Ryan Stanton
MLive.com, Walker, Mich.
ANN ARBOR, Mich. — There’s still a gap in ambulance service in Ann Arbor, according to Fire Chief Mike Kennedy.
Kennedy, who publicly raised the issue late last year, continued to speak out at a City Council budget work session this week, making the case for adding an ambulance to the fire department’s vehicle fleet.
So far, council hasn’t made a decision on whether to make the $243,000 purchase.
The chief, who previously told the story of an injured cyclist who gave up waiting for Huron Valley Ambulance and instead called Uber to get to the hospital, told council there have been continued delays in responses from HVA.
Ann Arbor firefighters are trained and licensed as emergency medical technicians and regularly respond to medical calls in addition to reports of fires.
HVA, a nonprofit owned by Emergent Health Partners, provides ambulance service for the Ann Arbor area.
With about 53 ambulances operating in Washtenaw County at any given time, HVA maintains its paramedics are responding to life-threatening emergencies in Ann Arbor in seven minutes on average and exceeding standards.
The average response for non-life-threatening calls is about double that, but still exceeds standards, according to HVA.
By the fire department’s count, over 158 days, there were 132 times when Ann Arbor firefighters were at a scene with a patient and it took HVA longer than 10 minutes to respond.
“The average delay that we are waiting on scene for HVA is 16 minutes for those 132 delays, and our on-scene time has been 1,804 minutes over the last 158 days,” Kennedy said.
The delays are having “tremendous impacts citywide,” Kennedy told council.
“Again, this is not to replace HVA,” he said of his ambulance purchase proposal. “It is to work in partnership with them, so when they go to zero status or they have delays, we have the ability to kind of catch them up.”
HVA spokesman Matt Rose has said HVA’s standard is to respond to life-threatening emergencies in 10 minutes or less at least 90% of the time and it’s exceeding that goal.
Life-threatening emergencies typically include patients who are having trouble breathing, experiencing chest pain or are unconscious, according to HVA.
Diverting an ambulance to a life-threatening emergency from a lower-priority call does occur occasionally, but cases of an ambulance being unavailable are rare, Rose said.
Rose provided a statement with some updated information from HVA in response to the fire chief’s remarks this week, saying it’s important for the community to understand how HVA paramedics respond to different calls.
When someone calls 911, the emergency dispatcher prioritizes the ambulance response based on the seriousness of the patient’s condition, Rose said.
Potential life-threatening emergencies require ambulances and fire departments to respond with lights and sirens, he said.
“In urban areas of Washtenaw County, the standard is to arrive on scene within 10 minutes,” he said. “During non-life-threatening emergencies, ambulances respond immediately but without lights and sirens and often without the local fire department. The standard for arrival time for non-life-threatening calls is 30 minutes or less.”
HVA’s 911 call center is staffed by certified emergency medical dispatchers who are trained to prioritize calls and determine an appropriate level of response, Rose said.
“The protocols to determine ambulance response and how quickly paramedics reach the patient are based on national standards and have been approved by the Washtenaw-Livingston Medical Control Authority,” he said.
The incidents the fire chief referenced are primarily non-life-threatening, Rose said.
“During the 158-day period the chief referenced, HVA’s dispatch records show there were 2,918 non-life-threatening calls with an average response time of 14 minutes,” he said.
“This response time is well within the established standard of care. HVA’s average response time to life-threatening emergencies in the city of Ann Arbor is seven minutes, which is also within the approved response time requirement.”
In many communities, Rose said, fire departments don’t respond to non-life-threatening calls because the patients don’t require immediate emergency medical intervention.
Whether Ann Arbor firefighters should be going on those calls is the city’s decision to make, he said, adding he’s not suggesting they shouldn’t.
Kennedy acknowledged many of the ambulance delays he cited were not life-threatening situations, but he said that’s further rationale to have firefighters who are EMTs handle them with a basic-life-support transport, rather than tying up HVA’s advanced-life-support ambulances and paramedics.
The fire chief provided a breakdown showing the different types of incidents associated with the 132 delays, including 47 falls, 11 cases of chest pain, 10 cases of convulsions/seizure, 10 cases of alcohol intoxication, nine cases of breathing problems and smaller numbers of incidents such as cardiac arrest, strokes, allergic reactions or an animal bite.
“One issue is that these delays are affecting our unit utilization rates,” Kennedy said. “Crews are committed to these incidents – we cannot abandon a patient.”
If firefighters are tied up at a medical scene and there’s another incident in their district, another fire department apparatus needs to respond, Kennedy said.
“This leads to an increased response time and creates further coverage exposure,” he said.
Council Member Kathy Griswold, D-2nd Ward, expressed concerns it’s posing a risk to residents to not have an ambulance in the fire department’s fleet.
Rather than wait until council approves next fiscal year’s budget in May, Griswold said she may bring forward a resolution sooner to authorize the purchase, as a new ambulance could take several months to arrive once ordered.
If council authorizes funding, the fire department will survey dealers to check the availability of already-built vehicles that meet the specifications, Kennedy said.
“If that is the case, we could take immediate delivery,” he said. “If not, we would have to order, which could take up to 10 months.”
HVA isn’t taking a position on whether the fire department should purchase an ambulance, Rose said, though he said it could tie up firefighters even longer if they’re transporting patients to the hospital and having to wait to drop them off, depending on how busy the hospital is at the time.
In the meantime, HVA has been working with the city’s administration and fire department leadership to address concerns and come to mutually agreeable resolutions, Rose said. There are always options to change the dispatching model or reposition where ambulances are staged, he said.
“The needs of the community are at the forefront of our daily operations,” he said. “We are continually striving to optimize our processes to best serve the residents of Washtenaw County.”
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