue to evaluate how many BLS units to put on the streets for the project and the best time of day to utilize the units. In addition, KCFD will work with area hospitals on discharging patients on a staggered basis instead of all at once.

“Anything that takes calls away from ALS ambulances will help response times,” Collins told Northeast News. “I think the BLS Project will work.”

In addition, the Kansas City Police Department (KCPD) launched a pilot program last week to further free up KCFD resources. Between September 30, 2011, and Sept. 30, 2012, KCFD dispatched ambulances 1,154 times to the detention center at police headquarters on emergency medical calls, most of them non-life threatening.

“We are the fire department’s No. 1 call for service for their ambulance care,” said KCPD Captain Eric Winebrenner.

The city’s detention center, used for arrests that occur within city limits, operates 24/7 without medical facilities on the floor. As a result, KCFD had to respond to calls to perform blood sugar tests and for someone feeling ill. Instead of solely depending on KCFD to provide medical care, the pilot program will utilize Jackson County’s contract with a medical services provider for inmates. The medical provider will work at the city’s detention center six hours a day, seven days a week. In addition, the contract will include four on-call requests per day. The pilot project will end on Jan. 30, 2013, when Jackson County’s contract with the medical services provider expires. If the pilot project is successful, KCPD will request that a medical services provider be added to the budget for next fiscal year.

While the calls to KCFD won’t be reduced to zero, Winebrenner said, “We are hopeful it will make a significant dent in the number of calls the fire department is responding to.”