Lifeline Delayed: Ambulances failed to meet response times

Target 8

GRAND RAPIDS, Mich. (WOOD) — American Medical Response, one of West Michigan’s main ambulance providers, acknowledges it did not meet response time standards in 2019 on some of the highest priority calls in urban areas.

“I can say before my time, we were not meeting our personal response times. We were not ‘up to snuff’ so to speak,” said John Robben, AMR’s regional director of operations.

“For too long we have tried to do too much with too little. So, we want to focus on our core customers — the largest of that being the Kent County Consortium and Grand Rapids,” said Robben, who took over as AMR regional director in July 2019. “We identified (problems) proactively, put in measures and have seen steady improvement. We’re not going to make excuses.”

Target 8 began investigating ambulance services in Kent County after receiving a tip in late 2019 that providers were not complying with response standards. Records obtained by Target 8 through the Freedom of Information Act confirmed delays.

According to data submitted to an oversight agency by AMR, LIFE EMS and Rockford Ambulance, aggregate response times did not meet standards for Med 1 (the highest priority) calls in urban zones throughout 2019.

A map of service areas for Kent County Emergency Medical Services. (Courtesy)

Under a contract between the three providers and a group of Kent County communities, ambulance companies must meet certain response standards in at least 90% of calls or risk fines.

Records show 2019 compliance percentages fluctuated from as low as 80% to a high of 89%.

IN 13 URGENT CALLS, RESPONSE TOOK 30 MINUTES OR MORE

In the first three months of the year, in 90 urban Med 1 calls, ambulances took 18 or more minutes to respond, which is double or more the allowed response time of just under 9 minutes.

In 13 of those calls, ambulances took 30 minutes or longer to respond.

While the data does not break down times by individual company, AMR confirmed it did not meet response times in 2019.

Individual data provided to Target 8 by LIFE EMS showed LIFE consistently complied with Med 1 urban zone time standards, and Rockford Ambulance reported that it does not cover that geographic zone.

Ambulance response time standards for Priority 1 calls:

  • Urban: 8 minutes 59 seconds, 90% compliance required
  • Suburban: 12 minutes 59 seconds, 90% compliance required
  • Rural: 15 minutes 59 seconds, 90% compliance required

2019 aggregate response time data for urban Priority 1 calls:

When Target 8 interviewed Robben on Feb. 10, he said AMR had achieved 94% compliance month to date.

“I was appointed to this position about six months ago and we identified some challenges,” Robben said. “So, we’ve been proactively addressing those challenges every day and we’ve seen significant improvement.”

Grand Rapids Fire Chief John Lehman wants to ensure the fix is long term.

CHIEF: DELAYED RESPONSE “ABSOLUTELY NOT ACCEPTABLE”

Lehman said firefighters, who can only provide basic first aid as medical first responders, began noticing ambulance delays in early 2019.

“When it’s taking 15 or 20 minutes (for an ambulance) to get to (an urgent medical call), that’s not acceptable. That’s absolutely not acceptable.”

Lehman said, in addition to impacting patient care, such delays tie up fire units, keeping them from responding to other emergencies in Grand Rapids.

“When firefighters …. are dealing with a critical patient, and it’s taking a longer period of time for the ambulance to get there, that’s extremely frustrating for them. They only have the most basic tools at their hands. They know what these people need, and to know that help’s not right around the corner, that becomes very frustrating for them,” he said.

Lehman said he was not aware of any negative patient outcomes due to delayed ambulance responses. 

“(AMR has) been receptive and they have been understanding about what their issue is, and they are taking steps to correct it. I want to be clear about the fact that I feel confident moving forward that we’re heading in a good direction,” he said. “But my main point is we need to make sure we’re providing the best care possible…”

VICTIM’S DAD: MINUTES A MATTER OF LIFE AND DEATH

In Byron Township, a dozen miles southwest of Grand Rapids, the family of a teenager who was hit by a car in late July was disappointed with AMR’s response.  

Brendan Marsman, 17, was going for a run near his home on 72nd Street near Byron Center Avenue when an SUV hit him.

“I wanted to try to improve ambulance times because if the ambulance gets their quicker, it might save a child’s life,” Brendan’s father, Bob Marsman said, in an interview with Target 8.

Marsman shared his concern at a September Byron Township board meeting.

“When you’re talking minutes count, that could be a matter of life and death,” Bob Marsman said.

In his son’s case, it took AMR 16 minutes and 18 seconds to arrive on scene.

In some areas of Kent County, the standard for responding to Priority 1 calls in suburban zones is 12 minutes and 59 seconds, nearly four minutes less than AMR’s response that day in July.

At the time of Brendan Marsman’s accident, Byron Township was served primarily by AMR, though the township did not have a contract with the provider specifying response times.

It was the Marsman’s neighbor who called 911.

“(Our neighbor) told us he was actually holding Brendan’s head waiting for the ambulance to get there,” Kay Marsman, Brendan’s mom, recalled. “He said it took way longer than what he thought (it would.)”

Brendan, who suffered a traumatic brain injury in the accident, spent four days in the ICU before he began to regain full consciousness.

Today, he’s doing well, and doctors are hopeful he will make a full recovery.

In November, several months after Marsman’s accident, Byron Township signed a three-year contract with LIFE EMS, which guaranteed specific response times.

“AMR had been the default ambulance service for our township for many years,” said Byron Township Supervisor Tom Hooker.  “Recently we had a citizen approach our board whose son had been hit … He was not pleased (with the ambulance response time) and challenged our board to do better.”

Hooker told Target 8 the township had already been considering a switch to LIFE.

“While lack of performance was not used in leaving AMR, residents’ concerns helped us realize the need to stay on top of the emergency services for our citizens. I believe our contract with LIFE EMS will provide a high level of care,” Hooker said.

AMR IMPACTED BY NATIONAL EMT, PARAMEDIC SHORTAGE

AMR said its biggest challenge in 2019 was the shortage of EMTs and paramedics, and that’s plagued EMS providers nationwide.

Working in emergency medical services can be a stressful and exhausting job, and it pays relatively low wages.

But in the past six months, AMR’s John Robben said the Grand Rapids company has hired an additional 52 employees, bringing its total staff to 191 people. It expects to hire 100 more employees in 2020.

The company has also increased the number of ambulances it regularly deploys in Kent County from ten or fewer daily to fourteen.

In addition, AMR has stopped offering services that take away from its core business. For instance, it no longer staffs football stadiums on standby.

“We redefined our core business, and we really shrunk it down to focus specifically on Kent County and Grand Rapids 911,” Robben said. 

In order to attract and retain staff, AMR in Grand Rapids will soon launch the “Earn While You Learn” program, which the company said has experienced great success in several other AMR markets nationwide.

“Instead of waiting for EMTs with certification to come to us, we are actively creating jobs in the city of Grand Rapids,” Robben explained. “We go out, we hire people, we pay for their training. They make a paycheck while learning to become EMTs. When they complete the program, they are guaranteed full-time employment with us, medical benefits and a 401k retirement.”

Robben said recruits will make $10 to $12 per hour while training, and AMR will cover their tuition and uniforms as well.

At AMR, EMTs start out making $14 per hour, which can go up to $16.72. There are also additional opportunities for advancement.

OVERSIGHT AGENCY: RESPONSE TIMES JUST ONE COMPONENT OF CARE

The oversight agency that tracks ambulance response times is reviewing its standards.  

“I think we spend a lot of time talking about one or two minutes in ambulance response time, and we miss huge opportunities,” said Dr. Todd Chassee in an interview with Target 8.

Chassee is the medical director of Kent County Emergency Medical Services (KCEMS), the organization that’s tasked with reviewing and investigating complaints regarding ambulance services in Kent County.

Chassee wants to see more emphasis on the entire continuum of pre-hospital care.

“Response times definitely matter, but with cardiac arrest, our most time-sensitive condition, ambulances would not be able to reach that patient in time. So, it’s important that we get the 911 system activated, that we get bystander CPR going and we get the AED to the patient. If there’s a public AED, fantastic. If there’s not, then our fire department, which is our closest resource to the patient, can get the heart shocked.”

While the public tends to focus on response times because they’re more easily measured, Chassee thinks cardiac arrest survival rates are a better measure of the quality of pre-hospital care. 

He points to statistics that show rates in Kent County are consistently higher than the rest of the state and comparable to rates nationwide. 

A chart of survival rates by year. (Courtesy)
A chart of cardiac arrests and survival rates by year. (Courtesy)

Chassee said that among patients who have chest pains but not cardiac arrest, there’s a “small subset” in need of advanced life support.

Those patients need paramedics to perform a 12-lead EKG as quickly as possible, so the patient can get to the hospital and have an artery opened.

“That is a small subset of our patients who are having chest pain,” said Chassee. “So I think it’s really important that we look to make sure that we identify that condition quickly when our paramedics arrive and that we have a short amount of time treating them on scene and that we get them to one of our three health systems (Spectrum, Mercy or Metro) for definitive care.”

Chassee also noted that Kalamazoo County’s Medical Control Authority has increased metro high priority response time standards from eight minutes to ten minutes.

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