Ambulances aren’t meeting response-time goals
Can training firefighters to be paramedics help?
In a nearly empty fast food restaurant on Federal Boulevard, Denver firefighters started oxygen for a man who was having trouble breathing while they waited for a Denver Health ambulance.
The man answered a paramedic supervisor’s questions until the ambulance wailed into the parking lot two minutes later, and then the two crews worked together to load the patient into the ambulance, bringing along his walker, which was piled high with his belongings.
The call was one of many times that day that Denver firefighters and Denver Health’s paramedics and emergency medical technicians worked hand-in-hand on the city’s streets, sometimes waving each other off from scenes — the man reported as a downed party was just asleep on the sidewalk, a firefighter told the Denver Health supervisor — and other times working together to provide patient care.
“Even though there are 200 of us, and however many on the fire (department) side, it’s still a small crew at the end of the day,” said Denver Health Lt. Alex Wilkinson. “… We’re all doing the same job, there are just different intricacies of it.”
The sometimes-fraught relationship between Denver Health, which provides emergency medical services in the city, and the Denver Fire Department has improved in the year since changes to Denver Health’s contract with the city gave more leeway to firefighters, officials from both agencies say, even as Denver Health still fails to meet response-time goals and the fire department considers adding paramedics to its crews in the outlying areas to fill in the gaps.
“It’s been night and day in terms of the cooperation,” said Denver Fire Department Assistant Chief Jeff Linville. “… Before, we did our thing they did their thing. We never got patient follow-up, we never sat down as agencies together and looked at cases from a quality improvement lens, and now we sit down monthly. We look at cases together. … We look for ways to improve the system. That has never happened before.”
The city changed its contract with Denver Health for 2023 after firefighters complained to Denver Post news partner Denver7 about paramedics’ slow response times, policies that limited firefighters’ ability to provide care to patients and what they described as the strained relationship between the two agencies.
Before 2023, firefighters received EMT training from Denver Health and were not allowed to place patient IVS, even though that is an Emtlevel skill. Under the new operating agreement, firefighter EMT training now happens in-house at the fire department, and firefighters can place IVS. The two agencies also agreed to hire a new medical director for the fire department, instead of having a sole Denver Health medical director on the paramedic side.
That new position in particular has increased collaboration between the two agencies in the year since the changes, Linville said. Denver has one of the longest-running hospital-based EMS systems in the country, a relatively rare arrangement across the U.S.
Brent Stevenson, deputy chief of operations at Denver Health Paramedics, suggested the firefighters’ concerns were overblown, but acknowledged the relationship between the two agencies has been a “hot button” topic for the last couple of years.
“I think, personally, a lot of it has been blown out of proportion, pre-2022,” he said. “We’ve always had a strong relationship with our public safety partners; we’ve always worked well together. We’d never claim that it was perfect. But I think everyone is in alignment that we want to make it better.”
Response times below goal
Despite the improved collaboration, Denver Health paramedic response times still fall short of the goal set out in the hospital’s contract with the city: that paramedics will make it to calls within nine minutes at least 90% of the time.
Ambulances made it to the scene within nine minutes 85% of the time in 2023, according to Denver Health. That’s up from 81% in 2022 and 84% in 2021, but down from 2020, when
Denver Health met its goal 90% of the time.
“It’s where we are, and that’s the reality,” Stevenson said. “We would like to do better, but there are a lot of factors that play into what the response times are currently.”
He cited higher call volumes, 911 calls for nonemergency needs, heavy city traffic and an ongoing struggle to hire and retain paramedics as reasons for the slower response times. Denver Health acts as the city’s safety-net hospital and is struggling financially: state lawmakers have approved $10 million in emergency payments to the hospital in the past year to try to stabilize the system as it provides an increasing amount of uncompensated health care.
Denver Health has about 245 field staff now — about 91% of its full staffing level of 269 field staff, a count that includes paramedics and EMTS but excludes administrators and support staff, Stevenson said. On any given day, there are likely between 23 and 28 ambulances on the street, he said, with a handful fewer during the overnight hours.
The nine-minute response time is a goal in the city’s contract with Denver Health, not a requirement, Stevenson said.
There’s also growing recognition in the field that the nine-minute mark is an arbitrary goal that doesn’t impact patients’ outcomes, said David M. Williams, a former paramedic and national expert on ambulance system design.
“That number is based on one study in 1979 and it has been replicated across the country and the world for years,” he said. “Communities live and die by that number … and there is no medical evidence that it makes any difference.”
Generally, most emergency medical calls are for situations that are not immediately life-threatening, like general illness or mild trouble breathing, so an ambulance arriving in nine or 15 minutes doesn’t have a major impact, Williams said.
“If you see a Denver Health ambulance driving by your office, the natural reaction is, ‘Oh gosh, they must be going to something important,’” he said. “They’re not, most of the time.”
In truly life-threatening situations — like a cut artery or a person choking — nine minutes is way too long of a response time, Williams said. In those situations, the people involved need to take immediate action by calling 911 and following dispatchers’ instructions for care.
“And then the next fastest person — and this is where the fire service can make an amazing difference — is having EMTS on a fire engine or EMTS on a police car come, because they tend to have shorter response times,” Williams said. “… They are the ones who could make a life-saving difference.”
Firefighters’ role in emergency medical services
The sometimes-fraught relationship between Denver Health, which provides emergency medical services in the city, and the Denver Fire Department has improved in the year since changes to Denver Health’s contract with the city gave more leeway to firefighters, officials from both agencies say, even as Denver Health still fails to meet response-time goals and the fire department considers adding paramedics to its crews in the outlying areas to fill in the gaps.
The department was not able to provide The Post with its response time compliance rates prior to this story’s publication.
The majority of calls the Denver Fire Department responds to are medical calls — 68% of the calls firefighters responded to between 2018 and 2022 were for medical treatment, according to the agency’s annual report. Only 3.5% of the fire department’s calls were for fires.
All firefighters are also basic EMTS — the lowest level of emergency medical technicians — and provide basic life support care until an ambulance crew arrives to provide advanced care.
The fire department is considering training some firefighters as paramedics and putting those paramedics on fire trucks, particularly in the outlying areas of the city where Denver Health response times tend to be slower. While EMTS go through as much as 200 hours of training and can do basic skills like splinting or giving oxygen, paramedics complete as much as 2,000 hours of training and can administer medications, perform intubations and perform other advanced tasks.