Beach ambulance service in question

VIRGINIA BEACH -- On a rainy day in December 1951, a woman struck by a car lay in the middle of Atlantic Avenue and 24th Street with a broken leg and a fractured skull.

 J. Peter Holland III, a local lawyer with no experience in first aid, rushed to help.

 ``I didn't want to move her. She was badly hurt,'' said Holland, now 78 and retired.

 He had someone call for help, but the fire department's ambulance was broken down. Holland then called Fort Story, but was refused help because the victim wasn't in the service.

 Holland persisted for about 45 minutes, climbing the chain of command until Fort Story sent an ambulance to take the woman to the hospital, three blocks away.

 That incident spawned the Virginia Beach Rescue Squad, the largest and richest of the city's 11 all-volunteer ambulance squads.

 But critics claim that the volunteer service is having trouble coping with the problems it was designed to fix.

 Patients have waited 45 minutes for an ambulance, paramedics sometimes lack equipment to perform life-saving procedures, and firefighters trained as paramedics can't practice their medical skills because of bureaucracy, critics say.

 At election forums, City Council and civic meetings, on radio programs, in news reports, letters to the editor and e-mail chat rooms, a debate rages about the quality of emergency medical care in the resort city.

 Those complaints have led to calls for change.

 Critics say the city has become too large and too urban to rely on an all-volunteer ambulance service.

 Some call for a merger of the fire department and the Department of Emergency Medical Services, creating a system much like Norfolk's, with career firefighters and paramedics. Others say a paid service during the day would fill gaps in areas that lack volunteers, as it does in Suffolk.

 While city officials dismiss these ideas as unnecessary, they have made subtle changes that are improving emergency medical services.

 The fire department, for example, has installed advanced life-support equipment on 16 fire engines, 10 more than were equipped just a month ago. That means firefighters cross-trained as paramedics can provide drugs and use their advanced life-support skills without having to wait for a volunteer ambulance.

 A city committee scheduled to meet for the first time today is studying other improvements.

 Perhaps its biggest challenge is to smooth out hard feelings between rescue squad volunteers and firefighters who have raised concerns about delays in medical service.

 Of the country's 200 largest cities, only Virginia Beach relies on all-volunteer rescue squads. Volunteers number 750, with about 650 of those actually riding in ambulances. The rest perform administrative tasks, training or mechanical work.

 Cities the size of Virginia Beach -- such as Kansas City, Mo.; Long Beach, Calif.; and Albuquerque, N.M. -- moved to paid services long ago.

 Measuring the success of volunteer squads is difficult. Virginia Beach officials say they know of no patients who have been harmed by a delay in ambulance service. And there have been no lawsuits in at least 10 years claiming negligence or malpractice by rescue squads.

 The Virginia Beach EMS department frequently mentions its 97 percent patient satisfaction rating, based on periodic surveys. The department does not survey relatives of patients who die. On the most recent survey, 1 percent of respondents -- about seven people -- were not satisfied.

 The department and the city's medical director oversee all paramedics and emergency medical technicians, or EMTs, making sure they meet state and local training standards. Ambulances also have strict equipment requirements.

 Otherwise, there is no monitoring, except when someone files a complaint with the state.

 No Virginia Beach EMTs or paramedics have been disciplined by the state in recent years, according to Gary Brown, director of the state Office of Emergency Medical Services.

 But one complaint filed with the state is indicative of what critics say are flaws in the volunteer system: poor response times, unprofessional behavior and friction between paid firefighter paramedics and ambulance volunteers.

 In December 1998, a Beach firefighter filed a complaint alleging that volunteers with the Chesapeake Beach Rescue Squad:
 
 

In letters to the Beach EMS department, the firefighter also cited unprofessional conduct by volunteers, including reckless driving, unprofessional comments to patients' family members and a 45-minute ambulance delay for a patient with a broken leg.

 The state EMS office took no disciplinary action, but in May 1999, sent the firefighter a letter stating that an investigation had been conducted and that the matter had been referred to the Virginia Beach EMS department for further review.

 The city EMS department said it revised and clarified some rules, publishing the changes in its monthly newsletter.

 ``Before we open our mouths on the scene, in the unit or at the hospital, we should always consider the patient's perspective,'' said the department's December 1999 newsletter.

 ``One patient was devastated when she overheard a technician making jokes about her medical condition,'' the newsletter said. ``Another patient was aghast that the EMS providers would divulge and discuss confidential patient history with lay people.''



 Critics of the system also complain about response times, usually measured from the time an emergency call comes in until an emergency vehicle arrives on the scene.

 Virginia Beach rescue squads had an 8.6-minute average response time last year.

 It's difficult to gauge how that compares to other rescue services.

 There is no industry standard, although the American Ambulance Association recommends a response time of 8 minutes, 59 seconds. The faster the response, the better chance a critical patient has of survival.

 The state does not collect response-time data, but will start in July. 

Ed Brazle, coordinator of regulations and enforcement for the Beach EMS department, said he's not yet ready to report response times. The city is in the process of replacing the computer systems that maintain those records, and the department does not save records from prior months, Brazle said.

 Norfolk, with its combined firefighter-paramedic service, had a 5.5-minute average EMS response time last year. Chesapeake, also a combined system, had a 6-minute average, and Portsmouth's combined paid system had an average response time of 5 minutes.

 In Suffolk, the average ambulance response time was 3 to 4 minutes downtown and in the suburbs, and 15 to 20 minutes in rural areas. The average firefighter response time was 5 minutes.

 Brazle points out that different cities report response times differently. Some cities report when the first EMT arrives on the scene. The Beach EMS reports when the first ambulance arrives.

 While the Virginia Beach EMS had an 8.6-minute average, firefighters handled nearly half of the city's emergency medical calls last year, arriving, on average, within 5 minutes.

 Previous response-time studies in Virginia Beach have shown the fastest times at the Oceanfront, and in Kempsville, Davis Corner, and Chesapeake Beach areas, with an average response time under 7 minutes.

 The longest waits occurred in Creeds, Blackwater and Knotts Island, where the average response time was 15 minutes. Calls in those areas account for 5 percent of all calls, or less than two a day.

 The EMS department has reduced response times by placing paramedics in ``zone cars'' in the busiest sections of the city. The paramedics respond to calls and begin treatment before an ambulance arrives. Sometimes, zone cars are staffed by volunteers, and sometimes, by paid firefighter-paramedics.

 

 Faced with new issues that some perceive as a threat to their existence, the volunteers have banded together. Advertisements tout the commitment and diversity of services, from EMTs and paramedics to dive, bike and boat teams.

 When the firefighters' union raised issues such as delays in service, the volunteers took it personally.

 ``It's sort of like having a family member who doesn't want to be a member of the family,'' said William Kiley, a volunteer in Rescue Squad 14 and the paid deputy chief of the city EMS department.

 The firefighters' union insists its dispute is with the city and the EMS administration, not the volunteers. Union officials also say they have no desire to take over EMS service in the city.

 ``They're afraid of that, but that's not what we're advocating,'' said Dean DaSilva, union president.

 ``I don't believe that. . . . They don't have a consistent message,'' Kiley said.

 Both sides have hired public relations firms.

 ``It's reached a point where the public believes they're not getting quality emergency medical care, and that's just not true,'' said Dr. Stewart W. Martin, the city's medical director.

 But the firefighters' union has succeeded in some ways. After it mounted its campaign for change, the city formed a committee of firefighters and EMS personnel to work on the issues.

 Starting a paid service is not one of the options on the table, said Oral Lambert, the city's chief operating officer.

 What will be discussed is a request by union leaders to drop the requirement that firefighter-paramedics join a city volunteer squad before they can practice their advanced life-support skills.

 The fire department claims that dropping the requirement would add 37 paramedics to the 27 currently working as firefighter-paramedics -- numbers disputed by the city EMS department.

 Under the rule, firefighters don't have to commit to volunteer hours. The rule is meant only to ensure consistent training, city officials have said.

 But the firefighters' union has support on the issue from some rescue squads.

 The Kempsville Volunteer Rescue Squad bought an ad calling for the city to end the affiliation rule for firefighters.

 Kevin Lipscomb, Kempsville squad president, said the ad was placed ``to correct the mistaken impression that there is a turf battle being waged between the firefighters' union and the volunteer rescue squads.''

 Firefighters also have tried to quell notions of a turf battle.

 ``It looks like we're trying to be pitted against the volunteers,'' said firefighter Tim Riley. ``Our problems are with the bureaucracy.''

 Mayor Meyera E. Oberndorf, a staunch supporter of the volunteers, said she understands that.

 ``Our folks take a great deal of pride in providing emergency medical service, whether it's the firefighters or EMS,'' she said. ``I think that's the bottom line.''