Does Every Second Count? For-Profit Ambulance Service Creates Problems


“When every second counts, you can count on Piedmont” reads the Emergency Services page on Piedmont Healthcare’s website. The same page on the website of St. Mary’s Hospital, also in Athens, promises “faster emergency care, by design.” But how can these hospitals make good on their promises when patients don’t make it to their emergency rooms quickly?

Emergency signIn 2009, both Athens-Clarke County hospitals shifted from providing their own ambulance services to contracting with National EMS, a private for-profit company (Ben Emanuel’s 2008 article in Flagpole details some of the discussion at the time). Finding accurate data on response times has been near impossible, and although National’s contract requires it to meet certain standards, the company recently shifted to measuring “patient outcomes,” saying response times don’t matter. What exactly constitutes a “patient outcome” is undefined.

Athens for Everyone members were concerned enough about this issue to add it to our 2018 platform, chosen from a list of options at the annual meeting last month. That plank reads:

Improve ambulance response times to provide better pre-hospital care for residents of Athens. Our private, for profit ambulance provider routinely puts profit above public safety by abandoning emergency response zones and pulling 911 ambulances to run profitable, non-emergency transports. We will demand transparency of 911 medical response time data, require that all 911 medical calls be handled by the ACC 911 Dispatch Center, and insist that National EMS run a priority 911 ambulance service by establishing separate emergency and non-emergency divisions.

Recently, one candidate for a seat on the A-CC Commission had a situation where his mother collapsed and was in excruciating pain. He called 911. He explained his emergency to the dispatcher. He was put on hold while the call was handed off to National EMS, where he had to explain his emergency again. After waiting over 15 minutes for an ambulance response, he loaded his mother into the car as best he could and drove her to the hospital himself.

Ex-St. Mary’s paramedic Bob Gadd (who worked for National EMS) and EMT Sam Rafal have been raising the issue of response times since 2008, when St. Mary’s and what was then Athens Regional changed their policies of providing ambulance service. The state of Georgia does not require counties to have any kind of ambulance service, and the Athens-Clarke County mayor and commission had no say in the original decision. That said, Athens-Clarke County subsidizes National to the tune of $100,000 a year (as do Oconee County, St. Mary’s and the hospital now known as Piedmont Athens Regional).

A Flagpole article from last year points out that:

Although National is overseen by a committee made up of county, UGA and hospital officials, Gadd noted the “complete lack of transparency” in a letter to the Mayor and Commission, because all of the data comes from National itself. He suggested asking the ACC 911 center to compile the raw data itself and taking an anonymous survey of “street-level” police and firefighters.

In a time-critical, life-threatening emergency, seconds count and minutes matter. William Ballard, M.D., an interventional cardiologist with the Piedmont Heart Institute states, “The most important thing to remember about chest pain, particularly if it’s a heart attack, is that time is muscle. In other words, the longer you are deprived of blood flow to your heart, the more permanent the damage can be.” The St. Mary’s Department of Interventional Cardiology writes, “In the event of a heart attack or coronary blockage, saving time means saving lives.”

The medical journal Stroke says the difference between a 7-minute response and a 17-minute response to a stroke is just under 20 million brain neurons, and Taylor Esdale, RN, stroke program manager at Piedmont Atlanta, says, “Time is brain when it comes to treating strokes. The faster we’re able to get stroke patients the care they need, the less brain damage there is.”

Time is even more important when it comes to pediatric medicine. Greg Pereira, director of trauma transport for Children’s Healthcare of Atlanta, says, “We talk about the ‘platinum 30 minutes.’ Every second counts.”

Other counties in our area (even more rural counties that generally provide fewer services than Athens-Clarke does) provide county-operated EMS, including Oglethorpe, Jackson and Barrow counties. Considering all of the evidence about the importance of timeliness in emergency medicine, why is National EMS changing its focus to “patient outcomes”? Why won’t it turn over its data? Why aren’t the mayor and commission advocating more forcefully for transparency on an important public health issue?

Athens for Everyone
April 11, 2018

 

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