The first four spreadsheets are the raw, unprocessed data from 2014 to 2017 as received from the Georgia Department of Public Health through a state Open Records Request. Excel spreadsheets 5-8 are the data as processed by our accountant. We are also attaching further documentation, including a copy of the Open Records Request itself.

The type of call we are tracking are those that come in through 911 and are labeled “911 Emergency Response” by the Georgia Department of Public Health (Column C of the Excel spreadsheet, “Type of Service Requested”). All 50,918 calls we tracked have the words “911 Emergency Response” in Column C. Transfers between hospitals do not typically come in through 911 despite what National EMS Chief Operating Officer Benny Atkins recently claimed.

Note that in the raw data Excel spreadsheet, Column A is “Service Name – National EMS,” Column B is “Incident County – Clarke,” and Column C is “Type of Service Requested – 911 Emergency Response.” Again, all 50,918 calls we had analyzed are from Column C and labeled “911 Emergency Response” by the Georgia Department of Public Health. This means that all calls were made from Athens, Georgia and started as 911 emergency calls.

Finally, we would like to emphasize further that averages can be highly deceptive. The National Fire Protection Association 1710 and Commission on Accreditation of Ambulance Standards call for EMS response within 8 minutes and 59 seconds 90 percent of the time, as does National’s contract, with no mention of a required average. We have been asking National for years to provide the time within which it answers 90 percent of its calls and it has steadfastly refused to release those numbers. Now we know why.

Athens for Everyone
July 2, 2018

National EMS consistently fails to meet the required response times. Its contract guarantees that the company will meet the national standard of 8 minutes and 59 seconds on 90 percent of 911 calls. But between 2014 and 2017, National EMS only responded to 39 percent of 911 ambulance calls within 9 minutes and only 48.5 percent within 10 minutes. Between 26,235 and 31,055 calls failed to meet the standard set out in the contract, by their accrediting body, and by the National Fire Protection Association (NFPA) 1710. In 2016 and 2017, National EMS answered 90 percent of its calls within 18 minutes (more than double the 8 minute and 59 second standard; see table below).

We obtained the data through an attorney and an Open Records request through the Georgia Department of Public Health. These numbers have been processed according to standards established by the American Institute of Certified Public Accountants. You can see the raw data and other supporting documents here.

National EMS admittedly and systematically abandons state-mandated 911 coverage zones to run more profitable, non-emergency transports. Sam Rafal, coordinator of our EMS response initiative, asked the owner of National EMS, “Can you assure me that if a member of my family has a time sensitive, life-threatening emergency that the 911 ambulance designated to cover our zone will not have been pulled to run a non-emergency transport?” The answer was an emphatic, “No, I will not.” Additionally, when an emergency occurs, callers have to explain their medical or traumatic emergency twice — once to the Athens-Clarke County dispatcher and again when the call is handed off to National EMS. This is confusing, inefficient and extremely dangerous. National EMS refuses to establish a separate division for running 911 calls, choosing to put profit over public safety.

Recently, District 1 commissioner-elect Patrick Davenport had a situation where his mother collapsed and was in excruciating abdominal 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. According to Commissioner Elect Davenport, “I felt like I had done something wrong when I called 911.” He had not. This is just the system we have in Athens-Clarke County, Georgia.

To address long EMS response times, Athens for Everyone demands the following:

1. That the ambulance service in Athens-Clarke County, Georgia, be a public service run through our fire department. If this public safety service remains under (for-profit) private control, we demand the EMS provider run separate 911 and non-emergency transport divisions.

2. That National EMS immediately stop abandoning 911 coverage zones to run non-emergency transports.

3. That all 911 medical calls be handled through our 911 Athens-Clarke County Dispatch Center.

For further reading, please check out this website or our previous blog post on the topic.

911 Ambulance Response Data for Athens-Clarke County

National EMS 2014-2017

Data Source – Georgia Department of Public Health

Data Reviewed by Turner and Patat, P.C. Certified Public Accountants

Percentage of 911 Ambulance Calls Responded to in Under 9 Minutes

**According to the Commission on Accreditation of Ambulance Services and the National Fire Protection Association, ALS (advanced life support) ambulance response should occur within 8 minutes and 59 seconds 90% of the time.

Percentage of 911 Ambulance Calls Responded to in Under 10 Minutes

**According to the Commission on Accreditation of Ambulance Services and the National Fire Protection Association, ALS (advanced life support) ambulance response should occur within 8 minutes and 59 seconds 90 percent of the time.

Athens for Everyone
June 26, 2018

p.s. Concerned about EMS services in Athens? Let the hospitals know! You can see numbers to call and a script here.

In 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