By Asia Simone Burns
The Atlanta Journal-Constitution
DEKALB COUNTY, Ga. — For years, critics of DeKalb County’s ambulance service have said its response times are too slow and that risks the lives of people across the state’s fourth most populace county.
Those concerns were validated late last year by a consultant’s review that was critical of the ambulance service and DeKalb’s private ambulance provider, American Medical Response. The report said AMR was not deploying adequate resources to handle the county’s needs and was well below national standards for response times on life-threatening emergencies.
In April the company agreed to pay a penalty to the county of more than $1.3 million for its substandard performance the previous two years, according to a letter the company sent to DeKalb Fire Rescue Chief Darnell Fullum.
As DeKalb commissioners prepare to vote on a new ambulance contract as early as this week, AMR is poised to remain the go-to service for the county, according to county officials.
The new contract budgets for a $77 million county subsidy to AMR over the course of the five-year agreement — roughly $15 million per year. That’s a significant increase from the $4.89 million annual county subsidy included in the current 18-month contract AMR has with DeKalb. The previous five-year contract had no subsidy, according to Fullum.
DeKalb leaders have expressed optimism that AMR’s experience and the increased subsidy investment will improve service and response times.
“Looking toward the future with recognizing the past, what I have seen with AMR is considerable work being put forth in the system to improve it,” Fullum told The Atlanta Journal-Constitution.
A county bid evaluation committee, which included Fullum, rated AMR the top choice among four private ambulance contractors that submitted proposals earlier this year.
The Commission’s Public Safety Committee approved the contract last week, and the full commission is expected to vote to approve the contract at its regular meeting on Tuesday.
District 6 Commissioner Ted Terry said he’s encouraged by the fact the county has challenged AMR to improve response times.
“Obviously, we have the right to sort of check back in as things are going on, but this new contract seems a huge improvement in terms of what we are asking for and what we expect to get out of it for DeKalb County taxpayers,” Terry said during a recent Public Safety Committee meeting.
AMR declined an interview request for this story. The company, which operates ambulance services across the United States, has been DeKalb’s ambulance provider since 2013. Local residents and leaders have complained of the company’s lagging response times for nearly as long.
In 2018, Dunwoody asked the state to withdraw from the ambulance service agreement in DeKalb after residents reported waiting for ambulances for more than 30 minutes during emergencies.
That November, the county agreed to dedicate additional ambulance resources in Dunwoody, but the city had to pay a $566,000 subsidy for the enhanced service.
That same year, AMR reached a settlement with the county to pay nearly $600,000 as a penalty. As part of the overall $1.9 million settlement, the company agreed to make service improvements valued at $1.3 million.
DeKalb signed a new five-year contract with AMR in 2019. The new agreement added more oversight and more specific penalty provisions if the company failed to meet performance standards.
Still, problems persisted.
Fullum told the AJC those years saw dramatic changes in the health care system that contributed to the ambulance delays. The challenges included residual problems from the COVID-19 pandemic, hospital closures in DeKalb and staffing issues across the health care industry that put pressure on ambulance services.
Fullum said despite the struggles, AMR has been a good partner with the county.
“Throughout this process, the one thing that I can say is that AMR has stayed at the table and has worked with us to improve this system,” Fullum said. “Through that process, that gave me the belief that they were capable of being within the proposal process.”
AMR’s travel time in 2023 was 23 minutes or less in 90% of serious calls, according to DeKalb’s consultant, Fitch & Associates. That didn’t come close to the standard set by the Commission on Fire Accreditation International, which recommends ambulance travel time should be approximately 5 minutes or less in 90% of calls, according to the Fitch study.
During the same period, DeKalb County Fire Rescue’s travel time to medical emergencies was 9.1 minutes or less in 90% of calls, according to Fitch’s study. The county’s goal for response times is less than 11 minutes for the most serious calls and less than 15 minutes for calls that require rapid intervention, such as continuous seizures and falls that result in injuries.
Lynn Deutsch has been Dunwoody’s mayor since 2020 and has had a seat in the city’s government for more than a decade. She said the county’s size, heavy traffic and lack of defined ambulance service zones can make it challenging to respond to emergencies.
“We have a system in which if there’s no ambulance nearby, the nearest ambulance could be 45 minutes away,” Deutsch said. “We shouldn’t have to face a call coming from across the county at rush hour. They’re just not going to get here.”
In February 2024, the county invested $3.8 million into DeKalb County Fire Rescue’s ambulance program to bolster service throughout the county. At the same time, it extended its contract with AMR through June 2026 and added a $4.89 million subsidy to increase the number of AMR ambulances in service.
The county reported in June that those efforts had helped slash response times by nearly 3 minutes.
District 7 Commissioner LeDena Bolton, who chairs the Public Safety Committee, said she was initially skeptical of renewing AMR’s contract last year, but eventually voted for it. She said she’s been pleased by the progress the company has made with additional subsidy from the county.
“When I look at the reduction in the response times — since that time, even — there’s been a significant drop,” she told the AJC. “If we could consistently receive service at this lower response time, I think that the county will benefit greatly from it.”
During a recent Public Safety Committee meeting, Commissioner Robert Patrick, whose District 1 includes Dunwoody, said he’s been contacted countless times by city leaders and residents, urging DeKalb to improve the ambulance service.
He told the AJC he sees encouraging signals.
“The administration under our CEO, as well as Chief Fullum and the rest of the staff, are focused on improving,” he said. “That’s my expectation and, right now, they’re meeting it.”
Some city officials in DeKalb are watching closely to make sure response times don’t slip as the county gets ready to sign another contract with AMR.
“We’re continuing to monitor the DeKalb County response times,” city of Brookhaven spokesman Burt Brennan said. “We are getting reports quarterly from DeKalb County Fire Rescue .”
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