PW: Did Philadelphia ambulance response time kill a woman?

In yesterday’s Philadelphia Weekly I shared the story of Vlad Glikman, who blames a failure in Philadelphia’s ambulatory system for the death of his mother.

Jan. 20, 2008: Glikman receives a frantic call from his 81-year-old father telling him that his mother, Adalina, is unconscious in their Somerton apartment in the Northeast. His father says a private ambulance company, Century, is on the way. Twenty minutes later, Glikman arrives at his parents’ home and finds his mother on the ground, still unconscious, with no ambulance in sight. His father calls Century again, but according to Glikman, the ambulance driver says he can’t get his engine started due to the blistering cold. Desperate to save his mother, Glikman dials 911. Fifteen minutes later—far too late by most national standards—a city-dispatched ambulance arrives just in time to pronounce her dead. Read the rest here.

While it focuses on Glikman, the story serves as an update from a May 2006 story by Mike Newall on Philadelphia’s poor ambulance response times.

Read the story, comment, then com on back, as always, and see what didn’t make it into the final story.

Vlad Glikman

  • The private ambulance driver was formerly a driver at an elderly care organization that Glikman’s parents used.
  • Glikman had CPR training.
  • “I asked him [my father] where is the ambulance? Why is no one here.”
  • “Twenty-five minutes [the driver] he says he can’t start his truck. But he never made the call to 911. So I did.”
  • Third floor of apartment building
  • Only dept. of health can revoke ambulance licenses, Glikman said.
  • The private ambulance ignore the state EMS Investigation manual, Glikman alleges.
  • “I filed it because they completely ignored that manual.”
  • This complaint was botched,
  • All told, Glikman, 55, says it took more than 30 minutes for Century to arrive but came up the long walk and the two flights of stairs unprepared.
  • Glikman, who has had CPR and first-aid training, says, “I started yelling, ‘Are you going to do something or just crawl around?” “I guess they were just going to crawl around.”
  • One crew member returned to his ambulance to get additional equipment as the 911 ambulance arrived.
  • Glikman is focusing his ire on Century, but neither Lomov’s company, nor the city responded on time by most national standards, and that’s become fairly common in Philadelphia.
  • It was in her adopted American city that Adalina, Glikman’s mother, celebrated her 78th birthday. One week later, it was where she died, though her son says things should have gone differently.

Dave Kearney, recording secretary
Philadelphia Fire Firefighters’ UnionIAFF Local 22
Member of the Philadelphia Regional EMS Council

  • “The additions impacted slightly, but not to the point where it making the difference on people’s life.”
  • “It would be thinking out of the box here. Anywhere else, it’s doing what everyone else is doing.”
  • We put people who are shot in the back of a cop car. We are getting away with it when we shouldn’t. That wouldn’t cut it in other cities.
  • “The industry standard by the union to give the time to train, to freshen up, avoid skill degradation and burnout is .35 or .45. That means 35 or 45 percent of a unit’s time is spent out responding to calls, making runs to hospitals. We have units doing .9.”
  • In Philadelphia, we look at it system-wide of .65. So that means an airport truck that does maybe 3,000 runs a year gets averaged in with one pulling 9,000 runs.
  • “We can’t measure our survival rate, but we know it ain’t good.”
  • “There are maybe 50 guys who were paramedics and who are now firefighters. Give me ALS gear, and let me work overtime as a paramedic. Instead, the city takes a guy like me and ties my hands.”
  • Private ambulances  do transport but, you know, typically not for emergency.
  • They’re driven by profit. If it’s not profitable, they might not do it.
  • “Insurance companies only pay for transport. So private ambulances take that. You know what I mean? We’ll provide service, and they’ll transport. So a private company wants to get in the system, but, you know, they want to stay in their communities, like up in the far Northeast. If they come in the system and get sent to a neighborhood where maybe most of the people are under or uninsured, well, then these companies can’t survive.”
  • “Private companies, fire department ambulances, they are all licensed by state, but private ambulances don’t have specialized training for going into a sitution with carbon monoxide or with terrorism, an attack.
  • “I take an oath for the people of Philadelphia. There’s more to this than simply a pay check or a contract.”
  • “The difference, and they hate this, but the difference between a private ambulance and us is, well, it’s hiring a cop or hiring a security officer. They both guns. They both have uniforms, but if the bank is being robbed who do you want with you?
  • “We still have trouble hiring paramedics.”
  • “We have no way to deal with, what I call, BS calls. People who call because I have a pimple on my arm.”
  • There are many different industry standard suggested response times, Kearney says. Some say four minutes for first responder and eight for transport. The American Heart Association says six minutes. the American Ambulance Association says 90 percent of the time transport needs to come in less than nine minutes.
  • “By any standard, we don’t reach that benchmark, and the city plays games with our numbers.
  • If you’re in a large region or it’s a busy day you’re scrwed.
  • “You don’t have a constitutional right to an ambulance.”
  • Many suits have lost on the basis of due process, but, Kearney says, he would like to see someone see leaders on the basis of serving as a negligent provider.
  • Five more were added last year. “But there’s always an increase in need, that’s barely keeping up,” says Dave Kearney the recording secretary of the Philadelphia Fire Firefighters’ Union IAFF Local 22. “That’s a little improvement to a big problem.”
  • The administration, “has already cut seven companies. Those are in the first responder system, not just water and ladders. Our response times are going up because of it.
  • There are other ways to simply cut down on bureaucracy and other costs, which remain persistent “roadblocks to success.”
  • Kearney says other cities use an advanced practitioner system, where calls for certain types of care are directed to the appropriate level of treatment – “instead of racing everyone to the emergency room who has a pimple on his arm.”

I wrote a shorter feature on the Century Ambulance news for NEastPhilly.com, the online home of NEast Magazine. See all my posts here.

Photo courtesy of Flickr user enryb (busy renovating house). See it here.