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Buffalo Ambulance Shows Up 40 Minutes Late

They Were Busy Elsewhere

THE BUFFALO, NEW YORK, CITY COUNCIL is learning what "preserving limited resources" means when it comes to contracted ambulance service.   Last year the City Council contracted with Rural/Metro to operate the city's emergency ambulance service and two weeks ago Rural/Metro released a statement touting their success operating in the city:

Rural/Metro successfully transitioned assignment of ambulance responsibilities from Erie County leading to improved dispatch and quicker response to calls requiring Advanced Life Support services.

"Rural/Metro continually adjusts our ambulance deployment plan to ensure excellent response times and we have highly trained professionals ready to respond every day, every time of the day," Jay Smith, Division General Manager of Rural/Metro Medical Services of Buffalo said in a news release. "Working with the ambulance board, we adjusted the system to optimize response times, which has shown very positive results in patient outcomes.

"Our success in serving Buffalo is a direct result of our excellent working relationship with the Board, the Fire Department and our talented, dedicated employees who are focused on providing clinical excellence to all our customers."

Buffalo News

Friday afternoon a 9-1-1 call came from the Erie County library in downtown Buffalo just before 1 pm for a patron having seizures.  WGRZ-TV describes what happened next:

In Buffalo, the fire department also responds to medical emergencies. Firefighters arrived at the library within three minutes at 12:58pm. They treated the patient.  The ambulance did not come until 1:43pm, or a full 48 minutes after the call.

While firefighters are able to provide medical treatment, their training is often limited. Also, they're not allowed to take a patient to the hospital.

"Eight minutes is the time they're supposed to respond," Buffalo Common Council Member David Franczyk said. "And, anything more than eight minutes is a problem. If you add 40 to that eight, it's a disaster."

Rural/Metro says that at the time of the call it was responding to 10 other emergencies in the city. Also, the dispatch office determined the emergency at the library was not life-threatening, meaning, it did not need to send an emergency crew immediately unless the situation changed.

"If this is a one-time only, it's a dangerous one-time only," Franczyk said. "They should do everything in their power to make sure that never happens again. And if there is a pattern of it, that's scary."

Rural/Metro says its average response time for emergencies in Buffalo is seven minutes, but acknowledges it has had other "extended calls" like the one on Friday.

The Buffalo City Council seems to be surprised at this.

Firegeezer is puzzled, too.  If the city needs help at a fire, then they call a neighboring town to send help.  So if they need help at a medical emergency, then why don't they call a neighboring town for that as well?   Did nobody think of that?

Read the entire story posted by WGRZ-TV HERE.

Last month the Buffalo News reported HERE on an FBI investigation into Rural/Metro Western New York's billing practices.

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Comments - Add Yours

  • Jeff

    Jeff left this Comment:

    Firegeezer-I can’t speak for the city of Buffalo, but I can speak for the area of St. Louis in regards to your edit on why a neighboring city did not send a mutual aid ambulance to the call after the extended time to arrival. Several municipalities in the St. Louis area contract out to private companies for ambulance response and transportation, and do not have their own fire department ambulances. This is viewed as their choice, and neighboring municipalities will not give mutual aid since they do not have a contract with the private company and there for will not be receiving mutual aid in return for ambulance calls. There are exceptions; the main ones being for extreme life threat calls (cardiac arrest with CPR in progress) or multiple casualty incidents.Several municipalities are looking for cost cutting measures, and this is one of the areas of concern for several fire departments that have their own ambulances. The argument of not receiving mutual aid, mostly due to the private company “promising” in contract that they will not run out of ambulances or keep in a certain response time, is what is being argued by several departments. As we have just seen in Buffalo, it is entirely possible for a private company to run out of ambulances and get themselves in trouble.

  • BH

    Firegeezer is puzzled, too.  If the city needs help at a fire,
    then they call a neighboring town to send help.  So if they need help at
    a medical emergency, then why don’t they call a neighboring town for
    that as well?   Did nobody think of that?

    Why doesn’t Detroit?  Why doesn’t Chicago?  Why doesn’t DC?

    Or do they get a pass because they’re fire-based?

    • Angela Osmun

      i can explain for detroit – no fire, EMS, or police make runs to area’s of detroit anymore, the reason; because citizens attack us (i’m an EMT).  no offense, but people need to stop thinking that EMS and fire and these limitless entities – most patients avoid paying until the company comes after them, and on some calls, we even get attacked, which is unacceptable.  if you’re calling an ambulance to help you, i’m sorry, but the rule is that if it’s no safe for the EMT to enter, they don’t have to until police assistance arrives or until it’s deemed safe.  for area’s of detroit, there’s no way to ensure our safety, so we’ve stopped responding.  end of story.  i wouldn’t have it any other way.  

  • Firemanemtdeputy_from_tn

    why would a seizure not be considered a life threatening situation?

    • http://www.facebook.com/people/Roger-Look/100000462697547 Roger Look

      all seizures are not life threatening, but you would not know till you got to the person to see what was going on.

      • http://www.facebook.com/profile.php?id=1210196026 Nick Carey

        Correct, it’s the underlying cause of the seizure that is potentially life threatening. This is why an actively seizing patient is critical until proven otherwise.

        • Medic 5

          http://www.naemd.org/articles/whatis.html

          It really depends on how the unit is dispatched. Take a look at the ProQA system developed by emergency medicine physicians. This system is used in several cities across the nation. The unit is prioritized based on a set of questions developed by ER docs. The system has held up in court as well. Why would you respond to a cough in the same fashion you would a full arrest. Driving emergency traffic is dangerous, why put yourself at risk like that?

  • Joe

    Unacceptable, its just screaming lawsuits..

  • Ben P.

    Problem is EMS involves money. Fire departments get a minimal amount of money per fire, and usually mutual aid is not paid… This is known, and accepted. However EMS is treated differently. If you don’t pay us, we don’t show up. Also there is the mentality of a 2 year old in the management. “MINE” or “That’s my territory” is the mentality of EMS management. EMS business is about the $$$ not saving lives. Being an EMT or Paramedic is about saving lives, unfortunately we work for people who only see the money. 

  • Vertigo91

    Simple– the Rural/Metro is a private service. Money is their motivation. Mutual aiding a neighboring service means losing money on a patient. A stable patient pays just like an urgent or emergent. Their frame of mind is probably just like most other private services, “its their emergency, not mine.”

    • Nick

      You hit the nail on the head. As a former RM employee, that’s exactly how it is.

  • http://www.facebook.com/people/Darius-Sharpe/818355440 Darius Sharpe

    It doesn’t matter whether or not it is a private company or a fire department doing ambulance transport in the area.  If there are 10 ambulances and 10 calls go out at once, the system is now at 0.  Mutual aid policies are made between the local EMS agencies (the government bodies), the county board of supervisors and the surrounding counties to deal with that situation.  The transporting companies can make suggestions, but don’t have ultimate say.  This is a problem at the local government level, there should have been an appropriate mutual aid policy in place.  The council member seems to want to blame the ambulance company instead of himself and the board he’s on for not having a good policy in place for when the system get strained.

  • Danmed32

    First of all no one can make any legit comments/concerns on this article because simply all the facts are not here. Being a paramedic in the neighboring city and knows how’s this company operates the facts are just not there. And in all reality seizures are not life threatening. Seizure patients rarely ever go to the hospital maybe and really emphasizing maybe 1 out 10 go. These patients are all educated along with the family and it’s the “public” view seeing one have a seizure that’s scares them ( medic personnel like to call this a case of the cell phone hero’s). They all have a protocol per say from a primary dr. Why waste another hospital bed for no reason, because we all know there is always enough ER beds in city hospital and I do believe Buffalo has Approx. 7-10 hospitals and still are all ran (but that’s another bitch no one ever looks at fixing either).

  • http://www.facebook.com/profile.php?id=1210196026 Nick Carey

    Because Rural Metro is a for profit service, so unless there is a mutual aid contract with another agency they can’t call for mutual aid. If there was a mutual aid contract it wouldn’t shock me to learn that it would take some sort of operations manager approval. This is what happens when a municipality cuts corners and contracts a service out to a for profit agency. The for profit agency is responsible to their bottom line and share holders of their parent company. Bill, bill, bill! While I’m confident that is not the motive of the (most likely) over worked and underpaid Medics and EMT’s who are the back bone of for profit services, it is still the motive of the organization. For profit agencies should not be permitted to be the primary 911 response for an entire area, they serve the bottom line not the community. Local governments need to get their heads out of their butts and stop letting the fire service scare them into an over inflated budget with little service in return. If firefighters want to be Medics and EMT’s , Great!! then buy them an ambo and let them do the transport too! What’s that?! you don’t want to transport? Then stop letting your unions trick people into thinking that you are providing a service to the tax payers with “first response” just so you can keep your jobs. Could you imagine the S*&T STORM that would ensue if a city said “we’re contracting the police service out to Blackwater” or “we decided to contract the fire service to Joe’s hose and sprinkler supply”?

  • Nick

    This is in response to your last question. We have Rural/Metro in Knoxville, TN and surrounding counties. It’s typical for them to be overextended and be very late to calls which is why they don’t have a very good relationship with the city FD. They don’t call for mutual aid purposely. Rural/Metro always provides it’s own dispatch apart from the 911 call center. If they decide to call for any mutual aid, they will only call another county with RM which can take easily 30min. At least here, dispatch is not allowed and would never call another EMS service (county or private). Bad patient care you say? Ya, we know, but I don’t wear a white shirt and make the decisions.

  • DigitalMedic

    I hear what many of you are saying aout private service. I have had my own experiences with RMA. Some positive, mostly negative. I have however had the experience with a private company that encouraged patient advocacy. It’s about leadership versus the bottom line. I have watched RMA bottom line themelves out of many a town.

  • TheReaper

    See people dont understand…… As much as I am not a fan of RMA, as a former employee…. People think ambulances just fall off trees and just show up no matter how many calls their are. I have worked for many different services and now own one of my own. It’s a typical response by the council member not to make himself look bad and blame others, because they cant provide a mutual aid, either because they have no policy in place, or do not have the funds to provide it. People don’t get it. Especially for New York. Ten calls can go out in a matter of 3 minutes and if you have ten trucks, you don’t have anything left to send out. Maybe a bigger subsidy, and looking at EMS as a needed service and actually funding enough to be adequate would help. Instead of looking at EMS as, ehhh… do we really want to put money into something we might need to use. And then only put money in when something bad arises. It’s just like having health insurance… you can not buy it, and take a risk and save money…. but when you get magled up in a car accident…. you’re screwed. So to the Council man… Maybe instead of saying they should do everything in their power to make sure it doesn’t happen again; Maybe you need to think about your funding to how much you pay to them to provide service, and provide more if they can’t handle it. We are business, we are here to make money. That’s how we keep on providing service. We have a hard enough time getting paid as it is. You can’t continuosly run an ambulance service in the red and expect them to still be there……… Just my two cents..

  • Medic 5

    There are a couple of issues here. 

    1) Priority Dispatching– The seizure was deemed a low priority so the ambulance was dispatched as such. This makes sense in the world of sensless 911 calls. If a toe pain call came in right before a pedi-code wouldn’t you want the resources diverted from the toe pain to go to the pedi-code? Same principle here. We have 10 911 calls at the same time the resources are limited so we prioritize the calls. We triage emergency room patients why not emergency calls? Several cities use this model of dispatching (proQA).  Next, as we all are taught in EVOC or CEVO driving with lights and sirens increases our probability of getting into an accident. It only makes sense to not drive code on your way to a non-life threatening emergency. In a downtown location at lunch time driving with the flow of traffic I could see 48 minutes being a possibility.

    2) Private Ambulance Services –What we don’t know is how many other units were taking transfers or private ambulance calls at this time. Having worked for services similar to rural metro I’ve learned that the 911 contract is only a small portion of the revenue portfolio. More money is made in the private transfer side of the ambulance business where payment is arranged before transportation. If rural metro has 15 units five are on private transfers and 10 are fielding 911 calls it sheds some light on contributing factors in this situation. First, Rural Metro is not managing its resources well…this is kind of obvious. Second, this sheds some light on to why there is no mutual aid. If I were a surrounding municipality why would I send one of my units to cover RM service district when they are sending units on transfers. I would never agree to send my units to a service district that could not make the calls because of bad management.

    3) We need to understand averages — Rural Metro here states that they have a seven minute AVERAGE response time. Averages are deceptive. As responders lets look at averages for a second. We have all got the call and realized that the address was literally from the pay phone across the station with a response time of 2 minutes ( really whatever it takes to oped the bay door and pull out the unit) Now our next call lets say it was another seizure at the library and it took us 48 minutes to get there… well our AVERAGE response time is only 25 minutes for those two calls. We get a few more quick calls and we’ll be back down around where we need to be.