'A critical tipping point': Kan. county EMS wait times reach dangerous levels
An investigation into Sedgwick County EMS showed providers were late to more than 11,000 potentially fatal emergencies since 2019
This is part of a series from The Wichita Eagle about what it calls "a broken emergency medical system that's growing worse by the day." Check out additional coverage of this ongoing story:
By Chance Swaim and Michael Stavola
The Wichita Eagle
SEDGWICK COUNTY, Kan. — When you call 911 in Wichita, the odds are good that Sedgwick County EMS will show up late to a life-threatening emergency.
When 7-month-old Greyson Seng stopped breathing, Sedgwick County EMS didn't reach him for nearly 15 minutes after his father's anguished 911 call. He later died, never seeing his first birthday.
When 8-year-old Owen Poole had a seizure and fell out of his treehouse, Sedgwick County EMS didn't get to his side for nearly 24 minutes.
The national accreditation standard for life-threatening calls is 9 minutes.
Sedgwick County EMS response times have gotten dangerously slow under Dr. John Gallagher, director of the department, a Wichita Eagle investigation found.
Since 2019, when Gallagher took charge, Sedgwick County EMS has shown up late to more than 11,000 potentially fatal emergencies, no longer meeting its national accreditation standards. This year, the odds of getting life-saving medical attention in the Wichita area within 9 minutes of calling 911 are less than one in three.
Jaice Seng, Greyson's father, said the slow response time killed his baby boy. Owen's mother said the delay increased Owen's chances of permanent brain damage and death.
Eagle interviews with more than 50 past and present Sedgwick County EMS employees, county officials and EMS experts — coupled with an analysis of county records obtained by the Eagle — reveal a broken emergency medical system that's growing worse by the day, creating a public health crisis that potentially puts thousands of lives at risk of preventable death.
The slow response times are tied to a mass exodus by paramedics, who are fleeing the department in revolt against Gallagher.
"This organization is at a critical tipping point," said Cole Mitchell, a Sedgwick County paramedic. "At this point, the safety and well-being of the citizens we serve is being measured by nothing more than luck."
The Eagle also found that while Gallagher's promotion was under consideration two years ago, a powerful coalition of local authorities helped gloss over a deeply controversial EMS response that has garnered national attention: Gallagher's decision to deny an ambulance to a man with a gunshot wound to the head for 5 hours.
County leaders are aware of widespread problems in the department but have ignored, dismissed and publicly whitewashed concerns raised by EMS employees for years, the Eagle's investigation revealed.
Meanwhile, Sedgwick County EMS leaders have also made it more difficult to identify the problem. They stopped reporting response times to the public when Gallagher took over. And their internal response-time data counts only a portion of the time a patient actually waits after calling for help, The Eagle found.
Sedgwick County paramedics say they fear EMS response times are putting the entire community at risk, including their own families.
Since 2019, nearly a third of Sedgwick County EMS employees have quit, taking ambulances off the street and exposing vast areas of the county to diminished ambulance service.
Despite officials' stated concerns about staffing, having fewer paramedics was part of a plan going back years, a cost-cutting move Gallagher said would improve patient care, The Eagle found.
"It's putting a half million people who live in this community at risk," said Austin Woolsey, a paramedic who recently quit Sedgwick County EMS.
Paul Misasi, deputy director of EMS operations, acknowledged problems with EMS response time after The Eagle presented its findings and methodology.
"EMS leadership is both aware and concerned about this," he said.
Jaice Seng knew something was wrong when his 2-year-old son woke him up on the morning of April 30.
"Baby," the boy said, meaning Greyson, his 7-month-old little brother.
Greyson was lying face down. His eyes were slightly open. His body was warm but pale, Seng said.
"I just saw his legs, and I just knew something was wrong," Seng said. "I could tell that he wasn't breathing."
At 8:52 a.m., he called 911.
But the closest Sedgwick County EMS post — 3 miles away — had no ambulances available. The one 3.3 miles away, also none. The closest available ambulance was 6 miles away.
By the time EMS paramedics got to Greyson, 14 minutes and 41 seconds had elapsed. That's 5 minutes and 41 seconds longer than the 9-minute standard for a patient-not-breathing call.
The delay potentially cut Greyson's chances of survival in half, studies show.
He died eight days later in the hospital, his brain never recovering from the lack of oxygen and blood during cardiac arrest, his father said.
Before April 30, Greyson had been a healthy baby boy, Seng said. "He would literally just wake up and look at the sun and start smiling and kicking his feet and laughing. He was just the happiest little baby ever."
But at some point that morning, Greyson had rolled himself over, stopped breathing and gone into cardiac arrest.
Sedgwick County EMS has a response time standard that calls for arrival to at least 90% of emergencies like Greyson's within 9 minutes, but recent studies show patients are more likely to survive if EMS arrives within 6 minutes. If they show up between 10 and 15 minutes, the chances of survival are cut in half.
It's unclear exactly how long it took to get his heart pumping.
The ambulance was staffed with a paramedic with a year of experience and a part-time EMT hired in January. An additional paramedic with more experience was called to the scene to help. He didn't arrive until 18 minutes and 31 seconds had passed.
Seng said he believes the slow response time ultimately led to the death of his son.
"If they would have gotten there sooner, I really feel like I would still have my son," Seng said. "He was fighting. He opened his eyes and looked at us (at the hospital). He was fighting hard. He wanted to be here, but his little brain had just suffered too much."
"I mean, I caught it pretty quick," Seng said. "I could tell that he was still there a little bit, you know? But from the time it took me to call 911 to the time that they got there — he just couldn't last that long."
Gallagher declined to offer his professional opinion on whether the delayed response time contributed to Greyson's death.
"I can however tell you that none of the information I have reviewed suggests that any of the EMS care or response was unusual," Gallagher wrote in an email.
Gallagher added: "while there does not appear to be any fault to assign, I extend my deepest condolences to the parents of the deceased child. As a parent myself, I hope to never experience the anguish they must be feeling."
A growing problem
Baby Greyson is not alone. While Sedgwick County EMS responds to about 25,000 life-threatening emergencies each year, EMS leaders say the department has been unable to meet its response time standards for Wichita since before 2017 and the entire county since 2020.
On May 15, the troubles hit home for 8-year-old Owen Poole of Colwich, who had a seizure and fell from his treehouse while his parents were at dinner in Wichita.
The EMS response was so slow that Owen's mother, Cara Poole, left dinner and beat the ambulance home, even though she was 2 miles farther than the nearest EMS post. The ambulance that eventually showed up came immediately after clearing another call 12 miles away, records show.
"There was nothing, just us," Cara Poole said. "I mean our neighbors had come over to help with our 3-year-old, but otherwise there were no emergency vehicles here at all."
Owen has struggled with seizures since he was 18 months old, but he hadn't had one in 2 1/2 years. His parents lived in Wichita at the time.
This time, the response was much slower.
"Every other time we've had an ambulance, they've been there before I got there," Cara Poole said. "Once, I was seven minutes away, and they were there before I got there."
It took 911 nearly 8 minutes to dispatch an ambulance and Sedgwick County EMS nearly 24 minutes to reach him.
That's 15 minutes later than the national standard and 14 minutes later than the county's own revised standard of fewer than 10 minutes for calls outside Wichita.
The delayed response time put Owen at increased risk for permanent brain damage or death, according to research on seizures. He was suffering a seizure for the duration, his mother said.
Most seizures end on their own within a few minutes, but paramedics are trained to treat any seizure that lasts more than 5 minutes as a life-threatening emergency. Research shows those that last more than 30 minutes can kill.
Cara Poole said her son's seizure lasted between 35 and 40 minutes, starting before he fell from the treehouse. Owen also suffered a concussion from the fall.
EMS paramedics say the response was delayed because of an ambulance shortage that night. At one point, EMS had seven calls on hold and no available ambulances.
Records show Sedgwick County EMS suffered from an ambulance shortage on May 15 — something that's becoming more common as paramedics quit the department. EMS registered 25 status alerts (meaning fewer than three ambulances are available for more than one minute) throughout the day.
For more than 37 minutes, no ambulances were available in the entire county the day of Owen's seizure.
"We needed EMS here," Cara Poole said. "It took so long. We just kept saying, 'Where are they? Where are they?'"
"His breathing was getting worse and worse," Cara Poole said.
During a six-month period from November 2020 to May 2021, Sedgwick County had three or fewer ambulances for more than 144 hours, the equivalent of one full day each month for an area of more than 1,000 square miles and 500,000 people. Sedgwick County had zero ambulances available for more than 8 hours during that time, records show.
Despite Owen's long wait, he survived. But his recovery took longer than it would have with a shorter seizure, and he required 24-hour supervision for weeks following the seizure, his parents said.
"They could have given him his medicine faster, and then it would have been over," Cara Poole said.
Owen's parents had nothing but good things to say about the EMS paramedics who helped save their son.
"I do want to be clear that EMS did a great job once they got here," Cara Poole said. "I just can't believe how long it took to get here."
Missing the mark
Based on the county's own calculations, if Greyson or Owen had needed help in 2017, there would have been a nearly 89% chance an ambulance would arrive on the scene in 9 minutes or fewer anywhere in Sedgwick County.
But the likelihood of EMS showing up late has more than doubled since then, growing worse each year, according to an Eagle analysis of EMS data obtained through the Kansas Open Records Act.
In the first half of 2021, Sedgwick County EMS showed up late to the scene of life-threatening cases more than 25% of the time, compared to 11.4% in 2017.
But even those numbers don't provide the full picture of Sedgwick County EMS response time.
The Sedgwick County EMS response-time database provided through an open records request includes hundreds of calls logged as zero-second responses, such as when a resident flagged down an ambulance or someone collapsed at a sporting event or concert, which drove down the response time calculations.
Sedgwick County EMS's formula for calculating response time also largely ignores the perspective of the patient, The Eagle found. It measures its response rate from the time 911 dispatches an ambulance to when it pulls up at a scene, leaving out the time it takes to dispatch an ambulance and the time it takes an ambulance crew to contact a patient.
In Greyson's case, he waited 14 minutes and 41 seconds. But the county's formula counts the response time as 12 minutes and 9 seconds — ignoring the additional 1 minute, 40 seconds it took to dispatch an ambulance and 32 seconds it took to reach the patient.
Owen waited 23 minutes and 40 seconds, but the county's formula shaved 8 minutes and 52 seconds off in its clock, logging a response time of 14 minutes, 48 seconds. It didn't include the 7 minutes and 57 seconds he waited before an ambulance was actually dispatched or the 55 seconds before EMS made contact with him after arrival.
Not counting the patient's true wait time makes it more difficult to recognize problems within the EMS response chain, which includes 911 dispatch time.
The county's accreditation commission is considering a change that would start the clock when a resident calls for help and stop the clock when an ambulance crew reaches its patient.
Measured that way, the odds of getting an ambulance in time to make a difference in Sedgwick County have become even worse.
In 2017, EMS missed the 9-minute mark on 50.5% of life-threatening emergencies when counting the total response time. By early 2021, EMS was late to more than two out of three rescues, or 67%.
How often did Sedgwick County EMS reach a patient within 9 minutes in life-threatening emergencies?
- 2017: 49.5%
- 2018: 49.1%
- 2019: 44.1%
- 2020: 43.9%
- 2021: 32.9%
How does Sedgwick County EMS count those same calls?
- 2017: 88.6%
- 2018: 87.7%
- 2019: 85.2%
- 2020: 77.4%
- 2021: 74.6%
Misasi, deputy director of EMS operations, declined to calculate patient wait times or verify The Eagle's total response time findings based on the county's recorded times from 911 call to patient contact.
He claimed patient contact time is sometimes "an unreliable time marker" because of how it's entered into the database. But The Eagle found it comes directly from computer-aided dispatch records, the same as the other time markers used by EMS to calculate response time.
"I am willing to stipulate that your calculations are likely correct," he said.
Every minute counts
Response times, along with CPR, have long been associated with increased survival rates for people who suffer sudden cardiac arrest outside of a hospital, such as Greyson.
The best chance of survival comes when CPR is administered quickly and EMS paramedics arrive to deliver resuscitation within 6 minutes, studies have shown.
The likelihood of survival is cut in half when ambulance response time increases to between 10 and 15 minutes, with or without CPR, a new study published in the American Heart Association Journal found.
In response to questions about Greyson's death, Gallagher attempted to downplay the significance of EMS response time.
Contrary to medical research showing a strong correlation between response time and cardiac arrest survival, Gallagher said, "Currently there is little evidence to tie response time to cardiac arrest survival."
Dr. Mickey Eisenberg, a pioneer of modern emergency medicine and former medical director of the King County EMS in Seattle, has published decades of studies showing the importance of rapid response to cardiac arrests. He declined to respond directly to Gallagher's comments, but agreed to speak to response times in general.
"There is a reason EMS vehicles and fire engines use lights and sirens," Eisenberg said. "The sooner treatment begins for critical events, the better the outcome."
Dr. Bryan McNally, the executive director of the Cardiac Arrest Registry to Enhance Survival program at Emory University School of Medicine, said cardiac arrest survival drops 7% to 10% for each minute from collapse to "definitive care," which could include defibrillation or medication.
"Every minute counts," McNally said. "A patient's chances of survival increases when you minimize the time from collapse to intervention, the time from collapse to first CPR, time from collapse to first defibrillation, time from collapse to first EMS contact. All those are important. Cardiac arrest is ultimately the most time-dependent condition you can find in the prehospital setting. Time matters."
Research published by the American Heart Association Journal in October also suggests Gallagher's conclusions are out of step with the latest research, which effectively debunked the notion that EMS response time isn't tied to survival rates.
The study, "Shortening Ambulance Response Time Increases Survival in Out-of-Hospital Cardiac Arrest", found that other important factors in cardiac arrest survival have improved as response time has gotten slower.
For example, as ambulance response time has increased, time from collapse to defibrillation has remained the same in many areas due to more firefighters and police officers carrying defibrillators.
"Again, this could contribute to the false conclusion that ambulance response time is a less important factor for patients experiencing cardiac arrest," the study says.
Medical treatment for cardiac arrest continues to improve, saving lives that otherwise would have been lost decades ago. With quicker EMS response times, even more lives could be saved, the study showed.
It projected that if ambulance response times in the United States improved to 6 minutes for cardiac arrests, 19,950 additional American lives could be saved each year.
Paramedics shortage by design
Misasi, the deputy director of EMS operations, said the response times are suffering because the department no longer has enough paramedics to fully staff its ambulances. That wasn't always the case.
Since Gallagher took over the department in 2019, at least 53 paramedics have left. As of June 1, only 18 had been replaced.
Others have been pulled off the street and placed in the training department or special units that can't transport patients, such as the ICT-1 program and single-medic responders in Clearwater and Cheney.
Gallagher and Sedgwick County Manager Tom Stolz recently called the staffing shortage "a crisis."
But the pared-down roster was by design, The Eagle's investigation found.
Sedgwick County EMS used to have enough paramedics to staff each ambulance with two, called a "dual-paramedic crew configuration."
But in 2018, then-Medical Director Gallagher signed off on an internal report authored by his predecessor that called for eliminating 35 paramedic positions and replacing them with lower-paid, less-qualified EMTs as soon as 2021. The move was expected to save $287,735 to $411,145 a year.
The cost-cutting maneuver aimed to staff ambulances with a cheaper paramedic/EMT crew and ditch the two-paramedic system that had been in place since 1975.
Gallagher wrote that it "would be expected to have no effect, or perhaps a positive effect, on patient care within our county."
Now, Sedgwick County EMS doesn't have enough paramedics to staff all of its ambulances.
A majority of paramedics who left the department blame Gallagher and county leaders who disregarded their concerns, according to an exit survey conducted by EMS employees and Eagle interviews.
Unlike EMTs, who can provide basic life support, paramedics are qualified to give advanced life-saving care, such as administering medications and intubating people to secure an airway.
In Sedgwick County, EMTs get paid $29,047 to $42,500 a year. Paramedics can make $38,918 to $65,913, depending on rank and experience.
Since Gallagher became director, the department had a net loss of 35 full- and part-time paramedics by May 2021, the exact number cited in the internal report he endorsed. It has gotten worse since then, The Eagle found.
Gallagher and other county leaders blame a national paramedic shortage.
"I don't have any problem getting up to our EMT target," Gallagher said. "It's doable. We can't be, like, super picky, but we can be choosy, and we can make sure that we have quality EMTs. On the paramedic side, the supply chain has gone to dirt."
Forrest Walker, a former Sedgwick County EMS paramedic, said Sedgwick County's problem is "absolutely not" the national paramedic supply.
"Imagine a patient is bleeding out, but instead of fixing that wound, you blame the American Red Cross because they don't have enough blood to send," Walker said. "That's what Gallagher is doing when he blames a national paramedic shortage.
"But that's his thing — he's never to blame."
Cries for help
Parents of Greyson and Owen told The Eagle their 911 calls for help were mishandled.
Greyson's father had to dial 911 twice because the first call mysteriously dropped while he was asking instructions on administering CPR to a baby.
Sedgwick County 911 operators are trained to instruct people over the phone how to provide CPR. Records show the operator entered Greyson's address within seconds. But no instructions were given.
Audio of the two calls obtained through the Kansas Open Records Act captures a harrowing disconnect between the urgency of the emergencies and the capacity of authorities to respond.
"My son, I need to know how to do baby CPR," Seng said at the start of his first call for help. "Please help. Please. Please. Oh my god. Oh my god. Oh my god. I'm going to go ask for help. Please help, my son's not breathing."
In the recording, Seng pleads for help until the 40-second mark and the line goes dead. Twenty-six seconds later, the operator finally speaks: "Ma'am, are you there? Hello?"
Seng said he thought the operator hung up on him. Sedgwick County Emergency Communications Director Elora Forshee said she can't explain what went wrong.
When Seng called back, he got a different operator. He again asked for help administering CPR.
"Please help me. ... I don't know how to do it," he said in the recording.
"Is there a defibrillator available?" the operator says. "If there's one available, send someone to get it now."
"Yes," the operator says. "You probably don't have one. OK, take a deep breath. I'm sending a paramedic. Stay on the line. I'll tell you exactly what to do next."
Seng followed the operator's instructions, alternating between mouth-to-mouth and chest compressions for several minutes until Wichita firefighters arrived and took over CPR.
But what Greyson needed to get his heart pumping again was a shot of adrenaline, which could be administered only by a paramedic, not a firefighter.
Owen's mother also called twice after 911 failed to dispatch an ambulance. "There was just no one coming until I called back," she said.
Sedgwick County Emergency Communications did not provide audio from Poole's second call, despite it being in the time frame requested in the Eagle's records request.
Poole reported that her son fell from his treehouse and was unresponsive. In other circumstances, 911 dispatches an ambulance immediately to life-threatening calls.
But in Owen's case, 911 waited nearly 8 minutes.
Forshee said it took that long because it was unclear whether Owen needed an ambulance.
That explanation contradicts what's heard on the 911 audio. Owen's babysitter called 911 about 32 seconds after Cara Poole's call.
The babysitter told the 911 operator that Owen was conscious but unresponsive after hitting his head. She said his pupils weren't dilating correctly. Three minutes into the conversation, the dispatcher said he was sending paramedics.
But records show 911 didn't dispatch an ambulance until 7 minutes and 57 seconds after the original call.
Sedgwick County officials allowed the problems with Sedgwick County EMS response times to go undiagnosed for two years without public scrutiny.
In the past, Sedgwick County EMS directors posted response times on the county's website, showcasing whether the department had been meeting its accreditation standards.
Scott Hadley, Sedgwick County EMS director from 2010 to 2018, said providing those numbers helped hold him accountable and allowed the department to maintain public trust.
"To me, that's being transparent," Hadley said. "That's showing the public, good or bad, it got put out there. These are our targets, these are our goals, and are we achieving those or not. And if we're not, why are we not achieving those goals? What do we need to do to achieve it? I believe that's the right thing to do."
That practice was abandoned when Gallagher took over the department in 2019, as response times grew slower.
"I'll admit it wasn't a front-burner item for me," Gallagher said during a June 1 interview with The Eagle. "When I first got started, there was plenty to work on. ... And while we have yet to put out our first one, we've been working with our data analysts to make sure that we put stuff out that is both technically accurate and also consumable. ... My hope is that in the next couple of weeks we'll be able to do that."
"We certainly don't want it to come across as if it's not being reported or trying to hide something. That's certainly not the case," he added.
No such information had been posted online as of July 10, 39 days after the interview.
When Sedgwick County Commissioner Jim Howell pressed for response times this spring, Stolz, the county manager, initially rejected his request.
"Gallagher and his team are trying to improve the quality of EMS service and get away from the quantitative numbers game used historically which did not tell the whole story and value of the EMS department," Stolz wrote Howell in an April 14 email.
Howell was later provided a copy of the full EMS database for 2020 and 2021, after threatening to submit an open records request.
If a resident wants to see response-time data from Sedgwick County EMS, they would have to submit a Kansas Open Records Act request and pay $90. Then they would have to do the math themselves with incomplete data.
When The Eagle made its request, Sedgwick County deleted basic information about EMS rescues from a copy of its Excel file recording response times, claiming it had to remove ZIP codes, addresses and city names to protect patient privacy under the Health Insurance Portability and Accountability Act, or HIPAA. It also removed patient ages, but only for patients over age 89.
During The Eagle's investigation, Sedgwick County EMS officials were slow to acknowledge slower response times. But it's unclear how closely they were tracking them.
When The Eagle asked Sedgwick County officials to compare EMS response times to the Eagle's findings, it took a week for the county to run the calculations and confirm The Eagle's numbers were correct.
"We continuously study and adjust our operations, with the resources we have, to meet our goals," Misasi, EMS deputy director of operations, wrote in an email. "Unfortunately, as you can see in this data, our system is not currently capable of meeting these internally-based goals for (Sedgwick County or the city of Wichita), nor has it been since before 2017 for urban areas and 2020 for the entire county."
As slow as Sedgwick County EMS has become at responding to emergencies, its response times pale in comparison to the time it has taken county leadership to recognize there's a problem — despite warnings from frontline employees.
"The current state of the EMS organization was literally forecast by employees over the past two years," Mitchell, the paramedic, said. "And it was 100 percent avoidable."
(c)2021 The Wichita Eagle (Wichita, Kan.)