BUSY SIGNAL

EMSA, fire department’s clash over ambulance availability could be factor in OKC’s contract decision

The Emergency Medical Services Authority, commonly known as EMSA, reported more than 160 times last year that it was at “level zero,” indicating it had no ambulances available to respond to emergencies in the metro area, according to figures compiled by the Oklahoma City Fire Department.

When ambulance service goes to level zero, Oklahoma City sends fire rigs to all medical calls, defeating efforts to reduce costs and keep fire department paramedics free to respond to the highest-priority calls.

Jim Winham, EMSA’s chief operating officer, said the situation on the streets is less dire than it would appear on paper. Factoring in situations where, for example, an ambulance has dropped a patient at a hospital but not yet returned to “post” shows that true level zero is an extraordinary event, he said.

EMSA’s record of meeting contractual requirements that ambulances respond within 10 minutes and 59 seconds to life-threatening calls 90 percent of the time and patient outcomes, highlighted by a better than 40 percent survival rate for heart attack patients, show the system works well, Winham said.

The city council was scheduled to receive a public safety briefing Tuesday at which level zero could be discussed. Police Chief Bill Citty, Fire Chief Keith Bryant and a representative of EMSA were to speak.

Just a week ago, on Feb. 9, EMSA went to level zero for four hours and 21 minutes, from about 6:30 in the morning to almost 11 a.m. Fire rigs made 11 “extra responses” during that time to lower priority calls that normally would be handled solely by

EMSA ambulance crews, fire department records show.

“It’s always because, ‘We’re busy.’ That’s just kind of become the reason,” Brian Stanaland, the fire department’s support services battalion chief, said in a recent interview.

Busy is the word for emergency response in Oklahoma City, where ambulances constantly are staged among “posts,” or stations, based on data about where the next call likely is to come from, Winham said.

“We’re a high-call volume, very busy system,” he said. “It’s unique, and it’s dynamic. It’s constantly changing. Constantly, constantly, constantly.”

The fire department responded to all medical calls for many years, regardless of whether the fast response times and skills offered by firefighters were necessary.

Waiting for information from EMSA before deciding whether firefighters needed to go “was causing unacceptable delays,” Oklahoma City Manager Jim Couch said in a 2012 memo to the council.

As the city grew, the number of calls had grown to the point where firefighters were called out 88,284 times in 2011, Stanaland said. The majority were medical calls.

EMSA worked with the fire department to integrate the agencies’ dispatch systems, improving the flow of information. Under new protocols, firefighters would respond only to the more serious calls.

Adopted with the agreement of the city council in 2012, the changes made a difference.

Stanaland said fire department calls dropped to 69,173 in 2013 and 69,046 in 2014.

The reductions are significant compared with the 924 “extra responses” because of level zero that were logged by the fire department between Dec. 29, 2013 — when Stanaland said the department had noticed an increase in the frequency of level zero events — and last week.

Still, there is a cost. Taking the $73 per hour with a one-hour minimum the city charges property owners to send a fire truck to a call at an abandoned building, “extra responses” have cost about

$67,500.

Able to respond

Statistics show the difference in how EMSA and the fire department measure level zero.

On March 10, 2015, the fire department recorded five instances of level zero and 33 “extra responses” to low-priority calls.

One instance of level zero occurred between 1:20 and 2:50 p.m.

At 1:25 p.m., though, EMSA found it had eight ambulances at “destinations,” such as hospitals, that had been on site at least 10 minutes, meaning by EMSA’s measure that they could respond immediately to a call if needed, Winham said.

The difference arises between “destinations,” where an ambulance crew is dropping off a patient, and “posts,” strategic locations where crews await a call, he said.

Contract consideration

This is a year when Oklahoma City can evaluate its contract with EMSA.

Once every five years, the city has a one-month window of opportunity during which it could decide to withdraw from the EMSA trust agreement, Couch, the city manager, said in a recent memo to the council.

The window opens Oct. 1.

Couch outlined five options the council could consider should it desire to withdraw.

In the memo, Couch said current ambulance availability “can be insufficient to meet overload demands due to limited staffing.”