By Dan Klepal and Jessie Halladay
Courier-Journal
Copyright 2008 Courier-Journal
LOUISVILLE, Ky. — Budget cuts have reduced the number of ambulances and emergency vehicles on duty in Metro Louisville this spring — increasing response times by 41 seconds on average, a Courier-Journal analysis shows.
Largely because of deployment changes designed to save on overtime, average response times slowed from 5 minutes, 46 seconds in early January, to 6 minutes, 27 seconds in mid-March, according to data from Metro Louisville Emergency Medical Services.
The newspaper’s analysis also shows that EMS has had an average of one fewer ambulance and three fewer fly cars per shift since $258,000 was cut from the department’s budget early this year. (Fly cars are utility vehicles that carry more experienced paramedics to life-threatening emergencies.)
Despite those findings, EMS administrators and members of Mayor Jerry Abramson’s administration say public safety has not been compromised, and they say Metro EMS’ response times remain in line with the highest performing agencies in the nation — particularly when responding to life-threatening emergencies.
And the city’s average response time remains well below the accepted national standard of 8 minutes, city officials say.
“You’re getting a higher level of service than you ever have in this community,” said Abramson spokesman Chad Carlton, who said $8million has been added to the EMS budget over the last two years. “It would be easy to focus on the smaller number (cut) and miss the money that’s been added.”
But some Metro Council members and area fire officials remain concerned about the EMS cuts, saying the response times don’t reflect that some calls are taking much longer than 6 minutes — and a few have taken up to 30 minutes.
“If you’re out in a rural area, you may not get an ambulance for 20 or 30 minutes,” said Craig Willman, president of the Louisville firefighters union, who said he hears complaints from firefighters about long waits for ambulances. “If you’re performing CPR that long, there with the family freaking out, it’s a bad scene.”
The mayor has asked all departments to look for savings to offset a projected $9.4 million revenue shortfall. EMS Director Neal Richmond was instructed to cut most of his costs by reducing overtime.
As a result, Richmond says, fewer ambulances and fly cars are being used, particularly when overtime would have to be used to staff ambulances when someone calls in sick or has unscheduled leave.
“For me, there are no sacred cows anymore,” Richmond said. “On some occasions, we will not staff a unit we normally would. (But) we are still very close to the highest-performing systems in this country.
Data provided by EMS and reviewed by the newspaper show that since the budget reductions were announced in February, emergency response times have consistently exceeded 6 minutes.
During the week of March 17, the average response time was 6 minutes, 27 seconds — though the number of calls was nearly identical to the week of Jan. 7, when the average response time was 5 minutes, 46 seconds.
And during the weeks of Feb. 11 and March 3, when 100 additional service calls came in each week, response times were a few seconds shy of 7 minutes.
Outlying areas hard-hit
The loudest complaints about response times has come from outlying areas of Jefferson County.
For example, Brent Davenport, chief at the Eastwood Fire Department, said Louisville’s EMS service is excellent — when it gets there.
There have been several instances, he said, when Eastwood residents waited 20 or 25 minutes for an ambulance.
“People out here have less coverage now than they did before merger,” Davenport said. “They took ambulances off the street, and it’s just not doing the taxpayers right. EMS does a great job, but there aren’t enough of them.”
The average response time to Eastwood’s 22 calls last month was 11:35, according to run data provided by EMS. Richmond said that’s a good time for one of the farthest reaches of the county.
“No system has the resources” to station ambulances in sparsely populated areas, Richmond said. “If we’re getting there in an average of 11 minutes, and they can get a fire truck there in five minutes, that’s an effectively and efficiently operating system.”
Richmond has created 27 locations to deploy emergency crews with the goal of reaching 80 percent of Jefferson County within eight minutes — the national standard that EMS agencies use for high-priority calls. Not all locations are staffed at all times.
In addition, every fire department in the county has an agreement with EMS to respond to certain types of calls, depending upon the department.
For example, some, like Fern Creek, respond only to the calls that are the most immediately life-threatening. Other departments, like Worthington, will respond to a larger number of calls that include serious but not immediately life-threatening calls.
Overall, fire departments respond to about 33 percent of all EMS calls, based on statistics from January to mid-March provided by EMS.
Small cut, big impact
Although the funding cut only amounts to 1 percent of EMS’ $25.4 million budget, Richmond has been told he can not overspend his budget this year. The department had a $2.4million overage a year ago.
That will be a challenge with Kentucky Derby events and spring’s typical increase in service calls, he said. EMS spent far more on street operations in the final three months of last fiscal year than in any other quarter — $926,061, compared with the next highest, $742,770 in the first quarter.
Richmond said it will take creative scheduling, working with the emergency rooms and having increased access to events.
“If we get to the point where we can’t make it, I’ll go back to the mayor and the council” to ask for more money, he said. Several Metro Council members — particularly those representing suburban areas — maintain that EMS’ average response time doesn’t represent how long it takes ambulances to get to scenes outside the old city limits.
The Courier-Journal’s analysis shows that Metro EMS vehicles arrived at nearly half of 436 calls during March 18-19 in less than 6 minutes, based on the national standard for computing response times.
On high-priority Code 3 calls, where a life is in danger, the percentage of responses under 6 minutes rose to 53.5 percent.
There were 30 runs in which EMS took 15 minutes or longer to arrive on the scene.
And three runs took longer than 30 minutes. In one case, Richmond said the call was canceled but not cleared out of the MetroSafe dispatch system for about a half-hour. In another case, the call was a low priority.
And in the third case, the call involved a woman who had fainted but was in stable condition, Richmond said.
Richmond said he doesn’t like to see calls take 30 minutes, but in a system as busy as Louisville, they will occur occasionally.
“It’s a rare episode,” Richmond said. “The community could always try to buy enough resources to try to prevent even that one case.” But he added that it ultimately comes down to what the community can afford.
Council member Hal Heiner, a Republican from the 19th District in far northeastern Jefferson County, wants a deployment study to determine a minimum number of ambulances needed for complete coverage of the county.
“Response times in suburban areas are totally unacceptable,” Heiner said. “I get very concerned when I hear that there is no minimum number of ambulances.”
Richmond admits that the department rarely had fewer than 22 vehicles on the street last year, and has moved away from that philosophy.
But he says the deployment system is designed to be fluid, so that ambulances move to areas as coverage is needed.
“Deployment is really a living, breathing organism,” Richmond said. “It’s shifting and moving all the time.”