Delays in Finding Open Facility Frustrate Paramedics, Public

Call 911 and in a few minutes chances are that paramedics will be on the scene to treat the patient and load him into an ambulance.

But often these days, instead of speeding off, the ambulance just sits there, while friends and relatives of the victim grow impatient as frustrated paramedics wait for word on where to transport the victim.

John Wilson, general manager of Crippen Ambulance Service in Covina, said the wait can stretch from five to 20 minutes. And even after an ambulance is on the way to a hospital, he said, it is not uncommon to be rerouted, meaning that family members, and perhaps the family doctor, are going to one hospital while the patient heads for another.

Wilson said such breakdowns in the emergency-care system are “causing a lot of grief.”

Patrick McAlmond, regional manager of Cole-Schaefer Ambulance Service in Pomona, said that in one case paramedics took a patient to three hospitals before finding one that would grant admittance.

“Originally, the patient wasn’t in bad shape,” McAlmond said, but by the end of the ordeal, the condition had turned critical. While such an extreme example is rare, he said, there is no doubt that “the whole system is in a crunch.”

35-Minute Wait

In a more typical case, a county Fire Department paramedic squad in South El Monte responded to an accident on the Pomona Freeway Thursday that involved six victims. The paramedics said they loaded the victims, none of whom were seriously injured, into ambulances and then sat on the freeway for 35 minutes waiting for direction.

Each paramedic unit in the county is assigned to work with a base station hospital, which directs patient treatment by radio or telephone and tells the paramedics where to take their patients. Six hospitals in the San Gabriel Valley have been designated as base stations.

If the nearest emergency room refuses to take the patient, the ambulance must wait while the base hospital searches for an alternative that is no more than 10 minutes away, or in the case of a trauma center, within 20 minutes. If all the facilities contacted are closed, paramedics are instructed to take the patient to the nearest emergency room anyway.

Eileen Rice, pre-hospital care coordinator at Methodist Hospital of Southern California in Arcadia, which is a paramedic base station, said there is no way of knowing in advance when a hospital will be too busy to handle another emergency, and so paramedics must await instructions on each run. “A lot of time,” she said, “the wait seems longer than it is.”

County paramedic Bob Cormack said he was at the scene of an accident about six months ago on the 605 Freeway, near the Pomona Freeway, that involved 12 victims. One of the victims, he said, was showing worrisome symptoms, and “I wanted to get her (to the hospital) as quickly as possible.” But the accident was 100 feet outside the service area of a trauma center, he said, and it took 45 minutes for his base hospital to persuade the trauma center to take the case.

Priority Patients

Cormack said critically ill or injured patients receive priority and there is no delay in getting them to a hospital. He said the delays are occurring for patients who seem to have less serious injuries.

But one of the problems, he said, is that paramedics cannot assess everyone’s condition with certainty. “We have good training and all,” he said, “but we can’t tell if someone is bleeding a lot inside.”

Virginia Price-Hastings, director of the county’s paramedic and trauma hospital program, said she has heard so many reports about paramedics “standing around” at emergency scenes that such complaints “are probably valid.”

Part of the problem, she said, is the sheer volume of emergency calls. Paramedics countywide responded to 425,000 calls last year.

Not only is the volume huge, but the calls tend to come in bunches, with more Thursday through Sunday than Monday through Wednesday, Price-Hastings said. Also, there is always a spurt in January and early February for reasons that are not entirely clear. “Some people attribute it to the flu season,” she said. “Others say people are opening bills after Christmas and having heart attacks.”

Price-Hastings said hospitals are allowed to turn away ambulances with paramedics aboard because paramedics “have the ability to manage the patient.” But hospitals cannot turn away emergency cases in which patients arrive at the hospital under their own power or in an ambulance without paramedics on board.

Cormack, who works on a paramedic squad based in South El Monte, said that because local emergency rooms are closed so frequently, emergency runs that took an hour two years ago are now taking an hour and a half or more.

“Patient care is really getting compromised,” he said. “We do everything we can in the back of an ambulance . . . but there is only so much you can do back there. They’ve got a lot better equipment at the hospital, and they’re a lot more trained than we are.”

In some cities, such as Pasadena, paramedics transport patients to the hospital in city ambulances. In other cities, such as those served by paramedics from the county Fire Department, patients are transported by private ambulance, with paramedics going along to the hospital only when necessary.

Refusing Care

Cormack said that because paramedics often cannot take patients to their preferred hospital, people increasingly are refusing care and saying they will get to the hospital on their own.

One ambulance company executive said he has heard of a case in which paramedics bailed out of an ambulance just before it reached a hospital so that the hospital would have to take the patient. A paramedic who works for a private ambulance company said he once heard a colleague advise a man who had complained of chest pains to have his wife drive him to the nearest emergency room and save himself an ambulance ride to a hospital farther away.

McAlmond of Cole-Schaefer Ambulance Service and Rice of Methodist Hospital scoffed at those stories. “That would be tantamount to abandoning a patient,” Rice said, adding that no paramedic would be foolish enough to risk the legal liability of leaving a patient on his own. McAlmond put it more simply: “If one of my paramedics did that, I’d kill him.”

‘Dial 911’

County Fire Capt. Eugene McCarthy, a paramedic coordinator, said some of the heavy load on paramedic services is coming from people who do not have the money or insurance to pay for care. “When the state cuts funding for health clinics,” McCarthy said, “where do these people go? They dial 911.”

McCarthy estimated that 60% to 70% of the emergency calls that are answered by paramedic units do not require paramedic skills. He said eventually the county may have to adopt a system of having dispatchers decide whether a 911 call requires paramedics or could be handled by lesser-trained emergency medical technicians. He noted that Los Angeles and other cities are beginning to establish such priority systems.

The county Fire Department has 40 paramedic squads, including 10 scattered through the San Gabriel Valley. In addition, eight engine companies have a single paramedic on duty who can assess a patient’s condition and undertake some life-saving procedures until a two-member paramedic squad arrives.

McCarthy said the number of paramedic squads has not increased for at least five years.

The county system is designed to get paramedics to the scene in eight to 10 minutes, but in Claremont, city officials say the response time is often much longer than that, and they are seeking permission to have a private ambulance company provide paramedic service.

Daniel G. Gold, president of Medic-1, said his company has offered to provide paramedics to Claremont without cost, and he believes that he can do so at a profit, charging customers for the service.

But ambulance companies that provide paramedic services to Pomona and El Monte under a similar arrangement say they are losing money on the service.

Joe Dolphin, who owns Medevac Inc. in El Monte, said his company reduced the number of paramedic units on duty at any one time in El Monte from two to one two years ago because revenue was not covering expenses. “It was draining the company,” he said.

Dolphin said the business is unprofitable because so many patients fail to pay their bills. The county pays $3 million a year to ambulance companies to help pay for indigent patients, but Dolphin said the amount is not enough to cover the costs.

In Pomona, McAlmond said Cole-Schaefer loses money on the paramedic service because only 53% of the patients pay their bills. Dolphin said the collection rate is even lower in El Monte.

Fund-Raising Drive

El Monte Fire Chief Leslie E. George said the city cannot afford to establish its own paramedic squad or pay Medevac or the county to provide supplemental service. As an alternative, George has embarked on a fund-raising effort to acquire defibrillators for each of the city’s fire trucks so that firefighters will be equipped to treat cardiac arrests.

The county Fire Department also has begun equipping all of its fire stations with defibrillators.

Capt. McCarthy said that unless the funding problems are resolved so that hospital emergency rooms are open when needed, the strain on paramedic services will continue.

“The paramedic system is just as fragile as the hospital system,” he said. “When they collapse, we collapse.”

‘Love What They Do’

“There isn’t a paramedic that I ever met who doesn’t want to give good service, who doesn’t want to get there as fast as he can,” McCarthy said. “They love what they do. This job means everything to them.” And so, he said, it is particularly frustrating to paramedics when they find themselves out in the field at the scene of emergency waiting for direction.

County paramedic Jeff Kaliher, who is based in South El Monte, said he responded recently to an emergency call from a woman who had abdominal pain. The woman’s boyfriend became irate, Kaliher said, because “we couldn’t go anywhere until we found out what hospital was open. The man was screaming at us, ‘Do something! You guys aren’t doing anything!’ ”

Kaliher said that whenever there is a delay of that sort, “We try to explain (the problem) to them, but they don’t understand.”

24-HOUR HOSPITALS SERVING THE SAN GABRIEL VALLEY

1-- Alhambra Community Hospital

100 S. Raymond Ave.

Alhambra

Emergency room beds 9

Critical care beds 13

2-- Garfield Medical Center

525 N. Garfield Ave.

Monterey Park

Emergency room beds 9

Critical care beds 18

3-- Monterey Park Hospital

900 S. Atlantic Blvd.

Monterey Park

Emergency room beds 5

Critical care beds 4

4-- Huntington Memorial

Hospital

100 Congress St.

Pasadena

Emergency room beds 20

Critical care beds 48

5-- St. Luke Medical Center

2632 E. Washington Blvd.

Pasadena

Emergency room beds 9

Critical care beds 12

6-- San Gabriel Valley Medical

Center

218 S. Santa Anita St.

San Gabriel

Emergency room beds 12

Critical care beds 19

7-- Methodist Hospital of Arcadia

300 W. Huntington Drive

Arcadia

Emergency room beds 16

Critical care beds 28

SOURCE: Figures supplied by hospitals Trauma Centers

8-- Greater El Monte Community

Hospital

1701 Santa Anita Ave.

South El Monte

Emergency room beds 6

Critical care beds 10

9-- Whittier Hospital Medical Center

15151 E. Janine Drive

Whittier

Emergency room beds 10

Critical care beds 11

10-- Presbyterian Intercommunity

Hospital

12401 E. Washington Blvd.

Whittier

Emergency room beds 16

Critical care beds 24

11-- Terrace Plaza Medical Center

14148 Francisquito Ave.

Baldwin Park

Emergency room beds 6

Critical care beds 8

12-- Santa Teresita Hospital

1210 Royal Oaks Drive

Duarte

Emergency room beds 11

Critical care beds 14

13-- Foothill Presbyterian Hospital

250 S. Grand Ave.

Glendora

Emergency room beds 6

Critical care beds 14

14-- Glendora Community Hospital

150 W. Alosta Ave.

Glendora

Emergency room beds 7

Critical care beds 10

15-- Inter-Community Medical

Center

303 N. 3rd Ave.

Covina

Emergency room beds 13

Critical care beds 24

16-- Queen of the Valley Hospital

1115 S. Sunset Ave.

West Covina

Emergency room beds 21

Critical care beds 18

17-- San Dimas Community

Hospital

1350 West Covina Blvd.

San Dimas

Emergency room beds 7

Critical care beds 8

18-- Pomona Valley Community

Hospital

1798 N. Garey Ave.

Pomona

Emergency room beds 26

Critical care beds 38

LAC/USC Medical Center

1200 N. State St.

Los Angeles

Emergency room beds 54

Critical care beds 66

PARAMEDIC SERVICES IN THE SAN GABRIEL VALLEY Community: Alhambra Agency providing paramedics: city Fire Department How patients are transported: city transport Units based in community: 2 Base station providing medical direction: Huntington Memorial Hospital Community: Altadena Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: Huntington Memorial Hospital Community: Arcadia Agency providing paramedics: city Fire Department How patients are transported: city transport Units based in community: 2 Base station providing medical direction: Methodist Hospital of Arcadia Community: Azusa Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: Glendora Community Hospital Community: Baldwin Park Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: Queen of the Valley Hospital Community: Claremont Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: * Base station providing medical direction: Glendora Community Hospital Community: Covina Agency providing paramedics: city Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: Queen of the Valley Hospital Community: Diamond Bar Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: * Base station providing medical direction: Queen of the Valley Hospital Community: Duarte Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: Base station providing medical direction: Community: El Monte Agency providing paramedics: Medevac Emergency Medical Service How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: Methodist Hospital of Arcadia Community: Glendora Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: Glendora Community Hospital Community: Hacienda Heights Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: 0 Base station providing medical direction: Community: Industry Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: Queen of the Valley Hospital Community: Irwindale Agency providing paramedics: county Fire Department How patients are transported: private ambulancec Units based in community: 0 Base station providing medical direction: Community: La Puente Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: 0 Base station providing medical direction: Community: La Verne Agency providing paramedics: city Fire Department How patients are transported: city transport Units based in community: 1 Base station providing medical direction: Pomona Valley Hospital Community: Monrovia Agency providing paramedics: city Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: Methodist Hospital of Arcadia Community: Monterey Park Agency providing paramedics: city Fire Department How patients are transported: city transport Units based in community: 2 Base station providing medical direction: Beverly Hospital Community: Pasadena Agency providing paramedics: city Fire Department How patients are transported: city transport Units based in community: 3 Base station providing medical direction: Huntington Memorial Hospital Community: Pomona Agency providing paramedics: Cole-Schaefer Ambulance Service private ambulance How patients are transported: Units based in community: 2 Base station providing medical direction: Pomona Valley Hospital Community: Rosemead Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: * Base station providing medical direction: Methodist Hospital of Arcadia Community: Rowland Heights Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: Queen of the Valley Hospital Community: San Dimas Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: San Dimas Community Hospital Community: San Gabriel Agency providing paramedics:no paramedics How patients are transported: Units based in community: 0 Base station providing medical direction: Community: San Marino Agency providing paramedics: city Fire Department How patients are transported: city transport Units based in community: 1 Base station providing medical direction: Huntington Memorial Hospital Community: Sierra Madre Agency providing paramedics: no paramedics How patients are transported: Units based in community: 0 Base station providing medical direction: Community: South El Monte Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: Beverly Hospital Community: South Pasadena Agency providing paramedics: city Fire Department How patients are transported: city transport Units based in community: 1 Base station providing medical direction: Huntington Memorial Hospital Community: Temple City Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: Methodist Hospital of Arcadia Community: Walnut Agency providing paramedics: county Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: San Dimas Community Hospital Community: West Covina Agency providing paramedics: city Fire Department How patients are transported: private ambulance Units based in community: 1 Base station providing medical direction: Queen of the Valley Hospital *Assessment units. Assessment units have a single paramedic on duty; paramedic units consist of at least two paramedics.