Dying for a Change
The city’s paramedic shortage puts residents’ lives at risk.
by Mike Newall
The 911 call came into the fire communications dispatch center at 10:21 a.m. on a recent Sunday. It was a code blue: infant cardiac arrest.
The frantic parents, a young Wissinoming couple, said they’d laid their five-month-old daughter in her playpen two hours earlier. She was barely breathing when they went to check on her.
It was a typically hectic morning at the dispatch center, a cramped windowless room in the basement of the fire administration building at Third and Spring Garden.
Emergency calls were flooding in, and the number of ambulances available was dwindling. The ambulance stationed a few blocks from where the baby lay dying was out on a call. So were all other nearby ambulances. The closest available squad was in North Philadelphia, more than 5 miles away from their Lower Northeast home.
Within minutes police officers and a first-responder fire truck arrived on the scene. As the baby’s parents hovered, firefighters unsuccessfully searched the curly haired infant for a pulse. Her brain wasn’t getting oxygen. She was turning blue.
“We immediately began CPR and administered oxygen,” recalls one of the responding firefighters. “We did all we could, but she needed the advanced care of paramedics.”
Firefighters can provide only the most basic medical treatment. Unlike paramedics, they’re not trained in intubation, a medical technique that more effectively restarts a patient’s breathing. Nor do they carry drugs that can chemically kick-start a heart. For a good chance at survival, the American Heart Association recommends paramedics arrive on the scene of a cardiac arrest within four to six minutes.
Ten minutes had passed since the 911 call was received, and paramedics were still five minutes away. Firefighters broke protocol and transported the baby to the ER in a police cruiser. The girl was pronounced dead at the hospital.
“No one knows whether paramedics could’ve saved her,” says Philadelphia paramedic Dave Kearney, who’s also a fire union representative. “But without paramedics, any chance of survival went out the window.”
Fire Department officials refused to comment on the baby’s death. But two dozen paramedics and firemen interviewed for this story say the circumstances surrounding the incident-no available ambulances, a long response time and inadequate patient care-are common occurrences within Philadelphia EMS.
Because of the small number of ambulances dedicated to Philadelphia’s ever increasing medical emergency calls-42 squads during peak hours and only 28 after midnight-paramedics say the city runs out of ambulances on an almost daily basis. (The International Association of Fire Fighters says Philadelphia should have 70 full-time ambulances.)
“We were out of squads or dangerously close to it every day last week,” said a fire dispatcher recently. “Crisis isn’t even the word anymore.”
Every paramedic and firefighter interviewed for this story rattled off recent incidents in which patients waited too long for help, including the retired police officer in cardiac arrest who waited 25 minutes, the middle-aged woman in seizure who waited 15 minutes, and the elderly man in cardiac arrest who waited 13 minutes.
Last year two men in their early 20s-Ricky Badway and Danny Rumph-suffered cardiac arrest and died while waiting 22 minutes and 31 minutes, respectively, for ambulances.
“Philadelphia fails to provide appropriate emergency medical service,” says union representative Kearney. “All too often we don’t get paramedics to the sickest people in the right amount of time.”
Cities with the recommended amount of EMS resources save 40 to 45 percent of cardiac arrest victims. According to Fire Department statistics, Philadelphia saves 4 percent.
Despite these grim realities, the Fire Department recently downgraded four ambulances from advanced life-support service (ALS) to basic life-support service (BLS), which means the squads are no longer staffed by fully trained paramedics, but rather, by EMT firemen with less training.
At last month’s City Council budget hearings fire commissioner Lloyd Ayers defended the downgrades, arguing the BLS squads free paramedics from responding to non-life-threatening calls that routinely tie up ambulances.
“We looked at the data,” said Ayers, “and saw we could reduce these medic units to a basic units and still deliver the same service to citizens.”
Council members weren’t convinced.
“I’m not being assured our constituents are getting the service they need,” said Council President Anna Verna after hearing the commissioner’s testimony.
Verna said she has “severe reservations” that the commissioner’s plan “will save the lives of citizens who need help.”
The mayor’s office didn’t respond to requests for comment.
Indeed, the heavy volume of calls and lack of resources, along with the department’s cursory call-screening process, have led to BLS units routinely being dispatched on serious ALS emergencies. For example, according to department sources, on April 15 the city’s four full-time BLS squads were dispatched on 113 runs, 53 of which were ALS emergencies. Two were cardiac arrests.
And on the afternoon of March 8, a salt-and-pepper-haired father of six from West Philadelphia experienced chest pains at a Center City parking garage. There were no available ALS ambulances nearby, so a BLS unit was dispatched instead.
Unlike paramedics, EMTs aren’t equipped with a heart monitor that would’ve signaled the man was having a heart attack. The patient went into cardiac arrest on the way to the hospital, and died two days later.
“Paramedics have the skills and drugs that could’ve helped this man,” says union representative Kearney. “But sadly, there weren’t any paramedics available.”
Mike Newall (firstname.lastname@example.org) writes the Philly Cuts column, which appears this week on p. 12.