By LESLIE COLLINS
Northeast News
October 17, 2012 

Ambulance response times are continuing to hover below city code requirements, and a recent city audit revealed response times have deteriorated since December of 2011.

City code requires that ambulance crews respond to life threatening emergencies citywide in 9 minutes or less 90 percent of the time.

Until December of 2011, both the Kansas City Fire Department (KCFD) and former ambulance service operator Metropolitan Ambulance Services Trust (MAST) reported similar response times. MAST’s response times for life threatening emergencies met the mark 81 to 89 percent of the time, and KCFD met the mark 82 to 89 percent of the time between May 2010 and November 2011. KCFD took over the ambulance service in April of 2010.

When KCFD changed its 911 dispatch protocol in December of 2011, lengthier response times ensued.

“I knew the change in protocol would increase response times, but I certainly didn’t think it would add an entire minute on the median,” Kansas City Council member John Sharp said.

According to the audit, 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.

Deputy Chief of the KCFD Technical Services Bureau Sal Monteleone explained that 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.

However, Fire Chief Paul Berardi said state law prohibits sending an ambulance to the scene without knowing the type of emergency. In addition, the new protocol is a trend nationwide, he said. It also enables KCFD to send the right resources to the scene at the right time intervals, said Dr. Richard Gist, principal assistant to the fire chief.

Gist explained that life threatening emergencies are divided into three categories: Echo, where seconds matter; Delta, where minutes matter; and Charlie, which is time sensitive.

Under the old system, ambulances were dispatched to about 75,000 calls per year without knowing the type of emergency, said Monteleone. KCFD averages 90,000 calls per year, he said. Since the type of emergency was unknown, reroutes to higher priority calls were as high as 270 some months, he said. Now, it’s less than 10 and oftentimes, zero, he said.

KCFD has also divided the city into nine different zones and uses data from its Computer Aided Dispatch (CAD) system to monitor peak call times and the number of calls from each zone. KCFD then uses the data to determine where ambulances should be posted.

“We found it created better coverage,” Monteleone said.

As a result of the zone coverage and placement of ambulances, the median ambulance drive time has decreased and was 54 seconds faster than MAST by June of 2012, according to the audit. Drive time is calculated from the time the ambulance crew reports they’re en route to the time they report they’ve arrived on scene.

Although the median drive time has decreased, overall ambulance response times are still lagging behind previous records. In December of 2010, ambulance response times met city code requirements 86 percent of the time for life threatening emergencies. In December of 2011, that number dropped to 78 percent, and from March to May of 2012, the percentage was 75. KCFD’s most recent report from August showed ambulances responded in 9 minutes or less 79.3 percent of the time for life threatening emergencies.

Both Monteleone and Berardi stressed KCFD is focused on “patient outcome.”

Monteleone said ambulance response times is only one piece of the KCFD ambulance service and that it’s “frustrating” the city hasn’t drawn a correlation between ambulance response times and patient outcome. Monteleone cited several scenarios, including one where an ambulance may not meet the time requirement for a time sensitive call, but the hospital is three blocks from the scene.

“So, we’re okay,” he said.

He also pointed out that even if an ambulance arrives on scene within the time requirements, other factors could hinder patient care, like the nearest hospital refusing to accept any more life threatening injuries, causing the ambulance crew to drive further to the next hospital.