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Wyoming EMS Provider Tells Patients to Wait

CHEYENNE – Through the end of May, 53 people who called for an ambulance were told they would have to wait.

That’s because the crews who work for American Medical Response, which services all of Laramie County, were tied up on other calls.

This is one example of what Cheyenne Fire and Rescue Chief Guy Cameron says are “alarming trends.” Not only is he unhappy with the delays, he’s not happy with the number of times AMR is at capacity.

This puts the public at risk, he said.

It’s not as if these people were out there bleeding to death. When an ambulance is called, Fire and Rescue crews, who are trained in first aid and life support, also are dispatched to the scene.

Still, the patient must wait to be taken to the hospital and to see a doctor.

Cheyenne Mayor Jack Spiker said these delays by AMR are just like having a power outage in a hospital emergency room with no backup system available.

“There is absolutely no excuse for delayed service,” he said.

On Thursday, Spiker put AMR on notice.

If the numbers don’t improve, Spiker likely will seek a vote by the Cheyenne City Council to sever ties with AMR, based in Greenwood Village, Colo., and sign a contract with another company.

The grounds for possible dismissal: Breach of contract. AMR has been asked to fix this problem since 2003, Cameron said. Its 2005-08 contract says they must remedy what are known as Code 10 calls.

While Cheyenne Fire and Rescue does have a trained paramedic for every crew that goes out, Spiker said this is not a move to get the city into the ambulance business. It’s about accountability.

In May alone, AMR logged 20 Code 10 incidents. This is the highest rate in any month since January 2005, the start of the new city-county contract.

“What it tells me, when you have a Code 10, you’ve run out of ambulances,” Cameron said. “Those numbers in May mean there wasn’t an ambulance available 20 times for a medical emergency.”

The AMR paramedics working in Cheyenne are “good folks working hard every day,” Cameron said. Management is the problem here, he said, “and possibly corporate.”

Cynthia Wentworth, AMR’s director of communications and government relations, said the company has added paramedics to Cheyenne’s fleet this year.

There currently are two full-time crews working 24 hours a day, seven days a week. There also are two on-call crews.

On Monday, they will add another on-call crew in Cheyenne, which had been in the works since April, Wentworth said.

From there, they will continue to evaluate the statistics and adjust schedules as needed to fill what are typically the busiest times.

“When you look at these (delays), it’s never more than 2 percent of the calls.” Wentworth said. “Smaller than 1 percent is optimal.

“Obviously, you don’t want anyone waiting. That’s why AMR is taking these steps.”

So what caused the spike of delays in May, even though the call volume didn’t spike along with it?

Wentworth said it was a timing issue. The paramedics were jammed with calls coming in at the same time. Other months, they were spaced out.

“Maybe it’s acceptable for AMR, but not if your family member is waiting on an ambulance,” Cameron said. “It’s not acceptable for me as a fire chief looking out for their performance on that contract.”

Laramie County also has a contract with AMR. Spiker had sent copies of the notice to county officials, but they said Friday that they are happy with AMR’s service.

At the county level in the last two years, there were 10 delays in one and 12 the next, said Laramie County Emergency Management Agency Director Rob Cleveland.

“It’s not an alarming number for the county at all,” Cleveland said.

Laramie County Commissioner Jeff Ketcham said he has received “no calls or complaints” about AMR’s service.

AMR has been Cheyenne and Laramie County’s ambulance provider since 1998.

In 2002, then-Cheyenne fire chief Scott Alvord wanted to do a study to analyze the benefits of having a city-owned ambulance service.

But Spiker said Friday they had backed off that idea because of the amount of “pushback from the county.”

“We were willing to go into the county,” Spiker said. “We felt we could go into the county quicker because of the number of stations.”

What the city did instead was train of number of firefighters to become full-fledged paramedics. There’s now enough so there’s one on every crew.

“I think that was really the right thing to do,” Spiker said.

When the contract with AMR was renewed in late 2004, Alvord included some penalty clauses. This meant that for every Code 10 and late response time, AMR would be fined, $500 for each Code 10 and $40 for every minute they were late.

The city would assess and collect 72 percent, with the balance to the county.

Even though AMR was logging delays, they were not fined by the city or county. That is, not until the city began fining in September 2006 under interim Fire Chief Jeff Fox.

This may be a “black eye” on Alvord, Spiker said.

“But the bright side of this coin is that he put together this performance contract,” he said.

The county still hasn’t enforced the penalties on AMR. Between January and May, AMR went to 430 county calls; there were 14 Code 10s.

“My thought on it is the amount of Code 10s does not justify that penalty clause,” Cleveland said.

Ketcham said he agrees with Cleveland.

“Unless (the Code 10s) were excessive, we wouldn’t impose any fines,” Ketcham said. “They’re within our standards.”

Cleveland is the “eyes and ears” on this service, Ketcham said. “He hasn’t brought anything to me.”

And the county’s volunteer fire districts have emergency medical technicians on their fleets. They aren’t as highly trained as the city’s paramedics, but the EMTs can provide basic life support, Cleveland said.

Dan Bond is the fire chief of Laramie County Fire District 8, which starts roughly at Gilchrist Elementary and extends to the western-most county border.

He said that “99 percent of the time,” his crews arrive before the paramedics.

“But since we’re all volunteers, especially during business hours, sometimes we’re delayed,” Bond said.

But he had good things to say about AMR. He had only been faced with a Code 10 once, but no one ended up needing a ride to the hospital.