Ambulance Times Doubted

DENVER — Denver paramedics reported that they failed to meet accepted response-time standards in a quarter of the city’s cardiac arrests and severe-trauma calls, a month-long quality-control check found earlier this year.

The data raises the possibility that Denver Health Medical Center is not in compliance with its contract with the city and county of Denver.

Data collected by the hospital in July showed that 23.8 percent of paramedic trips for cardiac arrests and severe trauma had response times of nine minutes or longer.

Medical experts, including the American Heart Association, say brain damage and permanent death start to occur in four to six minutes after someone experiences a cardiac arrest.

Denver Health undertook the effort to measure response times in July after it promoted Bill Johnston as the new quality improvement coordinator for the paramedics division.

But after seeing just one month of data, the hospital stopped compiling it, certain that paramedics must have been making mistakes in their reports.

“When I saw the information first included in the (quality assurance) report, I asked how the data was calculated, and determined that it was inaccurate,” said Dr. Chris Colwell, the medical director of Denver Health paramedics and the Denver Fire Department, in a prepared statement.

Hospital officials refused to provide specifics or answer questions about why they believe the data is inaccurate, providing only the written statement. In that, they say they suspect paramedics are entering data based on their recollections and making mistakes as a result.

Paramedics who declined to be identified publicly for fear of losing their jobs said they believed they had correctly reported their ambulance response times beginning with the time they were dispatched and ending when they arrived at a call. They pointed out that dispatchers send them electronic data on their pagers noting the time of dispatch and arrival, and that they used those to fill out the data forms.

They also pointed out that the hospital continues to rely on data provided by paramedics when it puts the hospital into a more favorable light, such as data showing quick turnarounds at emergency scenes.

Colwell stressed that the city’s Fire Department is sending basic life support service providers, firefighters armed with defibrillators, well before paramedics arrive at the scene. But the paramedics have the ability to administer medicine, while the firefighters don’t have that specialty.

The report compiled by Johnston, who declined to comment, found that of 38 cardiac arrests and four traumatic arrest trips that month, 10 had response times nine minutes or longer.

Denver Health’s contract with the city requires 85 percent of calls for service requiring lights and sirens to have a paramedic arrive on the scene within eight minutes and 59 seconds after being dispatched.

And that is generously calculated. The clock does not start running until after an ambulance actually becomes available to respond to the call. At times, all the ambulances are tied up on other calls, causing further delays, paramedics say.

Denver Health, in the prepared statement, said a separate data-collection relying solely on a computer-aided dispatch system, found that “response time compliance for all calls in July 2008 was 86.7 percent.”

Johnston’s July report didn’t specify whether any deaths occurred for any of the trips in which paramedics said their response times were nine minutes or longer.

At least one controversial paramedic trip that has received media attention occurred during that month of July.

Denver’s KGMH-TV Channel 7 reported on the death of a father from Parker, who died at Denver International Airport of pulmonary embolism after waiting nearly 40 minutes for an ambulance.

Denver Health officials told the station that a dispatch error contributed to the delayed response.

The city’s contract with Denver Health’s paramedic services is up for renewal as the year comes to a close, but some City Council members are already pushing for a delay.

Councilman Michael Hancock said he won’t support a new year-long contract at this point. He is advocating going to a month-to-month contract so the City Council will get to look at a long-awaited performance audit by Denver Auditor Dennis Gallagher’s office, which isn’t expected to be released until December.

“How can we renew the contract when we don’t even have the results of the audit, which could tell us what changes are needed?” Hancock said.

Hancock said he’s concerned because he thinks paramedic service is woefully inadequate in parts of his council district, particularly northeast Denver and at the airport.

As scrutiny of ambulance service intensified this past year, Denver Health announced in August that it was adding another ambulance to the daily fleet. It also has said it has hired a consultant to review EMS performance.

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