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Newsday runs story on troubling EMS response times

June 5, 2004

Summer was waning, and Bob and Phran Ginsberg were driving to their Suffolk County home after enjoying a dinner with their two teenagers, savoring their company before school resumed and everyone shot off in disparate directions.

Then, in a split-second crash of metal and glass, everything changed. The black Mazda driven by 19-year-old Jonathan Ginsberg skidded on a dark, slick curve in Lloyd Harbor and plowed into a sport utility vehicle. When Mr. and Mrs. Ginsberg came upon the scene in their own car seconds later, they found Jonathan and his sister Bailey, 15, unconscious. Mr. Ginsberg said someone nearby had heard the crash and called 911, but 20 minutes later there was still no sign of an ambulance.

That night in 2002, the Ginsbergs discovered what is often the stark reality of ambulance service in Suffolk County: a patchwork of autonomous and sometimes feuding ambulance companies whose ranks of volunteers are declining, routine failures to record crucial emergency data and waiting times of 30 minutes or more for an ambulance.

State data shows that the average response time of emergency services in Suffolk is slower than in Nassau and Westchester Counties.

”The system is failing,” said Mitchell Savino, a former chairman of the county’s Regional Emergency Medical Services Council, a state-chartered oversight group, which monitors ambulance service”Are people dying? Sure. People are dying because of this. Just listen to your scanner.”

Again and again in interviews, paramedics, police officers, rescue officials and patients’ families voiced feelings similar to Mr. Savino’s, many sharing accounts of a system that imperils people when they are at their most vulnerable.

As New York City prepares to spend millions of dollars to overhaul its 911 system, critics say it is time to re-examine Suffolk’s emergency response network, which relies solely on dozens of independent volunteer companies. The council that monitors the county’s ambulance companies is pushing for major improvements and greater oversight to raise Suffolk’s performance to the level of neighboring Nassau and Westchester Counties.

The county’s Department of Fire, Rescue and Emergency Services says it is trying to recruit more volunteers and to improve its response times, but the department commissioner, David H. Fishler, said responders did an ”excellent job most of the time” and referred to county data showing that a majority of ambulance calls are answered within nine minutes, the ceiling for an acceptable response time set by the county’s Regional Emergency Medical Services Council.

But a report prepared in March 2003 by the council and based on state data found that Suffolk’s average response time was about 12 minutes per call, compared with 8 minutes in Nassau County and 9 in Westchester. County officials say those figures have changed little in the past year. The quality of emergency response data in Suffolk is one of the main impediments to determining accurate response times. In a digital age, county dispatchers still record 911 callers’ information with pencil and paper and walk the forms to other dispatchers who radio local ambulance companies. If an emergency call requires both fire and ambulance services, dispatchers must fill out the same form twice.

Suffolk County was recently awarded a long sought state grant to overhaul and automate its computer dispatch system.

An examination of hundreds of thousands of records for the last two years found that tens of thousands of entries were missing the location of a call, the time an ambulance left the station, or the time it arrived at the scene of an emergency.

Without good data, paramedics and officials with the county’s emergency services council say, Suffolk’s ambulance companies cannot properly analyze their performance and detect weak points in the system.

An examination of the county’s data showed that the county received 110,000 emergency medical calls last year, and in more than 7,000 cases, callers waited 15 minutes or more for an ambulance. In at least 202 cases, the wait stretched on for 40 minutes or longer.

People in remote corners of New York State prepare themselves for waits like these, knowing that the nearest ambulance may be on the other side of the county, said Mark Henry, the medical director of New York State’s Emergency Medical Service program. But in suburbia, few expect help could ever be more than a few minutes away, he said.

”You just expect that you’re going to have service,” Mr. Henry said. ”They don’t think about how fast they’ll get there.”

In emergencies like heart attacks or strokes, seconds can mean the difference between living and dying, experts in emergency medicine say. The brain begins to die four to six minutes after the heart stops, and the chances of surviving a heart attack drop to 10 percent if emergency care does not arrive within 10 minutes.

Suffolk police officers and paramedics can reel off one critical case after another in which more than 10 minutes passed before help arrived. They describe a stroke victim who waited 25 minutes, an unconscious man who waited 15 and an elderly woman with chest pains who waited 22.

A volunteer for Nesconset’s ambulance service, Ed Zimmerman, remembers a call at 2 a.m. when his service was asked to rush five miles to Ronkonkoma to aid an elderly man who was having a heart attack. Dispatchers called Nesconset after ambulance services in several communities closer to Ronkonkoma failed to answer the call.

When Mr. Zimmerman’s ambulance arrived, police officers told him that they had been waiting 45 minutes, and were about to load the victim into a squad car and drive him to the hospital themselves.

Some response delays are caused by Long Island’s notoriously clogged roads and highways, and the sheer physical size of Suffolk County, which covers 912 square miles, but critics say the majority can be traced to dispatch problems and the structure of the ambulance network.

Suffolk’s system is rooted in volunteerism and local control, two principles that long defined early suburban life in New York State. Today, 98 local agencies — some fire departments, some individual ambulance corps — operate the 236 ambulances that respond to 911 calls, said David Brenner, the chairman of Suffolk’s Regional Emergency Medical Services Council.

The county and the council monitor all the agencies, but the ambulance companies are not part of any broader government agency.

Many are nonprofit corporations financed by local taxes. They set their own rules for how many hours a station is occupied, and how soon a dispatcher can radio another ambulance agency for backup if a company fails to respond to a first call. Some companies wait four minutes before putting out a broader call while others wait 10, said Dr. Jeanne Alicandro, the director of the county’s Division of Emergency Medical Services.

Some ambulance corps respond to calls in other districts every day, thanks largely to a mutual-aid dispatch system, but Dr. Alicandro said many companies were still quite territorial. Some go out of their way to avoid crossing into a neighboring district when on a call, emergency officials said. Some companies hire paid responders but do not allow them to take calls from adjoining districts, Mr. Savino said. ”This is almost the norm here, these days,” he said.

Some ambulance services have merged in recent years or hired paramedics to handle calls when few volunteers are available. But most of the services are still part-time, all-volunteer companies that handle a few hundred calls every year.

Next door, in Nassau County, service is more reliable because paid police ambulances answer about three out of every five calls for help, Mr. Brenner said.

Suffolk’s volunteers pride themselves on being able to roll out of bed when their beeper goes off or rush from work to speed a stroke victim to the hospital. Many are second- or third-generation volunteers who trumpet their companies’ lineage.

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