Report faults pace of EMS response

Philadelphia's city controller - contending Mayor-elect Michael Nutter should be assessing city services before talking tax cuts - yesterday reported dangerously slow response times on emergency-medical calls.

"Most of the departments we look at, we see gaping holes in service," Alan Butkovitz said at a news conference in which he released a performance audit by his office of the Fire Department's Emergency Medical Services Division. "We're in the midst of this tax-cutting craze."

Nutter has pledged to enact tax reforms, including scaling back the business-privilege tax.

In response to the audit, Nutter's spokeswoman, Melanie Johnson, said "the mayor-elect wants to review the controller's report and will have a more detailed comment after he has seen it. In reference to the controller's recommendation to freeze business taxes, the mayor-elect is committed to improving the business climate while at the same time improving on the delivery of city services."

The controller said the assumption behind the "tax-cutting craze" is that city services are up to snuff. But the performance by EMS ambulances is one example of a service that falls woefully short, he said.

National standards call for emergency medical personnel to arrive at an accident scene in 8 minutes, 59 seconds, Butkovitz said. Nearly one-third of EMS ambulance runs in Philadelphia last year took at least 10 minutes, according to the report on his audit, which took more than a year to complete.

He said the Fire Department generally does well at getting a "first responder" fire engine or ladder truck to the scene within the national standard. Firefighters are trained as emergency-medical technicians; they can provide basic medical care, but not transport to a hospital.

The controller said the problem does not lie with the EMS workers themselves, but with their inefficient deployment and the lack of enough ambulance units.

In response, Fire Commissioner Lloyd Ayers said department officials "agree with many of the findings in the audit, but there are many things we do not agree with." He did not elaborate.

"Does the EMS system [in Philadelphia] work? Absolutely, positively yes," Ayers said.

He said paramedics are in short supply across the country.

"Right now," he said, "we are doing the best we can with every resource we have."

Butkovitz, meanwhile, also urged that the 911 system be revamped. Currently, calls for police, fire and emergency-medical assistance go to 911, where operators disperse them. Butkovitz endorsed implementation of a 311 system, to take non-emergency calls off the 911 system.

The reliance on 911 increased about 30 percent from 1999 to 2006, even as the population declined an estimated 70,000 people, he said. Butkovitz attributed the dependence on 911 to an aging population and, possibly, a growth in the number of people without health insurance. Citizens call 911 for rides to the emergency room, he said.

When that happens, "You're jumping into a priority line," he said.

As emergency-medical calls tumble into the system, too few ambulances are available to meet demand, Butkovitz said. The reports states that "in many cases" an ambulance handles more than 8,000 calls a year. The recommended range cited is 2,500 to 3,000 calls a year.

The demand has worn down the EMS workers, resulting in low morale and high turnover, the controller said.

The audit, conducted by Gerald Micciulla of the controller's office, did not have enough information on patients to directly link the slow arrival time to deaths. However, Butkovitz said it was not an unreasonable leap to make, given the delay in responding to urgent calls.