2013-08-30 "Shooting and Stabbing Response System 'Broken' in Alameda County County plans to make changes to emergency response system after Investigative Unit exposes system failures"
by Tony Kovaleski, Liz Wagner and Mark Villarreal from "NBC" [http://www.nbcbayarea.com/investigations/Shooting-and-Stabbing-Response-System-Broken-in-Alameda-County-221401961.html]:
Alameda County is changing the way dispatchers prioritize 911 calls after the NBC Bay Area Investigative Unit discovered a potentially dangerous flaw in the current emergency medical response system.
Veteran paramedics and data reviews by the Investigative Unit have exposed that emergency calls for shootings, stabbings and penetrating traumas are often given a lower priority status than calls for patients who are vomiting, intoxicated or simply feeling clammy.
“I just don’t see how someone who is vomiting is in more dire straits than someone who is shot,” said an experienced paramedic who wishes to remain anonymous for fear of being fired. “I am afraid for anyone who needs help in the 911 system.”
In November 2011 Alameda County hired new paramedic company Paramedics Plus and changed its entire emergency response protocol from a first come, first served system where paramedics respond to whoever calls first, to the widely-used Medical Priority Dispatch System (MPDS) where calls are prioritized based on severity.
The triage process determines the level of a call from the least serious, lowest priority “Alpha” call through the most serious, highest priority “Echo” call. Each county that uses MPDS assigns its own response priorities to the triage results, but paramedics on the front lines say the prioritization system hasn’t been applied properly in Alameda County.
“Shootings are considered a very low priority,” said another veteran emergency responder who also wishes to remain anonymous for fear of retaliation. “What it says to me is we prioritize wrong.”
On December, 30, 2011—less than two months after the county’s emergency response transition—5-year-old Gabriel Martinez Jr. was struck by a stray bullet when someone opened fire on his father’s taco truck at 55th Avenue and International Boulevard. He died in his father’s hands.
“Right over there,” said Gabriel Martinez Sr. as he fought back tears and motioned toward a gate that is now covered by a large poster of his son’s face.
When Martinez called 911, dispatchers followed protocol and categorized the shooting as a low priority “Bravo” level call. According to Alameda County records, the ambulance responded in 4 minutes and 8 seconds—well within the 15-minute response time requirement. However, because it was deemed a “Bravo” call it meant the ambulance could have been diverted to so-called higher priority calls. Paramedics say the potential for diversion in low priority shooting calls like Martinez’s is precisely what’s wrong with the current emergency response system.
“It’s very well broken,” said the first veteran paramedic.
Martinez said the county made a mistake by categorizing his son’s fatal shooting as a low priority call. When asked whether he thought it was a mistake to code the 5-year-old’s shooting as a “Bravo” call the manager of the county’s emergency response system, Joshua English, said that he “didn’t listen to those tapes.”
When pressed about why the response wasn’t the highest priority call in the system English said that he doesn’t “like to second guess our paramedics and our EMTs and our dispatchers. They do a very hard job.”
NBC Bay Area’s research has found other recent high profile shootings in Oakland have also received low priority “Bravo” responses including the death of 34-year-old Santa Clara County paramedic Quinn Boyer, who was shot in the head in April when someone pulled up alongside him at Keller Avenue and Hansom Drive, and the death of 8-year-old Alaysha Carradine who was shot at a sleepover in July at a friend’s apartment in East Oakland. Although response times for both shootings were within the required time limits, both shootings had the potential for dispatchers to divert paramedics to other calls.
In April the Investigative Unit watched paramedics respond to an Oakland BART station for an intoxicated individual. The call offers a significant contrast to the emergency responses to the high profile shootings. According to system protocol, the call to assist a drunk was a “Charlie” category call—a higher priority than the three fatal shootings.
“The system is not being run correctly,” said Mike Dutra, another veteran paramedic in Alameda County.
Dutra and the other two emergency responders describe instances when they have been diverted from shooting and stabbing emergencies to calls for patients who were drunk, vomiting or dizzy.
According to county records, “Bravo” level shooting, stabbing and penetrating trauma calls were diverted 109 times since the start of the contract in November 2011, which equals more than one diversion a week.
“Any report of a shooting, if I was making policy,” said Dutra, “would at least come in as a Delta, if not an Echo.”
“Delta” and “Echo” emergencies receive the highest priorities and the shortest response times to metro areas at 10 minutes and 30 seconds, and 8 minutes and 30 seconds, respectively.
The Investigative Unit analyzed the first 15 months of emergency calls under the new dispatch system and found that 87 percent of all shootings, stabbings and penetrating traumas in Alameda County were classified as “Bravo” responses and therefore calls that can be diverted for higher priority emergencies. The same records show that 100 percent of the time, calls from people claiming to be clammy, received higher priority “Delta” level responses.
When confronted with these results, English said Alameda County plans to make changes to the dispatch system and that shootings and stabbings would “absolutely” become more of a priority.
“I don’t think anybody is going to have a problem with us increasing the priority level of penetrating trauma patients,” English said. “We want to make sure that when we respond to these that we are going to give them a higher priority. Say, a [“Bravo”] priority, so that the only thing that might trump that is somebody who is in cardiac arrest or respiratory arrest.”
The Investigative Unit also found that there may be problems with the number of ambulances on the street of Alameda County. Paramedics say there aren’t enough to meet the demands of the county.
Although managers in the county say response time compliance is greater than 90 percent, paramedics point to system-wide alerts that warn crews the county is operating under a level zero alert.
“That is when there are no ambulances to run a call in a certain area,” English said.
The Investigative Unit obtained photos of pagers that displayed level zero alerts, including one that stated calls were holding for 20 minutes. Paramedics say level zero alerts happen too often; sometimes multiple times a day.
English said it is not a new problem, but when asked how often the system operates under level zero alerts, English said he doesn’t know because the county doesn’t keep track.
The county does keep track of the amount of fines and penalties Paramedics Plus has paid for failing to meet contract requirements, including response time overages. According to county records, the company has paid more than $5 million since the start of its contract in November 2011.
The company’s Chief Operating Officer in California, Dale Feldhauser, admits Paramedics Plus has lost money since taking over the Alameda County contract but said the company is working to improve.
“We get better,” Feldhauser said. “We work to get better. That’s how it works.”
Emergency responders say they hope their voices will motivate the county and the paramedic company to constantly evaluate its processes and change what’s not working.
“It is for the greater good of citizens of Alameda County,” said the first veteran paramedic. “It could be me. It could be you. It could be anyone in the future. No one knows when they’re going to need an ambulance, or when they’re going to be tragically injured, sick in one kind of way. So I would hope that when all this is said and done the services may have turned around, and turned around for the better.”