Two city councilors questioned on Thursday whether an authorized increase to EMSA’s allowable response times on life-threatening emergency calls would result in additional work and expense for the Fire Department’s paramedics, who are first responders.
EMSA’s contract with its new ambulance service provider extends the allowable response time by two minutes — from 8 minutes and 59 seconds to 10 minutes and 59 seconds.
“I would argue that you are basically putting an extra burden on our Fire Department,” said Councilor Skip Steele.
EMSA Medical Director Dr. Jeffrey Goodloe told Steele that thatwas not true.
“It is adding up to two minutes that is allowable for an ambulance to be able to respond before that contractor would be subject to a fine by the authority (EMSA),” Goodloe said. “So it does not mean every call is going to take two minutes longer.”
Goodloe and EMSA CEO Steve Williamson told councilors there would be no additional workload for firefighters because they typically leave the scene of a call when EMSA leaves.
“We are not putting more on (the Fire Department); we are not costing (the Fire Department) more,” Williamson said. “We are using fire as the excellent first responders” that they are.
EMSA’s board of trustees awarded a five-year, $247 million contract to American Medical Response last month, lengthening the maximum allowable response times for EMSA ambulances responding to life-threatening emergencies and nonlife-threatening emergencies starting Nov. 1.
The new contract sets the benchmark for life-threatening emergencies, designated Priority 1 calls, at 10 minutes and 59 seconds. The previous maximum time allowable for Priority 1 calls was 8 minutes and 59 seconds.
The new response time must be incorporated into Tulsa ordinances.
Goodloe told councilors that the 8-minute-and-59-second requirement was based on a 30-year-old study from Seattle, Wash., that addressed only cardiac arrest patients.
Cardiac arrests account for less than 1 percent of EMSA’s calls in Tulsa, Goodloe said, and yet “we apply that (standard) to 100 percent of our calls.”
Goodloe told councilors the 10-minute-59-second response time was drawn from a study of best practices compiled by the University of Oklahoma School of Community Medicine at EMSA’s request.
The best practices were incorporated into EMSA’s request for proposals when it solicited for bids for a new ambulance service provider.
Goodloe said the first five minutes after a major medical emergency — such as a stroke or heart attack — is when medical care is most vital and that that care would continue to be provided by Fire Department paramedics.
In addition, Goodloe said, EMSA dispatchers are trained to instruct callers on how to provide emergency care such as CPR.
“The fact of the matter is, it’s not 8:59 that’s the difference-maker whether someone lives or dies. It’s more in the four- to five-minute range,” he said.
Lengthening the response time requirement would decrease the likelihood of traffic accidents involving ambulances without compromising patient care, Goodloe said.
“That’s what these response times are about,” he said. “They are about ensuring that patients continue to get the best care humanly possible, at the same time recognizing that this is an inherently dangerous practice of medicine.”
Steele said he thinks lengthening the response times had less to do with patient care and public safety and more to do with cost, “because it costs more to put more units on the street.”
“You are asking the citizens of Tulsa to accept something of less quality because you are increasing the time standard instead of deceasing it,” he said.
Goodloe disagreed, saying increasing the number of ambulance crews would result in individual paramedics working fewer calls and thus gaining less experience.
“How do you think people become qualified medical practitioners?” Goodloe asked.
Councilor Karen Gilbert said she was concerned about how the longer response times would affect firefighters and questioned whether the Fire Department had been a part of the process for developing EMSA’s new response-time standards.
“This isn’t a surprise,” Williamson said. “When we wrote the RFP (request for proposals), they knew what was in the RFP.”
Michael Baker, the Tulsa Fire Department’s emergency medical services director, has said the 12 additional minutes firefighters could be spending at the scene of a nonlife-threatening medical emergency, a Priority 2 call, are a concern and that a mechanism to evaluate the impact of the change needs to be in place.
Williamson told councilors that EMSA’s change in its mileage rate from $9 to $12 would have no effect on customers covered under the city’s TotalCare program.
Councilors took no vote on either issue Thursday and are scheduled to revisit the issues in September.
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