The EMS mess

While Sherry Kurek takes the wheel, two other Detroit paramedics climb in back of the ambulance on a recent night. They know that time can be a killer.

With siren blaring, Kurek pulls out of the eastside fire station and makes her way to an auto accident, running red lights and maneuvering around cars that have stopped to let her pass.

The rig pulls up to a shaken woman who is standing with two police officers; a hit-and-run driver smashed the passenger side of her car. While her co-workers examine the woman, Kurek checks out the car’s interior. If the steering wheel is bent, she explains, the driver may have taken a pounding to the chest or head. But it looks OK, and so does the patient. To be sure, they strap her in a gurney and rush her to Northeast Community Hospital.

Only about eight minutes pass between the initial 911 call and when Kurek’s crew arrived on the scene. But in most cases, Detroit’s Emergency Medical Service (EMS) does not respond this quickly — and sometimes the consequences are deadly.

But the city, paramedics and firefighters are at odds over how to speed up the service.

The Archer administration is proposing a plan to make firefighters “first responders” to emergency medical calls. The firefighters union is bitterly fighting the plan in contract talks and says the plan won’t work.

Paramedics say that making firefighters first responders could help in some emergencies. But they also say that the fundamental need is for the city to get at least 10 more ambulances on the street.

Archer administration officials say they want to improve the quality and reliability of the fleet, but it’s not clear how much the administration will push to expand it.

If they don’t, many paramedics say the public will continue to suffer.

Late on average

When Detroit’s EMS was established in 1972, the University of Michigan’s Highway Safety Research Institute recommended a 22-ambulance fleet to handle about 49,000 projected emergency medical runs annually. EMS runs have increased to about 125,000 a year, while the ambulance fleet has grown to 29 ambulances — 17 of which run 24 hours a day. Consequently, EMS Chief Gary Kelly says that the average response time is about 12 minutes, when it should be less than nine minutes.

Vince Fourment, who has been a Detroit paramedic 12 years, puts it more bluntly: “If we can’t get to your house in 10 minutes, you’re dead.”

Fourment says that patients often die because there are not enough ambulances to handle the volume of emergency calls.

“It’s a shame when you know someone died and they didn’t have to,” he says.

It is not as bad as Fourment makes it out to be, says Kelly.

“Do our rigs break down sometimes? Sure they do. Does it prevent us getting where we need to be? Sure it does. Do we have enough vehicles or response units? No. But I can’t subscribe to the ‘oh, my God, the world is coming to an end’ verbiage.”

Jim Zimmerman, who has been a Detroit paramedic eight years, says that earlier this year he responded to a call to help a man having a heart attack 22 miles away. Though about five ambulances were assigned to the area, Zimmerman says, each was busy with other calls. “Dispatch has to give the call to somebody and will give it to you even if it’s on the other side of the city,” he says. “They do that a lot because there are not enough ambulances available.”

Often the ambulances available are in disrepair or break down during runs, paramedics say.

Just last summer, paramedic Joe Barney says that his truck broke down a half mile from a senior citizens complex where an elderly woman was suffocating. While his partner stayed with the rig, Barney took his medical equipment and hitchhiked to the patient’s apartment.

“I was thumbing a ride and a number of cars didn’t stop,” he says. “Eventually, this woman picked me up in her van so it worked out.”

By the time Barney arrived, the woman was lying on her face, which had turned blue.

“The doctors said the woman would have died if I did not get picked up,” he says.

“The medics are burned out and the rigs are trashed because they run 24-7,” says Zimmerman. “Once we drove with a broken axle, but didn’t know it. We heard some noise, but
didn’t want to risk getting a worse rig.”

“The big picture”

In a 1998 incident that resulted in a lawsuit, Robert Mason’s wife called EMS after he collapsed in his driveway; she allegedly called three more times before an ambulance showed up a half hour later. The rig couldn’t travel more than 25 mph to 30 mph, according to attorney J. Douglas Peters, who is representing Mason’s family in the suit against the city. Finally, the ambulance’s brakes failed, and the rig slammed into another EMS rig at the hospital. Mason was pronounced dead on arrival of cardiac arrest.

Hans Massaqoui represents the city in the lawsuit and says that the judge dismissed a portion of the case because Mason’s wife could not prove that her husband died because EMS allegedly arrived too late. “It is our contention that he was dead long before EMS was called,” adds Massaqoui.

Nonetheless, Peters faults the city for inadequate ambulances and staff. EMS is treated like the “poor stepchild” of the fire department, he says.

According to a report issued by the paramedics union, Operating Engineers Local 547, in 1997 EMS received about 12 percent of the then $137 million fire department budget while the fire fighting operations received about 73 percent. (The balance went to ordinance enforcement, administration, vehicle repairs and communications.)

There are about 1,300 firefighters, compared to about 260 EMS paramedics and other medical staff. In 1997, firefighters handled about 35,400 emergency calls and EMS handled 125,952. There have been some improvements since, however.

Dick Stein, who oversees public safety for the Archer administration, says that since 1994, the city has constantly upgraded EMS. He says that EMS has eight more ambulances than they had last year and staff has increased from 270 to 281.

“You have to look at the big picture,” says Stein. “While employees say they don’t have this or that, it all revolves around the funds,” he says.

City Council member Kay Everett helped form an EMS task force in 1995, after several lawsuits were filed against the division and the city. She says that as a result of the task force there was more money put in the last two city budgets for EMS equipment and staffing.

Tough choices

Charles Wilson, executive commissioner of the Fire Department, is pivotal to what the city does to reduce the EMS response time. He says that there are two options: buy more ambulances and hire more staff, or make the firefighters first responders. But it seems that Wilson is hoping to do both.

“One thing we are trying to do is reduce the age of the fleet,” he says. “And one way to do that is to buy better ambulances.”

Another way is to replace a third of the fleet each year, he says, adding this will also reduce breakdowns and the need for repairs.

On the other hand, says Wilson, across the country and in Detroit the number of fires is steadily declining each year, and firefighters have less to do. In fact, he says, in most major cities and some smaller ones, including many Detroit suburbs, firefighters are first in line to respond to medical emergencies.

Firefighters would be trained to provide basic medical care. When an emergency call comes in, at least two firefighters would go to the scene and provide CPR or other basic care while waiting for paramedics to arrive. If more advanced care is needed, such as administering medications or starting an IV, this would be done by the paramedic, who also would transport patients to a hospital if needed.

Battling it out

John King, president of the Detroit Firefighters Association Local 44, says that the first-responder issue is major in contract negotiations, which have been going on more than two years. He is skeptical.

“It lets the city say we got there in three to four minutes, but it does not help the patient on the scene” if they need additional medical care that only the paramedics can provide, he says.

The only way to reduce EMS response time, says King, is to get more ambulances.

“They should have at least 32 rigs on the street to support the services they want to render,” he says.

According to the report issued last year by the paramedics, Dallas, which has about the same number of residents as Detroit, had 33 ambulances to Detroit’s troubled 29. Cleveland, which has half as many residents as Detroit, had 21 rigs, according to the report.

King also says that until the city agrees to say how much it will pay firefighters to be first responders — which he says they have not done so far — the union will not agree to anything.

Roger Cheek, who heads labor relations for the city, did not return Metro Times phone calls.

Stein would not talk about contract negotiations. But he backs making firefighters first responders.

“Certainly, it will reduce the time it takes to respond to an emergency,” says Stein. “If we add on 15 to 20 more (firefighter) vehicles … you could have a response time in, say, four to five minutes.”

City Council member Kay Everett also supports the proposal.

“Firefighters are not working all the time … and to have them just sitting there doesn’t do us any good, that’s just common sense to me,” she says.

Even EMS Chief Kelly says it makes sense to have a first-responder system. Firefighters eventually will be able to determine that a paramedic is not needed in some situations. That would free more ambulances for the roughly 60 percent of patients that need to be transported to the hospital.

But many paramedics are leery, including Jerald James, who has been a paramedic two years. He says that the firefighters should not be put in the position of making medical decisions, such as whether a patient needs advanced care that paramedics provide.

“If we had enough staff and ambulances, you wouldn’t need first responders,” adds James.

Rob Olkowski has been training to be a paramedic in Detroit about nine months. He was a paramedic in northern Oakland County for three years where firefighters were first responders.

“It’s helpful to have the extra pair of hands,” he says.

But Olkowski says that there are only a few tasks they can do, such as give CPR and help lift patients.

“Even if the city strong-arms the firefighters into being first responders,” says Kirkland, “the issue still remains — there are not enough ambulances. Ann Mullen is a Metro Times staff writer. E-mail [email protected]

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