AMR response time deficient

WOODBRIDGE - Oversight of the town's emergency medical services remains unclear. Woodbridge has a contract with American Medical Response to provide emergency medical services. The Emergency Medical Services Commission, along with the town's administrative officer, Joe Hellauer, has been responsible for monitoring the contractual compliance of AMR.

The effectiveness of the review of those contractual parameters has been questioned recently.

Review of the response times of AMR's ambulances to priority 1 (life-threatening) calls were deficient for eight of the first 11 months of 2007, according to statistics supplied by the town. Despite the fact that these response times are reviewed as "Key Performance Reports" at the quarterly EMS Committee meetings, no deficiencies were noted for any of those months.

In fact, meeting minutes from the June 2007 EMS Commission reflect that response times for February, March and April of 2007 were deemed to be "well within acceptable standards." In actuality, the ambulance response times to priority 1 calls for those months were all below the contractually required response times of 90 percent, according to statistics provided by the town.

Since 2001, AMR has provided emergency medical services for the town. The contract calls for AMR to provide a regional ambulance for transport and a town-stationed paramedic for advanced life support. Response times by the paramedic have been consistently above expectations. Ambulance response times have been less reliable.

From 1998 until 2001, the town was covered by its own ambulance service, however. In addition, just as is arranged currently, an AMR paramedic was stationed in town to provide advanced life support. Response times of the town ambulance unit were listed in several publications, including the New York Times, as within the six minute range.

While Amey Marrella was first selectwoman, the town disbanded its ambulance service and contracted with AMR to provide regional ambulance coverage; an AMR paramedic continued to be stationed in town. Since that time, AMR has provided ambulance service via circulating ambulances in the Greater New Haven area. This allows AMR to position its ambulances to service a number of area municipalities.

According to the town's AMR contract, when the company does not meet its contractual requirements to Woodbridge, certain actions are to be taken to address those deficiencies. According to Alan Tyma, chairman of the EMS Committee, "Anything outside the general parameters (of the contract) does require some monitoring."

Although AMR did not meet its contractual requirements for nearly all the months in 2007, none of those contractually-stipulated, precautionary measures were undertaken, and there is no evidence that any interventions were implemented to deal with those deficiencies.

Of concern, most of the deficient ambulance response times only came to light during a Jan. 4 special meeting of the EMS Commission. That meeting was convened to review the events surrounding AMR's prolonged response time to a medical emergency on Dec. 20. On that date, AMR's ambulance did not arrive on the scene for at least 23 minutes.

Although the Jan. 4 meeting discussed the Dec. 20 incident, much of the meeting was directed at AMR's overall performance for 2007. Tyma said of the numbers provided by AMR for 2007, "It looks like our compliance … has been right on. We have achieved what our contract calls for."

Although Chuck Babson, the manager of AMR, said he had not had time to thoroughly review those numbers, Babson said, "It looks like we've been within the parameters for the past 11 months."

Those results were: paramedic response times for all calls were under 9 minutes for 96 percent of the time; ambulance response times for priority 1/life-threatening calls were within 13 minutes 87 percent of the time and ambulance response times for priority 2/non-life-threatening calls were within 16 minutes 84 percent of the time.

Tyma reviewed the required compliance parameters, saying, "90 percent for priority 1 paramedic (within 8:59 minutes) and 80 percent for priority 1 ambulance (within 13 minutes)."

Tyma then stopped to review the contract after a question was raised that the contract required a compliance rate of 90 percent not 80 percent for priority 1 ambulance response times. After reviewing the contract, Tyma acknowledged that, indeed, 90 percent was the requirement for priority 1 calls, not 80 percent.

At that point, Babson said he questioned the compiled figures, saying, "This report says 87 percent, and I know for a fact it can't be 87 percent because I would have had a lot more work to do."

Tyma was then presented with monthly statistics for ambulance response times for priority 1 calls compiled by the Bulletin from AMR reports supplied by Joe Hellauer, the town administrator. Those results were: January 93 percent, February 82 percent, March 89 percent, April 89 percent, May 88 percent, June 86 percent, July 90 percent, August 86 percent, September 91 percent, October 87 percent and November 87 percent.

After perusing these tabulations, Tyma said, "According to a public bean count, it looks like we're slightly under," said Tyma

Tyma added, "The administrative officer of the town has continuous responsibility … Our general discussions, Joe (Hellaueur), have been that we've been at or above the requirements."

Tyma then pointed out that there are contractual exceptions that need to be accounted for, such as weather or traffic conditions that might affect response times. "Maybe we don't know about them, so it may well be that we're at the 90 percent except for exceptional circumstances," said Tyma.

"It may be necessary to tweak things … We'll work with Joe (Hellauer)," said Tyma.

Dan O'Brien, the chief executive officer of AMR, said, "We have trucks (ambulances), but we just can't move them around fast enough sometimes."

Tyma also suggested looking at the contractual requirements to see if requiring an ambulance response time of 13 minutes was appropriate. "We have to take a look at that because, as I gather it, there have been no untoward events with respect to priority 1 ambulances," said Tyma.

Both the EMS Commission and AMR expressed their intent to address any problems, but no specific directives were outlined.

Tyma said, "We don't want things … to ever endanger the health and safety of our citizens."

Although nearly half of the discussion at the Jan. 4 meeting concerned the deficiencies of AMR's overall 2007 performance, the recorded minutes of that meeting make no mention of this, only detailing the Dec. 20 incident. Those minutes, which are available on the town Web site, are the only record of that meeting.

Additionally, Tyma spoke before the Board of Selectmen on Jan. 9 to discuss the Jan. 4 special meeting. According to Tyma, "We've just recently signed a three year extension … with AMR because we have been pleased with their service."

Tyma also said, "During the course of our relationship … I've never seen any sanctions (against AMR) imposed."

Tyma did mention one deficient episode by AMR. He referred to the fact that the AMR ambulance had taken more than 20 minutes to respond to the Dec. 20 call. He said AMR was aware that the contract required a written explanation for any response time greater than 20 minutes. The contract actually stipulates that the explanatory response must be submitted within seven days of such a call. According to Hellauer, as of Jan. 14, there was no communication from AMR.

Ed Sheehy, the first selectman, suggested that the commission consider meeting on a monthly basis instead of a quarterly basis for the next six months to review the statistics. Tyma agreed.