Patients Wait While Private Ambulances Untapped in Philadelphia


Dave Davies | | Tuesday, January 15, 2008

PHILADELPHIA -- When Deborah Payne died early New Year's Day while waiting more than an hour for a Fire Department ambulance, help was only minutes away.

Just seven blocks from Payne's apartment on Rowland Avenue near Rhawn Street in the Northeast, an ambulance was parked and ready to respond.

"We could have been there in two minutes, and she would have been at Nazareth Hospital in another two minutes," said Rob Berkoff, administrator for Northeast Community Ambulance, a nonprofit ambulance corps.

Berkoff's ambulance wasn't called because Philadelphia, unlike some other cities, never uses private ambulances to help when Fire Department medic units are swamped with calls.

"All the city would have to do is call my dispatch center and say, 'I have an emergency at 8040 Rowland. Do you have a unit available?'" Berkoff said.

Fire Commissioner Lloyd Ayers, who said earlier this month that he was troubled by the delay in getting to Deborah Payne, said he has always favored a Fire Department-based Emergency Management System.

Using nonmunicipal ambulances presents legal issues for the city, such as how standards of care would be ensured and who would be liable if things go wrong, Ayers said.

But Ayers said there may be ways to use private ambulances in the future.

"None of these things are off the table," Ayers said. "I wouldn't say it's on the front burner."

Ayers said he wants to concentrate now on other improvements for the system, including better communications, more paramedics and educating the public to avoid calling 911 for nonemergency situations.

Fire officials are investigating the slow response to Payne, who called 911 at 2:39 a.m., when New Year's revelers typically generate a heavy volume of calls, Ayers said.

It took just over an hour for an ambulance to arrive. That ambulance failed to start after Payne was loaded into the vehicle. By the time a second ambulance arrived, an hour and 40 minutes after her 911 call, Payne was dead.

Jay Fitch, a Missouri-based EMS consultant, said that many cities call on private ambulances when their 911 system is overwhelmed.

"Look at New York. They've been doing it for more than a decade," Fitch said. He acknowledged that there are legal issues to work out, but said other cities manage to do it.

"It takes some well-reasoned thinking on how units are dispatched and how you maintain quality and supervision," Fitch said. "But those issues pale by comparison to someone having a heart attack or having to wait an inordinate amount of time."

Philadelphia's EMS system has come under heavy criticism in recent years for slow response times. A review last month by the city controller's office found that response times have been slowing, and nearly a third of Fire Department ambulances take 10 minutes or more to arrive. A national standard for the time it should take an ambulance to reach a patient is nine minutes.

Controller Alan Butkovitz recommended a major infusion of money to add more personnel and ambulances, and to improve communications.

David Kearney, a former paramedic and recording secretary for the firefighters' union in Philadelphia, said that while everyday reliance on nonmunicipal ambulances could be problematic, it makes sense to use them in a pinch.

"Disaster plans include the nonprofit services," Kearney said. "On New Year's Eve, when you've hit 50 runs you don't have ambulances for, you have to say this is a disaster, just as much as a train derailment at 30th Street."

Kearney said Philadelphia should also be coordinating runs with suburban rescue squads, which at times are in a better position to respond more quickly to a call in the city than a Fire Department unit.

"Lots of places coordinate those borderline responses. We don't," Kearney said. "The whole system needs to be better planned."

Tim Hinchcliff, managing director of the nonprofit Burholme Emergency Medical Services ambulances, said that at meetings of the regional EMS Council, he repeatedly has raised the issue of using nonmunicipal ambulances.

He said that Philadelphia officials tend to think that the city can handle everything on its own.

"It's been explored in the past by fire commissioners, but never seems to get very far," Hinchcliff said. "There are always labor issues and legal issues. So the option just lays there, and no one really does anything about it."

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