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Delayed Emergency Response

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

Even as he pores over sheets showing the hospital's reported ambulance response times growing over the past eleven years, Petre acknowledges that you can't rely on such measurements as the sole indicator of overall performance. For example, ambulances should not respond to a call for a broken wrist with the same urgency as one for a serious car crash. Lights, sirens and high speeds are warranted only in those life-threatening emergencies categorized as Code 10. Even so, he says, it's fair to expect emergency providers to meet the standards set for them.

"Just like doctors and nurses, [paramedics] undergo extensive training in order to provide advanced life support to patients," paramedics division chief Mike Nugent told Westword in 2006. "I think that the public has high expectations for the quality of services they are provided in this city."

But paramedics complain that Nugent has done nothing to meet those expectations since he became chief three years ago. In fact, last November he floated a proposal to reduce the number of certified paramedics that would be assigned to each ambulance. The division has long operated on a "dual paramedic" model, staffing its fourteen ALS ambulances with two highly trained paramedics. In 2006, it added six Basic Life Support ambulances operated by EMTs to handle less critical tasks, such as transfers between hospitals. Basic EMT certification calls for about 200 hours of training, while the base level of training for a working Denver paramedic is approximately 2,000 hours; in Denver, EMTs cannot give shots or provide medication. Now Nugent began advancing a plan that would switch the division to a "split-car" system — with one paramedic and one EMT.

The proposal was very unpopular with the street medics, who insist that having two certified paramedics respond to a scene is integral to maintaining high-quality care. Some paramedics even complained to their city council representatives, who began asking the hospital questions about the proposal. In early December, a Denver Health e-mail announced that Nugent would be resigning, but offered no explanation for his sudden departure. Hospital employees were even more baffled when they received another e-mail on December 13 from Denver Health CEO Gabow, who said that Nugent would stay on as chief paramedic. "We have seen many positive changes and improvements under Mike's leadership and saw his planned departure as a major loss," she wrote.

The day this announcement came out, a photo of a shocked face appeared in the paramedic division's break room, with these words written over it: "What!?! Nugent is staying!!" But Denver Health didn't find it a laughing matter, and longtime paramedics Greg Sawyer and Becky Sproul were ordered to undergo a lengthy handwriting analysis. At an April hearing, hospital administrators said that they'd determined that Sawyer had written the offending sentence.

The two paramedics had already been at odds with Denver Health over a private venture, a business they'd set up that since 2006 has contracted with the Colorado Convention Center to provide on-location EMS coverage during events. Sawyer's attorney, Dave Bruno, says this venture had the blessing of the paramedic division's medical director and that another division employee had confessed to the zombie posting. Still, on April 13, Denver Health informed Sawyer and Sproul that they'd been terminated. Because both Sawyer and Sproul had worked for the division before the hospital moved under Denver Health, they were among the few Denver paramedics still considered city employees — and they've appealed their firings to the Denver Civil Service Commission. A hearing is set for August.

For now, Nugent's split-car proposal has been put on hold, since "that does not seem to be an area that would be an advance in service," says Dr. Chris Colwell, medical director for the Denver paramedics as well as the fire department. "We have the obligation of putting everything on the table all the time to ensure that we're providing the best service."

But recently, EMT-basic ambulances — known around the division as "X-cars" — have been dispatched to scenes once reserved for dual-paramedic vehicles, for such emergency calls as broken legs and chest pains. "Some basic EMT — kids right out of high school, sometimes — is not going to have the savvy or feel for what's going on when they arrive at a scene," says one paramedic. "We can get wildly differing information from patients and bystanders. That's why it takes two sets of equally trained eyes to find out what's going on. There's lots to do and not much time to do it — and sometimes you can be wrong."

"The one call that continues to haunt me," says another paramedic, "was a guy in his late twenties, drug overdose and laying there flat on his back, vomiting into his mouth." When the call came late last year, this paramedic's ambulance was the only one in service and had to drive from south Aurora into Denver. "It took us seventeen minutes to get there," he continues. "I've got to tell you, I don't know if it would have changed anything if we were there in two or three minutes, but if someone would have cleared his airway in two or three minutes, he probably wouldn't have died."


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