By Tony Plohetski
Austin American-Statesman (Texas)
Copyright 2006 The Austin American-Statesman
Austin-Travis County Emergency Medical Services ambulances appear to be breaking down while responding to calls at significantly higher rates than those in other U.S. cities — although such failures account for only a fraction of total calls, according to a city report.
EMS officials, who conducted a three-month study that began in February, said 31 ambulances failed to make it to their dispatched calls through April because of problems that included a dead battery, a faulty door latch and a check-engine light.
Officials said that in each of the cases, dispatchers sent a second ambulance to the call and got patients safely to the hospital.
The breakdowns accounted for just 0.12 percent of the agency’s 26,066 calls during that time. But that’s still more than the rates at other emergency agencies studied by the Coalition of Advanced Emergency Medical Systems, an association of emergency medical providers in Tulsa, Okla.
According to the coalition’s findings, Austin’s so-called “critical failure rate,” the number of ambulances unable to respond to a call per 100,000 miles, was 10.5, well above the second-highest rate of 4.37 in Reno, Nev., which was followed by Little Rock, Ark. (3.8) and Tulsa, Okla. (2.28). Of the nine surveyed cities, Monterey, Calif., had the lowest critical failure rate at 0.03.
Dallas, Houston and many other cities don’t collect failure rates, so local EMS officials latched onto the Oklahoma coalition’s 2004 study as the best available data for comparison.
“We have room to improve,” EMS director Richard Harrington said. “We need to find out what we can do about the critical failures and what they are.”
EMS experts said calculating failure rates is growing in popularity across the United States as a way to measure the performance of ambulance service. EMS systems have traditionally monitored response times and other data.
According to a separate city study on response times finished last month, EMS fell just below its citywide goal of responding to the highest priority calls in 10 minutes or less 90 percent of the time.
City officials said they are still trying to verify that the cities in the coalition’s study all defined “critical failure” the same way. But they said they are concerned any time the first ambulance dispatched to a call can’t respond.
According to the city’s report, of the 31 calls in which the first ambulance couldn’t respond, only one was the highest priority - it involved a sick diabetic patient. A second unit responded and arrived at the scene 10 minutes and 21 seconds from the time of the original call.
The report also said that the failures did not reveal any specific ongoing mechanical problems with the ambulance fleet.
The 46 ambulances, which cost about $160,000, are among the highest quality in the United States, said Tom Wieczorek, the city’s fleet officer.
“You could operate on someone in them,” he said. “Every conceivable thing you could put in an ambulance is in them.”
The ambulances get serviced for two days every 6,000 miles — about four to eight times a year on average, he said. Mechanics inspect brakes and lights and change the oil, among other things.
Paramedics are also told to inspect the ambulances at the beginning of each shift and report any problems, Wieczorek said.
Before, EMS commanders were notified any time an ambulance broke down or could not respond, but the agency did not tally the frequency or review the breakdowns after ambulances were repaired.
“When an ambulance can’t go to a call, it obviously impairs the system’s response time,” said Jay Fitch, president of Fitch and Associates, a national EMS consulting company. “It affects the ability to serve patients. Another ambulance is going to have to be dispatched, and it is going to cause longer response times.”
According to the city’s report, EMS officials will begin meeting with fleet services representatives once a week to review critical breakdown reports to make sure problems are fixed. They also will compile a weekly report of breakdowns and give them to city management.
“We just want to make sure we are doing the right thing and have the best practices,” said EMS fleet commander Jason Martin. “The bottom line is: Can we do this better?”