2012-08-18 / News

Analysis: Poor management delays emergency medical help

By Charles Prince

BUCKEYE LAKE – Friday, August 3, was a typical summer afternoon – hot and dry. Suddenly it turned frantic on Dockside Drive in Cranberry Bay.

A neighbor ran to Paul Clark’s house, asking him to call 9-1-1 after she found her brother lying outside her home on concrete. He had apparently fallen off a second-story high ladder. The Licking County 9-1-1 Center received the call at 1:48:54 p.m. (All times are from the Licking County 911 Center call sheet and have been changed from military to civilian time). Forty-four seconds later at 1:49:38, Buckeye Lake Medic 422 was dispatched. Buckeye Lake didn’t respond.

The second dispatch to Buckeye Lake went out at 1:52:53 – three minutes, 15 seconds after the first one. Again there was no response. Clark said he twice heard the Buckeye Lake fire siren, but no emergency vehicle sirens.

So he called 9-1-1 again, this time from his cell phone. His call went to the Fairfield County 9-1-1 Center, but was quickly transferred to Licking County. Clark’s second call isn’t noted on the call sheet. He told the dispatcher that the Reynoldsburg man was having difficulty breathing and help is needed immediately. Clark said the dispatcher told him help was on the way.

Med Flight was dispatched at 1:52:39 with a 15-minute estimated arrival time. Both Med Flight and Air Evac offer air ambulance service in the lake area. Air Evac’s Fairfield County (101) copter is based near Pleasantville. Its Licking County (107) copter is based near St. Louisville. Both Air Evac units were dispatched at 1:53:31 and 1:53:39 respectively with 14 and 10- minute estimated arrival times.

With no response from two tones for Buckeye Lake, the 9-1-1 Center dispatched Hebron Medic 2 at 1:55:59 - seven minutes after the call came in and six minutes, 21 seconds after the first dispatch for Buckeye Lake. Hebron responded 49 seconds later that Medic 2 was en-route. Two paramedics were in Medic 2. Forty-seven seconds later, Hebron reported that the Chief’s SUV was also en-route. Hebron Fire Chief Randy Weekly told The Beacon that they often “chase their medic” on serious calls where additional manpower might be needed. Two paramedics accompanied Weekly to Buckeye Lake.

Hebron Medic 2 was on scene at 2:02:11 - six minutes and 12 seconds after dispatch and 12 minutes, 33 seconds after Buckeye Lake was first dispatched. “It seemed like an eternity,” Clark told The Beacon. “I was surprised, but not surprised, it was Hebron.”

The chief’s vehicle with two additional paramedics arrived 27 seconds later, closely followed by Buckeye Lake Police Chief Ron Small. Weekly, sensing the severity of the accident and aware of the air ambulance dispatches, asked Small to secure a landing zone at the North Shore boat ramp area.

Four Hebron paramedics with Weekly assisting were now treating a very critically injured man. Soon after arrival, Weekly heard another dispatch for Buckeye Lake for a cut finger. He remembers thinking that mutual aid might as well be dispatched right then for that call. That call for a finger cut by a saw on West 1st Street came into the 9-1-1 Center at 2:03:47. Buckeye Lake was dispatched at 2:04:34. Weekly was surprised when Buckeye Lake responded on the radio at 2:06:49. Buckeye Lake arrived on West 1st Street at 2:08:53, a little more than five minutes after the call came in. Buckeye Lake cleared that call in just under seven minutes, reporting “in service” at 2:15:45.

Meanwhile, Hebron Medic 2 left Dockside Drive at 2:12:51 for the North Shore landing zone. A few minutes later, the Buckeye Lake Medic arrived at the North Shore boat ramp. Weekly remembers seeing Asst. Fire Chief Rod Riley, Captain Dave Ruton, parttime EMT-Basic Amber Hicks and EMT- Basic student Missy Miller there. Hicks opened the Hebron Medic’s back door, asking the four paramedics if they needed help. She was told “no,” and the Buckeye Lake Medic moved away to help block traffic.

Air Evac 107 (Licking County) arrived at 2:34:36 after replacing Air Evac 101 (Fairfield County) when it experienced mechanical problems shortly after take-off.

Patients must be stabilized before they can be transported by air ambulance since there is little room for treatment. The man’s condition could not be stabilized so Hebron Medic 2 left the landing zone at 2:47:58 with four paramedics and now a flight nurse treating him. Hebron Medic 2 arrived at Licking Memorial Hospital at 3:01:20 - just over 1 hour and 12 minutes after the first call came in. Air Evac 107 flew to Licking Memorial. After some treatment there, he was transferred via air ambulance to Grant Medical Center in Columbus where he passed away.

Why didn’t Buckeye Lake respond?

Buckeye Lake didn’t respond because no part-time employees had been scheduled until 8 p.m. on August 3. Paid part-time EMT’s and/or paramedics are to staff three shifts daily – 8 a.m. to 8 p.m., 8 p.m. to 8 a.m. and 8 a.m. to 6 p.m. So two EMT’s/paramedics should have been on duty when the call came in. Ohio law requires at least two EMT-Basics to transport a patient. Unfortunately, Assistant Fire Chief Rod Riley, who responds to almost all calls, doesn’t count since he is not an EMT. On August 3, the first paid EMT didn’t arrive until 7:58 p.m. for the overnight shift. The only EMT working a Thursday, August 2 shift left at 7:19 a.m. Friday morning.

Was this a freak occurrence?

ABSOLUTELY, NO! An extensive Beacon analysis of work schedules and time cards for part-time employees for the months of May, June and July demonstrates that it was inevitable that a no crew or short crew (just one EMT available) event would delay help to a critical patient. That delay would be six to eight as the 9-1-1 Center follows dispatch protocol before dispatching mutual aid.

Buckeye Lake Fire Chief Pete Leindecker is paid $450 per month. He seldom goes on runs. His primary responsibility is to schedule the paid part-time EMT’s and paramedics. The Beacon has been told that Leindecker posts a monthly sign-up sheet which is later transferred to a handwritten monthly schedule. Apparently no efforts are made to fill open shifts. For example, there were 13 Saturdays in May, June and July. The same paramedic, Michael Harris, is scheduled to work both the 8 a.m. to 8 p.m. and 8 p.m. to 8 a.m. Saturday shifts. The 8 a.m. to 6 p.m. shift is only scheduled for five of the 13 Saturdays.

In May, a whopping 22.6 percent of all shifts were unscheduled. That dropped to 14.4 percent in June and increased to 17.2 percent in July. Our analysis of time cards shows that a few of these “unscheduled” shifts are ultimately filled if a part-time employee decides to come in. No shows – where an employee is on the schedule but doesn’t show up – compound the problem with unscheduled shifts. The most important number is unfilled shifts – the total of unscheduled shifts that aren’t ultimately filled and “no shows.” That number is frightening for anyone concerned about response time to medical emergencies in Buckeye Lake. The chart on Page 7 graphically depicts the shortfalls.

In May, 20.4 percent of the shifts were unfilled. The numbers were worse in June (25.6 percent) and July (30.1 percent). What happened on Dockside Drive on Friday, August 3, was a mathematical certainty.

The staffing and management issues are actually worse. Using employee time cards, The Beacon tracked what hours were actually filled. We created four standards:

• On-time: No more than a five-minute variance for time present versus the specified shift times;

• Tardy: Arrived late, left early or a combination of no more than 30 minutes;

• Late: Arrived late, left early or a combination of 31-60 minutes;

• Whenever: Arrived late, left early or a combination of more than one hour.

The results demonstrate a complete lack of management oversight or expectation of accountability. Remember, these dismal percentages are when an employee is actually present for a shift. In July, 30.1 percent of the shifts were NOT filled at all. On-time shifts exceeded 50 percent just once in the three-month period at 52.7 percent in May. That mediocre performance fell to 33.3 percent in June and dropped even further to 28 percent in July.

The “whenever” measurement doesn’t fully portray its impact on crew availability and hence response time since it includes all absences of more than 60 minutes. Our analysis found 25 shifts (9.1 percent of the total shifts) in the three-month period where the employee was late or absent more than two hours and 12 shifts where it was more than three hours.

What’s the impact?

If shifts are left unfilled, employees don’t show up or if they arrive late or leave early, response times will be much slower. Buckeye Lake does NOT tell the 9-1-1 Center that it doesn’t have a crew or a short crew (just one EMT or paramedic). According to Kevin Carver, Deputy Director of the Licking County 9-1-1 Center, current dispatching protocol or procedure is an initial tone and then a second tone three minutes later. If the department fails to respond three minutes after the second tone (six minutes after the first tone) then mutual aid is started. He told The Beacon, “If base clears traffic before six minutes then a request goes out to station at the six minute mark to see if they will be able to handle the run If the answer is yes, then we wait till the eight minute mark. If no response at that point mutual aid is started.”

On August 3, no one was working which delayed help for six very long minutes to a very critically injured man. A short crew situation occurs much more frequently and is a given between 8 p.m. and 8 a.m. since only one person is ever scheduled for that time period. The short crew delay can be eight minutes or even longer while the on-duty person either waits at the station to see if a volunteer responds or goes to the scene to assess the patient only to have to ask for mutual aid if they need to go to the hospital.

Next week: More details on Buckeye Lake Village’s broken emergency medical services, what it’s costing residents and what needs to be done to fix it.

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