Ambulance response time discussed at a special EMS meeting last week

WOODBRIDGE -A special meeting of the Emergency Medical Response Commission was convened on Jan. 4 to review the response times of American Medical Response ambulances to medical calls in Woodbridge. The review was prompted by an article in the Dec. 28 Bulletin concerning the prolonged response time to a medical call on Dec. 20. Along with members of the commission, the meeting was attended by representatives from the police department, employees of AMR, Michael Luther of the Board of Finance and Woodbridge First Selectman Ed Sheehy.

Dec. 20 incident

Concerns about the ambulance response time were raised during a holiday party at the Woodbridge Country Club on Dec. 20. A 9-1-1 call was placed to AMR because a partygoer had lost consciousness. Although the paramedic was reportedly on the scene in less than three minutes to administer advanced life support, the ambulance took 23 minutes to arrive at the scene.

The AMR paramedic that had handled the call was at the meeting to review the event. According to the paramedic, he arrived on scene within 3 minutes to administer advanced life support, having traveled from an extended care facility on Bradley Road. After evaluating the patient, the paramedic downgraded the call from a priority 1 to a priority 2, which is considered a nonlife threatening medical call. Since priority 2 ambulance calls do not require sirens and lights, in all likelihood, the ambulance would have taken longer to arrive at the scene.

Additionally, the covering AMR ambulance came from northeast New Haven, a relatively long distance. Dan O'Brien, chief operating officer of AMR, explained to the commission that covering ambulances are positioned around the region to provide the best response times for those towns serviced by AMR, such as North Haven. O'Brien said, "We do our best to maneuver the ambulances throughout the system to utilize them."

O'Brien said, "I feel comfortable saying … these (prolonged response times) are isolated incidents."

After reviewing the incident, the EMS Commission felt that the episode in question may have had some glitches, but the protocols used were appropriate. Alan Tyma, chairman of the EMS commission, said of the event, "In fact, everything was done in the proper fashion and as timely as possible."

AMR contract

In view of the Dec. 20 prolonged response time, the EMS Commission reviewed the town's contract with AMR. The town became involved in a contractual arrangement with AMR in 2001 during the administration of Amey Marrella. The town recently renewed its AMR contract through December 2010.

According to Joe Hellauer, the town administrative officer, the current contract is not substantively different from previous contracts except for the amount the town is charged per year. That cost rises incrementally, based on economic factors.

Under the contract, Woodbridge is covered by a two-tiered emergency system: the paramedic system and the ambulance transport system. Both of these entities are part of AMR. The town remits an annual fee for the paramedic services, but does not pay for ambulance coverage. For the 2008 contract, the town will pay AMR $245,510; for the 2007 fiscal year, the town paid $234,329.

The contract sets forth required parameters for the provision of emergency medical services. According to the contract, the paramedic, an employee of AMR, is stationed in town 24/7 except for mutual aid calls. Ambulances do not have to be stationed in town, but must be available to cover emergency transport requirements.

Acceptable response times are established in the contract for covering priority 1 calls (life threatening) and priority 2 calls (not life threatening). For the paramedic, all first calls must be responded to in less than 9 minutes for 90 percent of the calls. For the ambulance, priority 1 calls must be responded to within 13 minutes for 90 percent of the calls, while priority 2 calls must be responded to within 16 minutes for 80 percent of the calls.

The contract also details an algorithm to deal with prolonged response times in an effort "to motivate the performance of the transport ambulance." If during a routine month the response times do not meet the requirements, the following month becomes a "Reporting Month." If AMR fails to meet requirements in that ensuing month, the next month becomes a "Warning Month." Failure to meet requirements during a "Warning Month" can result in a penalty to AMR of $500.

The contract also stipulates that AMR must meet with and deliver a written explanation to the town administrator within seven days of the deficiency.

Additionally, the contract states, "Any response in excess of 20 minutes requires a written explanation from AMR within seven days of such call."

Tyma, who has been a member of the EMS Commission since 2004, reported that to his knowledge, there has never been a warning month or a penalty month. He said that statistics are reviewed by the commission at its quarterly meetings. Tyma commented that those statistics have been within expectations through November 2007.

Review of commission meeting minutes from June 4, 2007, for example, revealed that response times for February, March and April were considered adequate. The minutes state, "All were well within acceptable standards."

However, an independent inspection of the response times for those months by The Bulletin revealed that ambulance response times for priority 1 calls were found to be below the contractual requirements. The statistics for those respective months revealed the following response time compliance percentages: February - 82 percent; March - 89 percent; and April - 89 percent.

In fact, for nine of the first 11 months of 2007, ambulance response times for priority 1 calls were below 90 percent.

At the meeting, Chuck Babson, the general manager for AMR, presented figures that reflected a yearly average of response times for both the paramedic and the ambulance from January through November of 2007. Those figures revealed that although the paramedic not only met but exceeded expectations, the ambulance response time only met contractual guidelines for priority 1 calls 87 percent of the time overall.

Hellauer reported that the monthly statistics were reviewed quarterly at the EMS Commission meetings, but no other communications concerning response times were on file.

Tyma said, "The reports have been that we've been at or above where we need to be. It would appear as if some of the information we received tonight would be a little against the grain. Somehow we need to balance this."

He added, "I don't believe … we've gone through a reporting month or a penalty month because our general discussions, Joe (Hellauer), have been that we're at or above the requirements."

Although most deficient months were in the range of 86 to 89 percent, Tyma said, "There's a suggestion this evening that that closeness deserves another look."

Members of the EMS Commission pointed out that there are certain situations that release AMR from its contractual response time requirements, such as extraordinary weather or traffic conditions. Tyma thought the potential influence of these situations should be looked at when assessing response times.

Jeff Axt, a member of the EMS Commission, reported that he has already begun an effort to evaluate the data more closely. Axt, who described himself as a "computer geek," is working on ways to clarify the data. Axt said, "We need to get a handle on it so we are judging it appropriately."

O'Brien expressed his interest in making improvements, saying, "Globally, the system works. There are always areas and opportunities for improvement."

"I think we've got to go back and look at these exceptions to make them a little tighter, and look at numbers and that sort of thing. It's all about how to make the system the best that it can be," said O'Brien.

Tyma asserted that the EMS Commission is determined to meet the needs of the residents. Tyma referred to the contract, which states, "(t)he Town is committed to promoting the fastest response and highest quality emergency medical services to its residents and visitors."

"We're looking for compliance. It's important to us as a commission on behalf of the townspeople that everybody is on it," said Tyma.

Acknowledging that not having an ambulance in town is a trade-off, Sheehy said, "Arguably you could have an ambulance in town if you want to pay for it. We're relying on the ambulances that are circulating in the area."

Tyma was expected to make a report to the BOS at its Jan. 9 meeting for further discussion