By Daniel J. Chacon
Rocky Mountain News
DENVER — Denver’s emergency medical response system is dragging in three critical areas: dispatching 911 calls, getting first responders to the scene and then getting ambulances to sick or dying patients, according to a city audit.
The long-awaited review, which examined emergency response times between 2003 and 2007, found instances when Denver Health didn’t have any ambulances available.
A mutual aid partner or contracted private ambulance is called when Denver Health doesn’t have one available, spokeswoman Dee Martinez said.
But it’ll probably lead to a longer response time.
The audit, released Thursday by City Auditor Dennis Gallagher, also found that response times have continued to increase annually, which he called “distressing.”
The audit identified “systemic structural weaknesses and limited oversight practices” and revealed “significant limitations” in the emergency response system.
“When it comes to public safety and matters of life and death, the public demands and should expect that those entrusted with responding to a medical emergency do so in a timely manner, consistent with industry standards and best practices,” Gallagher wrote in an opening letter to Mayor John Hickenlooper.
An issue of contention between the auditor and Denver Health is industry standards.
The audit compared Denver Health’s response times to those established by the National Fire Protection Association. The NFPA standards, which the City Council adopted in 2004, say the goal is for an ambulance to get to a scene within 10 minutes and 30 seconds after a 911 call is received 90 percent of the time.
Other standards are stricter.
Denver Health was meeting its response time requirements under its operating agreement with the city, but it was starting the clock when an ambulance was dispatched instead of when the 911 call came in. Had the clock started when the call was received, Denver Health last year arrived at a scene within 15 minutes and 48 seconds 90 percent of the time.
“The agreement specifies that response times be reported from a point in time which occurs before the time of dispatch,” the audit states. “Under that standard, Denver Health has not been in compliance.”
Denver Health officials say patient outcomes, not just response times, should be measured, too. The city is working on creating standards that include response times and patient outcomes.
Patricia Gabow, the hospital’s chief executive officer, told the city’s Audit Committee Thursday that Denver has the best trauma survival rates in the country. She said survival rates for cardiac arrest are up to four times better than the national average.
Denis Berckefeldt, the auditor’s spokesman, agreed there are other ways to measure performance but said Denver Health’s survival rates are somewhat misleading.
“That only counts people who actually get to the hospital,” he said.
“If somebody dies before the ambulance gets there or if they die in the ambulance on the way there, they’re not counted in those statistics.”
Katherine Archuleta, a senior adviser to the mayor, said several steps have been taken to improve emergency medical services since the audit was started, including an agreement among agencies on when to start the clock to measure response times.
“This . . . is an important first step in being able to accurately measure the entire response period,” she wrote in a letter to the auditor.
Gallagher is recommending, among other things, an oversight entity to monitor and report on the performance of the 911 Call Center, Denver Health and the Fire Department, which provides medical first responders.
Berckefeldt said the whole system needs improving.
“The system is a little too cumbersome,” he said. “It’s duplicative, and it creates unnecessary delays.
“I don’t think they’re hard fixes, and I think the city is certainly addressing the need to try and shorten the amount of time that it’s taking to even start to try to find an ambulance.”