By Lauren Gregory
Chattanooga Times Free Press (Tennessee)
Copyright 2006 Chattanooga Publishing Company
Without state or federal guidelines on how quickly ambulances should respond to emergencies, Hamilton County emergency officials are left to measure their own performance.
“There’s no response time standard, period,” said Joe Phillips, director of the Tennessee Department of Health’s Emergency Medical Services Division. “Enforcing that would be too difficult.”
The target in Hamilton County is 8 minutes, said Emergency Medical Services Chief Kenneth Wilkerson. That goal was met last month and in September 2005, according to data samplings obtained by the Chattanooga Times Free Press.
Some systems try for 10 minutes, he said, “but that’s not acceptable for us. That’s too long.”
According to Mr. Phillips, service in urban areas is so different from service in rural areas that it would be impossible to impose a standard, either statewide or nationwide. Tennessee officials do not even suggest a target because software limitations prevent them from accessing any information about the 800,000 transports they oversee each year.
“We’ll attempt that when we get the data,” he said, explaining that a new system has been in the works for two years and is expected to be up and running in early 2007.
In 2005, Hamilton County Emergency Services recorded an average response time of 7 minutes, 48 seconds for September, records show. For the same month in 2006, the average response was 7 minutes, 16 seconds.
EMS is the responding agency for all 911 calls requiring ambulance service in Hamilton County except for in East Ridge, which contracts with private ambulance services. The agency answers about 27,000 calls per year, according to Hamilton County Emergency Services Director Don Allen.
Individual call times vary based on the location of available ambulances and the geographical conditions in different areas of the county, Mr. Allen explained. Inclement weather and rush hour traffic are factors, as are emergency room backlogs, which tie up ambulances that could otherwise be out answering calls.
Responses can range from 30 seconds to 15 minutes, he said, depending upon the circumstances.
The county’s 13 medic stations house a total of 14 ambulances, two of which are stationed in downtown Chattanooga. Medic 1 in Birchwood, Medic 2 in Bakewell and Medic 8 on Signal Mountain have tended to show the slowest responses, according to Mr. Allen.
Because those are more rural areas that yield fewer 911 calls than other parts of the county, he said, fewer resources are concentrated there. “Ambulances are stationed where you can get the most use in the most calls,” he said.
Medics 9 and 13 are both at the downtown Chattanooga station on Long Street, where call volume is significantly higher than anywhere else. That station tends to have the fastest response time, Mr. Allen said.
But ambulance response times do not tell the whole story, Mr. Allen and Chief Wilkerson cautioned. When the computer system at the Hamilton County 911 Center registers a call as a life-threatening emergency, first responders from local fire departments are dispatched automatically to bridge the gap until a full ambulance service can get to the scene.
“We’ve formed very close partnerships with volunteer fire departments and the Chattanooga Fire Department,” Chief Wilkerson said.
Those partnerships are key, according to EMS Medical Director Dr. Jim Creel. “You need to have this tiered system. All good systems do,” he said.
Dr. Creel heads a quality assurance team that meets monthly to review Hamilton County’s emergency care data. The team evaluates response times, paying especially close attention to any prolonged calls, as well as medical assessments and the dispensing of medication.
“It’s a pretty intense meeting,” Dr. Creel said. “We’ve established protocols, and I want to make sure those are being followed.”