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When Help is Too Late

PHILADELPHIA -- On April 24, 2006, Philadelphia School Board President Rotan Lee died from a heart attack. Initial reports said he had waited 20 minutes for an ambulance.

As anyone knows, in such a situation the sooner help arrives, the better your chances of survival.

But in Philadelphia, sadly, Lee's case probably is not an isolated incident.

The accepted standard for an ambulance to show up is 8 minutes and 59 seconds after the call is received.

But a performance audit released by Controller Alan Butkovitz on Thursday shows that in the year that Lee died, ambulances did not arrive on time in four out of 10 calls. Nearly one third of those who called for help had to wait 10 minutes or more.

Along with police and firefighting protection, providing emergency medical services is one of the most important functions of city government.

If Philadelphia is really going to be the Next Great City, this is one area where improvement cannot wait.

Butkovitz's auditors identified a number of factors contributing to the delayed responses. Chief among them are too few ambulances and trained medical personal and an inefficient deployment system.

At any given time, the city has 28 ambulances on the streets and up to 45 during special peak hours.

Butkovitz, who has nothing but praise for EMS workers, pointed out that some individual units have handled more than 8,000 runs per year, compared with the recommended range of 2,500 to 3,000 runs.

There can be little doubt some people may have died because of the delays, but because of federal patient privacy laws auditors could not come up with a number, let alone an estimate of how many.

Another contributing factor cited by the study is an increase in calls for emergency medical service - 210,000 last year compared with 165,000 in 1999. That's despite a 70,000 drop in population during that period.

Butkovitz attributed the increase to an aging population and a high number of calls that were not emergencies. Some people who have no medical insurance, he noted, call 911 to get a lift to an emergency room.

The situation underscores the need for a 311 system to handle non-emergency calls now being made to the overloaded 911 emergency line.

Butkovitz says the city needs at least 20 more ambulances. The Fire Department projects that buying the equipment and hiring more personnel would cost $20 million up front, then about $15 million a year.

Mayor-elect Michael Nutter and City Council must make EMS one of the top items on their to-do lists in 2008. Delaying could be a matter of life or death to someone.

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