Death By Design

Deborah Payne, a 55 year old northeast Philadelphia resident, called 9-1-1 because she had trouble breathing at 2:39 am on January 1, 2008. There were no city ambulances available. Engine 36 arrived within four minutes and started oxygen therapy. Ladder 20 brought more oxygen to the scene.

Medic 43B, an emt-staffed ambulance, arrived at 3:42 am. It failed to start after loading Payne into the unit. When the second fire department ambulance arrived, at 4:20 am, Payne was dead.

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Unfortunately, this situation was not an anomaly. While the first four hours of the New Year may be one of the busiest times for ems, the under-resourcing of Philadelphia Fire Department’s EMS section has received extensive documentation during the past few years. It was an item in my first column here, Walking the Fire-Based EMS Talk : http://firegeezer.com/2007/07/24/walking-the-fire-based-ems-talk/

Need at least 20 more ambulances

On December 20, 2007, City Controller Alan Butkovitz released an audit report “Emergency Medical Services: Strained Resources Creating Major Impediments to Quick Response Time.” You can download a copy of the 54 page, 2,133 KB Adobe Acrobat report by clicking here: http://www.philadelphiacontroller.org/page.asp?id=242 .

This report validated the statements made in earlier reports by the media and IAFF. The transport workload has risen significantly in the past five years, even as the city population shrank. PFD ambulances handle up to 8000 responses a year, with 20% of the ambulances running above 100% capacity. To translate that statement, it means they are responding to a call every 45 minutes.

Where can PFD get the money?

While the audit report is powerful, it has no teeth. The city controller has no ability to change city budget priorities or change city policy. Incoming Mayor Michael Nutter pledged to make tax cuts. This is one of a series of audit reports issued by Butkovitz pointing out “gaping holes in service” in many of the city agencies. The city controller is advocating the fixing of city services before making tax cuts.

The fire department attempted to disband four engine and four truck companies in order to establish eight additional 12-hour paramedic ambulances in 2004. That effort was stopped by an injunction obtained by Local 22. The injunction expired March 30, 2006. See this earlier column about Baltimore’s similar effort of fire-rescue roulette: http://firegeezer.com/2007/08/07/fire-medic-roulette/ .

EMS mutual aid?

Imagine a report of a structure fire in Philadelphia and there are no city engine companies available. There would be a call for mutual aid to get an “outside” engine company to respond to the fire. On the other hand, the city has refused to allow for-profit ambulance companies to cover the excessive 9-1-1 calls. Locals mention that the largest private service, American Medical Response, was run out of town. It took about two hours for Payne to die waiting for a fire department ambulance to transport her to a hospital. How long would she have waited if there was a back-up plan using private ambulance companies?

Mike “FossilMedic” Ward