Four years ago, City Controller Alan Butkovitz released a report revealing a Philadelphia EMS system in crisis: Sick people waiting too long for ambulances; paramedics dangerously overworked; and non-emergency calls overwhelming the system.
The report echoed the pleas of paramedics who had long called for change, and recommended steps to relieve pressure on the stressed 911 system.
Four years later, little has changed, Butkovitz said Wednesday as he released a follow-up audit that analyzed Fire Department data from 2009.
People are still waiting too long for ambulances. Paramedics are still running ragged. And routine calls are clogging up resources.
Only one of the 19 recommendations from 2007 has been fully implemented, Butkovitz said.
Worse, more than a third of Philadelphians who dial 911 wait longer than the national standard of nine minutes for an ambulance, according to department statistics.
In 2006, only 59.8 percent of ambulance calls resulted in a response time of under nine minutes; in 2009 it climbed to 63 percent, which Butkovitz discounted as a marginal increase.
That's well below the benchmark of a 90 percent successful response time.
Statistics for 2010-11 were not yet available, Butkovitz said, though a Nutter administration spokesman said the percentage rose to 68 percent last year.
"The city is putting lives at risk by failing to do all that it can to have EMS units arrive in time," he said. "EMS is life and death; it has to be a top priority. Right now, it's on a list of to-do items."
While giving the department credit for adding five ambulances in 2008, Butkovitz described a 911 system plagued by "overwhelming demand" and an "inadequate number of paramedics."
The department's statistics support the claim.
From 1999 to 2009, Philadelphia EMS calls skyrocketed from 165,234 to 224,485.
In 2002, the city had 280 paramedics. In 2009, there were 210.
Even though more than half of the calls flooding in are for non-emergencies, the department does not have a priority dispatch system, Butkovitz said. Rather, it operates "robotically" on "first come, first served." And the city's 311 system has not eased the load on 911, he said.
"To have this kind of volume over an extended period of time, and to simply shrug your shoulders as if there is nothing that can be done, is not reasonable in the 21st century," he said.
Fire Commissioner Lloyd Ayers defended the system.
"We still have time issues that we have been overcoming," he said. "But we serve the citizens very well."
The department takes the recommendations seriously and is acting on them, he said.
Response times have been steadily improving with the additional ambulances, Ayers said.
Thursday, the city will release a request for proposal for a priority dispatch system that can better "match critical calls with available resources," Ayers said.
The new system will also aim to better educate the public on when to call 911, Ayers said.
Paramedics have been calling for changes since 2005, when high-profile deaths first focused public attention on the overburdened system.
At Wednesday's news conference, Butkovitz spoke of a Northeast Philadelphia woman, Deborah Payne, 55, who died from respiratory problems early New Year's Day in 2008 after waiting more than an hour for a city ambulance to arrive. When the ambulance finally did arrive, it broke down.
Fifty ambulances currently cover Philadelphia. Some are staffed with paramedics who can offer advanced life support, while others are staffed with firefighters and EMTs.
Some go out of service at night, leaving the city with about 30.
Experts estimate that it would take about 70 squads to adequately serve a city the size of Philadelphia.
On a weekly basis, the city experiences periods without any available ambulances, said Jack Eltman, a trustee with Local 22 of the International Association of Fire Fighters.
"People with serious injuries wait too long almost every day of the week," he said.
To cover the workload, Philadelphia paramedics are wearing themselves out, Butkovitz said.
Some crews perform 8,000 runs per year, well over the recommended range of 3,000, according to the report.
A 2010 Firehouse Magazine survey listed Medic 8 in Kensington as the busiest ambulance in the country with 9,011 calls.
Paramedic morale is plummeting, and hiring is becoming a challenge, Butkovitz said.
"It's not a budget problem," he said. "It's a 'getting people willing to take the job' problem."
Ayers said a new class of recruits is being scheduled, which should fill 19 staffing shortages.
Individual changes will not fix EMS, Eltman and other firefighters and paramedics said. A complete reshuffling of resources is needed, they said.
Butkovitz echoed the sentiment, saying the department needed to bring its financial resources in line with its need: EMS incidents account for 82 percent of the department's workloads, but EMS receives only 17 percent of the department's budget.
Butkovitz called on the department to cross-train paramedics as firefighters. Unlike ambulances, fire engines usually arrive at emergency calls within three minutes of calls. But they are not staffed with paramedics.
Other cities have had success with paramedics on engines, Butkovitz said.
The city is taking a different route, Ayers said, deploying a new quick-response SUV that can get to emergencies quicker, then leave when transports arrive.
The department is awaiting an extensive review of its resources by the Pennsylvania Intergovernmental Cooperation Authority, the state-authorized agency that oversees city finances. That report, which includes input from the city and the firefighters' union, is due out in about four months.