No Overhaul for Denver Ambulances - @ JEMS.com


No Overhaul for Denver Ambulances


 
 

| Monday, December 1, 2008


DENVER -- When you're ill or injured, the last thing that should be on your mind is why the ambulance is taking so darn long to arrive.

But when you have the best trauma survival rate in the country, as Denver Health does, it's hard to criticize ambulance response times too harshly, either.

From 2004 to 2007, ambulance response times have increased in Denver at multiple steps of the 911 process - 46 more seconds for the police call center to process a request for help; 32 extra seconds for the call to emergency medical staff; 38 additional seconds of ambulance transit time.

And yet Denver's survival rate for cardiac arrest compares quite favorably with national data, according to a study by Tracy L. Johnson of Health Policy Solutions.

Shortening response times, though, is the crux of a dispute over an emergency services contract up for renewal before the Denver City Council on Monday.

So how long is too long to wait for an ambulance to arrive? There is no clear-cut answer. On the one hand, it's horribly stressful to have patients wait a long time for help. On the other hand, survival rates are not highly correlated, as you might expect, with ambulance times. In fact, there's very little correlation at all, according to Denver Health officials. That's in part because the first couple of minutes are when patients in cardiac arrest are most likely to die - and no system can guarantee response times that short. In addition, first responders from the Fire Department are usually on the scene before the ambulance paramedics, providing CPR and other assistance.

Still, we agree with council members who pushed to have the new contract stipulate that ambulance response times be calculated from when a call comes in as opposed to when an ambulance is dispatched to the scene. We're also heartened by the fact that the city and Denver Health have agreed to look at the issue of a performance standard together, with the goal of coming back to the council with a status update in January and a final decision by March.

Those officials will need to address concerns about reaching outlying areas in a timely fashion. Councilman Michael Hancock reportedly became a proponent of considering alternatives to the current EMS system after his sister died in a Montbello shooting six years ago; Hancock has said the ambulance response was too slow. Critics have also focused on response times to Denver International Airport - prompting formation of a committee to study the feasibility of an airport-exclusive ambulance.

As they proceed, Denver officials need to remember that it's not as if we're starting with a broken system. Denver Health has long been one of the premier trauma centers in the nation. Ambulance response times may have slowed, but we'd want to see evidence that this trend has affected patient mortality rates before we hit the panic button.

Some critics of the present system would simply pull the plug on Denver Health's emergency response services and move those duties to the Fire Department. That might please the firefighters union, but it's hard to see how that change could be made, and all of the claims about vastly shortened response times met, without increasing costs.

The current process involving the city and Denver Health, with the idea of reaching a mutually agreeable response time, holds promise. More radical ideas for revamping the system deserve to be shelved.


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Related Topics: Leadership and Professionalism, Trauma

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