911 calls can bring a slow response

David Kihara

Wednesday, Feb. 1, 2006 | 7:27 a.m.

Two private ambulance services that respond to 911 calls in the Las Vegas Valley are late about one out of every seven times, Clark County records show.

From December 2003 through November 2005, American Medical Response met national response time standards -- under 9 minutes for life-threatening emergencies, under 13 minutes for less urgent calls -- 82 percent of the time.

During the same period, MedicWest made a timely response on 85 percent of its calls, according to the records.

However, because of the way in which response times are calculated under the ambulance firms' contracts with the county, the companies were credited with arriving at the scene of an emergency within the target time on more than 90 percent of their runs.

The companies receive exemptions for late arrivals affected by factors beyond their control, such as tie-ups while dropping off patients at hospital emergency rooms that slow responses on the next runs.

Even with those exemptions, the two ambulance companies paid more than $677,000 in fines to Clark County, Las Vegas and North Las Vegas for late arrivals.

"It's a problem with the entire system," said Jim Spinello, assistant manager for the Clark County office of administration.

While Spinello understands that many delays can be blamed on overcrowded hospitals, he said most people involved in a medical emergency simply want the comfort of being able to count on an ambulance arriving on time -- not excuses for why that did not occur.

"We were not satisfied with the performance of emergency medical services," Spinello said. "The concern is that there are people waiting for ambulance service and waiting longer than they should."

Under the county contracts, AMR and MedicWest must arrive at the scene of a 911 call within 8 minutes, 59 seconds for a life-threatening emergency or 12 minutes, 59 seconds for a less urgent call.

The ambulance services are required to meet those national targets 90 percent of the time.

From December 2003 to November 2005, AMR responded to 192,172 emergency dispatch calls and was late 34,262 times, according to the county. Of those late arrivals, the company received 22,899 "exemptions," meaning that the potential fine was forgiven in those instances.

During that same two-year period, MedicWest responded to 107,416 emergency dispatch calls and arrived late 15,911 times, 12,151 of which were excused through exemptions, county officials said.

For AMR, those late arrivals resulted in fines -- assessed at the rate of $11.57 per minute beyond the national standards -- totaling $525,071.97, penalties paid to the county and Las Vegas. MedicWest's penalties to the county and North Las Vegas totaled $152,703.83, according to the county.

A small portion of the fines came from penalties for ambulance crews not reporting to dispatchers when they arrived on the scene of a 911 call.

"We did meet the franchise requirement," said Lee Haney of Rogich Communications Group, the company that represents AMR. "There are obviously strict fines, but I don't think they're higher than expected."

Last fall that fine structure was reorganized. Companies now pay a slightly higher per-minute fee -- $12 -- for being late.

Ambulance company executives say they are particularly troubled by late arrivals due to delays during hospital drop-offs, even though such cases are exempted and do not produce fines for the firms.

"We have a crisis in Las Vegas that is worse than anywhere else in the country," said Brian Rogers, MedicWest's vice president of operations. The lack of bed space at local hospitals, he added, causes persistent delays for ambulance companies.

"We're not turning our cheek to this, but these are truly reasons that are out of our control," Haney said.

When ambulances are tied up at hospitals, it affects response times for new 911 calls not only by slowing vehicles' ability to roll on the fresh emergencies, but also by sometimes forcing companies to dispatch ambulances from more distant locations.

"Do the hospitals have a role in this? Absolutely" said Dr. Dale Carrison, director of emergency services at University Medical Center.

"Would there be delays if all patients were dropped off within 30 minutes? Probably. Sometimes the EMS system is simply overwhelmed."

David Kihara can be reached at 259-2330 or at davidk@lasvegassun.com.