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Fire alarm: EMS service

Overwork is taking its toll on LIs medical volunteers, forcing some agencies to turn over more work to paid crews

BY ELIZABETH MOORE | STAFF WRITER

November 18, 2005

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The Suffolk County police officer ministering to a stricken Martin O'Brien in his Ridge retirement home in April 2003 was becoming increasingly annoyed, calling every few minutes on his cell phone, asking when an ambulance would be there.

After the Ridge Fire Department failed to answer an alarm from county dispatchers, the call kicked over to Rocky Point, then to Middle Island, records show, but neither department could provide an ambulance. After 37 minutes, Yaphank volunteers arrived at O'Brien's home.

By the time he made it to St. Charles Hospital in Port Jefferson, a stroke had already done serious damage, and the next day he suffered a heart attack.

"The doctors told me, 'If you'd gotten here sooner, we could have done a lot more for you,'" O'Brien, 84, said. Before the stroke, he walked three miles a day; afterward, he was happy just to make it as far as the bathroom.

Ridge, long one of Long Island's slowest ambulance services, finally took steps to deal with the problem this summer, hiring paid ambulance crews to staff the firehouse around the clock. Its average response time has dropped from 14 minutes to about 81/2, which is lower than the county average.

"I apologize for back then, not being able to answer the call," Chief Michael Gianmugnai said. "We're working very hard on it."

While officials say they can still muster volunteers for fires, overwork and burnout are driving Long Island medical volunteers away and forcing a rapidly growing number of agencies to turn their work over to paid crews. And in Suffolk, resident deaths have spurred lawmakers and health officials to push for more coordination and a bigger role for government in protecting the public.

Faster service

Long Islanders today generally receive faster ambulance service by more highly trained crews than when the system was studied by Newsday in 1988 and found to be "outdated and chaotic," plagued by long response times and uneven levels of care.

Though neither county collects dispatch records for all the calls answered, available Suffolk County records show it took an average of 9 minutes and 39 seconds for an ambulance to reach the scene of an emergency call last year, a significant improvement from the 12-minute average Newsday found in 1988. In Nassau, where most calls are answered by paid county police ambulances, records from 52 fire departments show callers waited 7 minutes, 23 seconds for volunteer ambulances last year. Newsday's 1988 analysis did not track volunteers, but found police ambulances took 10 minutes to arrive.

But delays continue to bedevil the system. In Suffolk, where medical duties are shared by 72 fire departments and 26 ambulance companies, residents who suffered cardiac arrest outside of a hospital over the last four years had only a 2.1 percent chance of surviving, health officials found, giving the county one of the nation's poorest records on a measure that experts tie directly to the speed of emergency response.

A Suffolk health department study found that those who dial 911 with medical emergencies are likely to get their first help from county police, who carry oxygen and defibrillators and usually arrive before the ambulance. Those and other discouraging statistics have left the volunteers on the defensive this year, resisting tighter regulations pushed by county lawmakers and health officials.

Nassau emergency medical officials say they do not have the money to study cardiac-arrest survival rates. But volunteers are turning a steadily increasing share of their burden over to county police ambulances, which Newsday found now handle more than half of medical calls.

Police have added at least two ambulances just since last year at the request of beleaguered southern Nassau fire officials. That development has spurred the usually diffident county fire commission, made of volunteer representatives, this year to ask for its first study of the county's emergency medical system, one so decentralized that no agency tallies how many calls for help came in countywide.

"We're starting to do a whole look at delivery," said Peter Williams, the former commission chairman. "The one thing I can tell you from statistics is that calls are going up every year -- they are not going down."

Emergency-work challenges

Fire-safety advances and an aging population have transformed emergency work here, just as they have across the United States. Once, ambulance runs were just a small part of the service fire departments provided, but they began to outnumber fire calls by the early 1970s. Between 1980 and 2000, civilian deaths to fire dropped by 70 percent and building fires by more than half throughout New York, while medical emergencies multiplied. Today, when a Nassau or Suffolk resident calls for help, it's almost three times as likely to be a medical problem as it is a fire call.

But fire departments still typically train many more firefighters than they do emergency medical technicians, records show. And fire alarms still tend to get the quickest, most reliable response, according to a Newsday analysis of more than half a million dispatch records and incident reports from the two counties from 2000 to 2005. Overall, Suffolk volunteers got to fire alarms about a minute faster than medical alarms, while in Nassau the gap was two minutes.

In the Village of Lynbrook, for example, residents waited an average of 8 minutes, 54 seconds for an ambulance last year, while fire emergencies got an engine in an average of 4 minutes, 58 seconds. That may be because of the startling difference in the burden its emergency medical company members carry: Lynbrook's roughly 25 medical company volunteers handled 1,326 calls last year, while the department's remaining 192 members tackled 367 fire alarms.

Calls for help are also much more likely to go unanswered if they are for medical emergencies, according to Suffolk dispatch records.