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You Call, We Haul' policy has EMS system working in tight shoes

Monday afternoon was not a good time for a heart attack.

At precisely 2:19 p.m., San Antonio ran out of ambulances. It's true. If you had gone into cardiac arrest at 2:20, sorry, not one of the city's 28 EMS units could have rushed to save your life.

On the other hand, if you had scraped your nose in a fender-bender at 2:15, a wailing siren would have sped to your rescue.

Don't know what caused the crisis--- Rain? Flooded streets? Bad timing? -- but whatever it was, our EMS system began to hemorrhage.

Fortunately, the ambulance shortage lasted only two minutes. Unfortunately, it could happen again and last longer under a hazardous policy called "You Call, We Haul."

Possible scenario: Man severs arm. Wife calls 911. Dispatcher says, "Sorry, my last EMS unit is treating a nosebleed."

New fire chief Charles Hood does not know the last time the city ran out of ambulances. But he knows this: "Even two minutes without one is unacceptable."

Thankfully, Hood is going to place dynamite under You Call We Haul. The policy needs to go ka-boom.

Hood will light the fuse in October. That's when four fire trucks will begin carrying equipment you'd find in an ambulance. Heart monitors. IVs. Needles. Drugs. Tracheal tubes.

That's when the trucks will become first responders to 911 calls. If the caller has a toothache, paramedics on the truck will render aid. If the victim needs to be hospitalized, an ambulance will be called.

In time, all 68 fire trucks will carry paramedic equipment and replace EMS units as first responders.

"Fire trucks as first responders is best because there's not an ambulance at every station," one paramedic explained. "And what we get called out for is usually not an emergency."

Hood rode with an EMS unit during Monday's storm. One stop, the chief recalls, was to treat a motorist in a minor accident. No hospital transport was necessary.

"When we ran out of ambulances," Hood says, "I'm sure a fire truck could have taken care of that patient."

Paramedics want the chief to lobby for more EMS units. Hood wants to overhaul EMS first, then add ambulances. His reasoning: More ambulances in a broken system will not improve efficiency.

One problem with EMS is a shortage of dispatchers. There aren't enough bodies to handle the crush of calls. That means dispatchers rarely have time to screen and prioritize calls. So a guy with a sprained ankle may get an ambulance before a baby who can't breathe.

Last Thanksgiving, the 1-year-old granddaughter of Lois Smith fell ill. The girl suffered from a breathing condition that can be fatal.

Smith called 911. As she waited, the baby began to turn blue. Ten minutes elapsed, then 20. No ambulance in sight. Smith feared the worst, but EMS finally arrived -- officially after 24 minutes -- and the baby survived.

Smith is grateful for the paramedics who treated her granddaughter, but she wonders: Why did they take so long to arrive?

"We could have lost her at any second," she said.

Just before the ambulance shortage on Monday, EMS raced to a bus stop to treat a woman in distress. The problem?

"Her shoes were too tight," a paramedic says, "and her toenails were bleeding."

On a day of heavy rains, slick streets and a shortage of vehicles with advanced life support equipment, an ambulance stopped for a woman who needed new shoes.

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