Delayed Emergency Response

Minutes can make the difference between life and death — but does Denver Health know how to tell time?

Although the paramedic division remained part of the hospital, experts agree that the glory days of Denver emergency care are long-gone. In a 2003 USA Today analysis, Denver didn't even rank in the top twenty cities for EMS response. And response times have only gotten worse since then, paramedics say.

By last November, the situation had gotten so bad that paramedics started talking. Worried about fallout on the job, though, many would only talk off the record, and only in the back of dark bar rooms or fast-food joints far from paramedic division headquarters on the Denver Health campus at 777 Bannock Street. A few even refused to give their names, afraid that word would get back to supervisors. They told variations of the same story: Morale is low, turnover is high, ambulances are routinely taken out of service and calls too frequently given to private ambulance companies with which the hospital has established mutual-aid agreements. They described a paramedic division that's understaffed, over-utilized and forced to drive longer distances to respond to emergency calls.

"I do know that people are waiting horrendous amounts of time for their broken legs, broken bones. Twenty minutes, twenty-five," said one paramedic. Another complained about the high attrition rate in the 150-member unit, estimated at between 15 and 30 percent in 2007. "People are going elsewhere because they know where this place is going," he explained. "It's going in the toilet."

Bob Petre wants Denver Health to play by the rules.
Mark manger
Bob Petre wants Denver Health to play by the rules.
Michael Hancock has asked for a review of response times.
Michael Hancock has asked for a review of response times.

These accounts stand in stark contrast to the official figures: According to Denver Health, its paramedic unit has continually performed at or above city standards. Its current contract with the city requires Denver ambulances not to exceed a utilization rate of 0.5 transports an hour while responding at an average of 6 minutes, 10 seconds; of these trips, 85 percent must be below 8 minutes, 59 seconds.

To many rank-and-file medics and dispatchers, it doesn't make sense that the division can continue to meet these criteria every year without adding ambulances or hiring more paramedics — particularly since the number of calls the unit responds to annually has increased 21 percent over the past six years, from 64,511 in 2001 to 78,002 in 2007.

"We're sending a unit from St. Joseph's hospital down to Tamarac and Hampton for an unconscious party, which is inexcusable care," says Bob Petre, a 23-year veteran of the Denver paramedics. "But if you look at our response times, everything's fine."

A few months ago, Petre became president of the Denver paramedics' union, IAFF 3634, with hopes of reviving membership and pushing for serious reform of the city's EMS system. He'd sat on the task force that studied moving the paramedics under the fire department a dozen years ago, and continues to criticize that group's work as biased toward the hospital. In fact, he points out, when the issue came up for a vote before a council committee, Webb took the unusual step of attending. "If there is something I will take to the streets to fight, this is it," Webb had declared.

Then as now, Denver operated under what's known as a "two-tiered system," meaning that fire trucks show up first at Code 10, or life-threatening, scenes and provide basic EMT care until the paramedics arrive. Both responders are managed by separate agencies with their own distinct chains of command, resisting the trend over the past twenty years for major cities to shift to a "fire-based model," in which paramedics are folded into the fire department. New York, Chicago and Los Angeles all use a fire-based model, as do numerous local suburbs covered by the North Metro Fire and Rescue and the South Metro Fire and Rescue authorities, which have employees trained as both firefighters and paramedics. Each municipality establishes its own response time standard.

When gauging the quality of its ambulance service, a municipality compares its response times with those of similar-sized communities. The vast majority of major cities use the benchmark set by the National Fire Protection Agency, an industry group that says Advanced Life Support (ALS) responders should arrive in 8 minutes and 59 seconds or less 90 percent of the time — a more stringent target than the 85 percent called for in the city's contract with Denver Health. That contract is a two-inch-thick operating agreement that Denver Health signs with the Department of Environmental Health, establishing everything from city-sponsored, free pre-natal clinics to the Denver CARES drunk-tank service. Denver City Council must sign off on the agreement every year; the last contract was approved in November 2007.

A 1971 report clocked Denver's ambulance service as responding to scenes within 6 minutes 99 percent of the time. But as demand for the hospital's services increased, the standard was relaxed to 8 minutes or less 90 percent of the time. In a 1990 memo to city officials pleading that more ambulances be added to its fleet of seven, then-paramedic medical director Peter Pons noted that cities with similar population demographics have twice that number of ambulances available on a daily basis. "At present, the Paramedic Division meets this time criterion in only 81-82% of our responses," Pons wrote. "In addition, there are several areas of Denver (Montbello, Green Valley Ranch, and Bear Valley) where our average response is unacceptably long (twice the rest of the city)."

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