“It recognizes the people who provide that first response, and the outstanding job they all do,” Krieger said of the weeklong celebration. “They are all highly-professional, well-trained, well-equipped and always just a phone call away.”

Emergency Medical Services Week is set aside as a way to show appreciation to emergency medical personnel who work 24 hours a day, seven days a week, to answer the call of those in need and to honor the dedication they display in providing lifesaving services as medicine’s front line. The first EMS Week was proclaimed in 1974 by President Gerald R. Ford.

In addition to bringing greater attention to all the work being done to maintain the highest levels of emergency medical response, it is also a time to focus on safety and injury prevention, critical care issues, and the partnership between citizens and EMS professionals.

The links in the chain that make up an emergency medical response begin with bystanders, and in some cases even the patients themselves, who are on the scene of a medical emergency. It all starts with prompt and effective reporting, acting to provide first aid, working with the Emergency Medical Dispatcher (EMD) providing information and following first aid instructions.

Emergency medical personnel include communications personnel who are the first to hear from those needing help, and dispatch the paramedics and emergency medical technicians (EMTs) who respond to the sick and injured. EMS personnel also include those who transport the sick and injured to medical facilities and the medical personnel on duty in hospital emergency rooms.

As part of the ceremony Bill Kereluk was recognized by fellow firefighters as YFD’s Paramedic of the Year, while Jesus Hernandez was chosen as the EMT of the Year and Gabrielle Trevino, the dispatcher of the Year. It was her second year in a row to earn the award.

“It is an honor to have been chosen for this by my peers,” Kereluk said. “It is also humbling as well.”

Kereluk, who has been with the YFD for over 17 years, said while the award means a lot to him, he praised his fellow EMTs and paramedics by saying it is a recognition he shares with many others. As first responders, he went on to say what they do is about providing the best care and life-saving treatment to those who need it.

“He continually leads through example with a positive attitude and demonstrated decision making skills,” Yuma Fire Chief Jack McArthur said in reading from Kereluk’s nomination form. “Patient care is second nature for Bill. He treats patients as if they were friends or family. He cares about the work he does, and it shows.”

In addition to being a YFD Firefighter/Engineer/Paramedic, Kereluk is an instructor in the paramedic program at Arizona Western College. He is also a member of the Tactical Emergency Medical Team, and trains with the Yuma Police Department to supply emergency medical support to police officers in critical situations.

Kereluk added that people may not realize how much time paramedics and EMTs spend away from their families. He said they work 24-hour shifts, holidays and weekends, not to mention the many hours they devote to continual training.

In recognizing Hernandez, McArthur spoke about how he continually provides an example for others to follow.

“Jesus is a very compassionate and caring individual who works well as part of the EMS team,” McArthur said. “He continues to hone his skills and has worked to help build confidence in newly hired firefighters.”

Trevino was recognized by her supervisors for being knowledgeable, consistent, efficient, and a valuable asset to the EMD program.

“Her professionalism is particularly apparent when using her skills to help residents calling in need of help and assisting those firefighters and paramedics she sends to the rescue,” McArthur said in reading from her nomination form. “She is always willing to help co-workers and helps in the training of new dispatchers.”

Trevino, as a dispatcher, has maintained the lowest overall average for processing emergency medical calls, at 48 seconds.

Read the story here.

GRAND ISLAND, NE — Communication barriers are a fact of life in Grand Island, where one-fifth of the population older than 5 speaks a language other than English at home.

But in a state of emergency, minutes and seconds lost in translation could be the difference between life and death.

Of Grand Island’s 63 street-level firefighters and paramedics, one is bilingual in Spanish. Grand Island’s 77-officer police force includes about 10 officers certified bilingual in Spanish and one officer certified in Laotian.

Grand Island’s lone bilingual 911 dispatcher, Shanna Andrade, estimated she uses her Spanish skills 10 to 15 times a week. The center used the language line, a translation service to handle irreconcilable language barriers over the phone, about once daily last year, almost exclusively for Spanish.

Emergency Management Director Jon Rosenlund called a language barrier a “speed bump” that can delay the emergency response process from the get-go. The challenges begin the moment one of the 15 dispatchers answers the 911 call. Valuable seconds and minutes are wasted as the dispatcher attempts to communicate with the caller and identify the most important pieces of information: the location of the call and the type of emergency.

Andrade described dealing with a language barrier over the phone as a “state of pause.”

“You’re kind of helpless at that point,” she said.

Rosenlund said dispatchers attempt to handle language barriers themselves, relying on cognates and common words, but they resort to the language line if communication proves impossible. The service, which costs 87 cents a minute, puts a translator on the line with the dispatcher and the caller.

According to department records, dispatchers used the service 369 times last year: 361 times for Spanish and one to three times each for Arabic, Amharic, Mandarin, Somali and Vietnamese. Rosenlund called the language line “a must,” but he admitted it has its drawbacks.

“(Emergency units’) response time is three or four minutes,” Rosenlund said. “It’ll take me two and a half minutes just to start the conversation. I could talk to them all day long and get every detail in the world. But if it takes me eight minutes to get responders there, it probably won’t matter.”

The difficulties don’t end once emergency personnel are on the scene, however. Police Chief Steve Lamken said language barriers also can impede accurate investigations.

“If it’s a crisis emergency, that is the worst time to have language barriers,” Lamken said. “We want to get the right information and make the right decisions.”

And in a medical emergency, language barriers present potentially harmful inefficiencies when patients are unable to communicate their injuries.

“If we spend a lot of our time trying to figure out what they’re talking about, they’re probably not getting treated as well as if they were speaking the common language,” Emergency Medical Services Division Chief Russ Blackburn said.

Blackburn told the story of a 1999 trailer fire on South Sylvan Street to epitomize the negative effects of language barriers. A woman returned home to her trailer near Barr Middle School to find firefighters battling a blaze that destroyed the unit and killed her 2 1/2-year-old son. If not for language barriers between the caller and dispatcher as well as the woman and the firefighters, Blackburn said, the boy might have been saved.

In the summer of 2003, a semi-tractor trailer hit a van holding four visitors from Korea. One woman was ejected from the van and sent to the hospital, where she died. Reports of the accident described a language barrier between the van passengers and the emergency responders. Early reports of the incident erroneously identified the passengers as U.S. citizens.

And on May 11, a minor car accident resulted in three ambulances and five patients being sent to the hospital because personnel on scene couldn’t communicate with any of the passengers to identify their injuries.

Emergency personnel generally depend on community members to transcend language barriers. Children, friends and neighbors often have some English skills when the patients or original callers do not, Lamken said.

“A lot of people understand their limitations and provide their own interpreters,” he said.

Some medical emergencies — unconsciousness, shortness of breath, heart failure — are more visual than verbal. Regardless, firefighter and paramedic Jedd Bohlender said he and others have developed a working knowledge of basic phrases in Spanish. Bohlender has learned to rely on anything that might provide important information: hand gestures, driver’s licenses, pill bottles — even smartphones.

As of late, Bohlender said, some firefighters and paramedics have taken to using Google Translate and other smartphone applications to communicate with patients. But Bohlender called the use of the services “iffy” due to dialects and the need for strong phone reception.

“It’s a technology crutch,” he said.

Lamken, Rosenlund and Fire Operations and Training Division Chief Tim Hiemer said their departments try to recruit people who are bilingual, particularly in Spanish.

“I don’t care if they’re unemployed; I don’t care whether they’re experienced,” Rosenlund said. “If they say, ‘I speak Spanish,’ or another language, that’s enough for me to bring them in to test them. We’re actively pushing for more Spanish-speakers.”

But Hiemer said bilingual recruitment is easier said than done.

“There’s just not that many people around here that are dual-language,” he said.

The Police Department has offered training sessions in the past for basic Spanish, and the city offers a $1,000 annual incentive to those who are certified bilingual in any language, meaning they can take and pass a rigorous language test. No one in the Fire Department has passed the test.

“When it comes to learning another language, cash generally isn’t sufficient to make you want to do it,” Rosenlund said.

Lamken said it’s difficult to recruit bilingual officers because the bilingual population often consists of recent immigrants who may not meet the qualifications to become an officer: 11th grade English language skills, reading and writing capabilities and U.S. citizenship.

“As generations evolve, our opportunities are going to increase greatly. But right now we’re sort of in that catch-22 period,” Lamken said.

In the future, Lamken said, he hopes to attain modern translation technology for officers.

“I just don’t know how fast or when we can afford technology like that,” he said. “There’s cost barriers.”

Other communities with large non-English-speaking populations face challenges similar to Grand Island, officials said. About 64 percent of Lexington residents older than 5 years speak a language other than English at home, according to the 2010 U.S. Census. Fifty-eight percent of Schuyler residents are in the same category, as are 40 percent of those in South Sioux City. The statewide rate is about 10 percent, and Grand Island’s is 21 percent.

“Big towns, small towns — everybody has this challenge,” Rosenlund said.

He added that the transience of immigrant populations makes language barriers difficult to surmount.

“As soon as you begin to tool yourself to meet the needs of Vietnamese or Laotians, then a lot of those community members leave and are supplanted by another group,” he said. “You’ll always be several years behind the next wave of languages.”

Read the story here.

That’s when Grace, just 4 years old, called 911.

“My brother’s not moving,” were her first words to the dispatcher Wednesday afternoon. Moments later, an ambulance was on its way.

Today, the Amityville Village preschooler is being hailed as a lifesaving hero by police, her parents and family friends.

“She was very calm, cool and collected,” police Sgt. John Sullivan, who took the 911 call, said Friday. “Time is of the essence when you have a child that’s not breathing.”

“Gracie amazes me on a daily basis,” said her mother, Alison Varley, 33, an attorney with the Nassau County attorney’s office.

A few months ago, Grace also showed her mettle.

Her little brother Myles accidentally stuck a lollipop stick in his mother’s ear, bursting an eardrum. While Varley was in pain, she said Grace soothed her tearful younger brother, saying, “Calm down, buddy. It’s OK.”

Then she turned to her mother and said, “Mommy, tell me what to do.”

The day Myles choked, the children were having dinner with their grandmother and baby-sitter — Christine Doran, 63.

“A chicken nugget was stuck in his throat,” Grace recalled. “I was scared. I thought he was never going to wake up.”

Doran said she carried the toddler to the sink, but he passed out. She tried the Heimlich maneuver and slapped his back. Nothing worked.

Hands shaking, Doran tried calling 911, but didn’t get through. Leaving the phone on the counter, the grandmother ran outside with the boy, screaming the names of neighbors.

Grace, left with baby brother Conor, 8 months, knew about 911 from her prekindergarten class. She got through on the first try, calmly answering Sullivan’s questions.

Officer John Andriella, 45, who happens to live next to the Varleys, was the first to arrive, about a minute later. Taking the boy from another neighbor, he put Myles upside down on his lap and slapped his back several times.

“He let out a cry, which to me was like music,” the officer said.

Myles, accompanied by his relieved grandmother, was taken by ambulance to Good Samaritan Hospital Medical Center in West Islip. He was released that night to his mother and father, real estate lawyer Myles Varley, 34.

Grace, who has a passion for princesses and all things pink, turned 5 on Friday. Myles turns 2 in six days. They’ll share a backyard bash Saturday — an event that was preplanned but is now suddenly poignant.

The hero worship, Grace figures, is just a bonus.

“I like it because it makes me feel very happy,” she said.

Read the story here.

MOBILE, AL — When a 9-1-1 operator says this: “Mobile County 9-1-1, what’s the location of your emergency?” What they expect to hear next is just that… an emergency. But far too often, it’s something like this actual call:

“9-1-1.”
“Hey, how you doin’?”
“Yes, ma’am.”
“Is this Mobile Water Works?”
“This is Mobile County 9-1-1″
“Oh, I’m sorry. Could you connect me to Mobile Water Works please?”

Or how about… this?

“Mobile County 9-1-1, what’s the location of your emergency?”
“Well, ma’am, it’s not quite an emergency. My brother’s power, he called me, and said the power’s been turned off, and I cannot find anywhere in the telephone book to call Alabama Power Company and speak to anybody. It’s always a robot. Is there a number or address where I can call them at in Mobile, Alabama?”

There probably is, but locating it is not the job of Mobile County’s 9-1-1 operators. Saving lives and property is.

“It’s a frequent problem that we have,” said Elaine Payne-White.

She’s been answering emergency calls at Mobile County’s 9-1-1 Center for nearly a dozen years. And every time she and her coworkers get a call on their screen, they have to assume it’s life or death.

Not exchanges like this:

“Mobile County 9-1-1.”
“Excuse me, ma’am, could you connect me to a phone number?”

And this:

“Mobile County 9-1-1, what is the nature of your emergency? Do you need police, fire or medical?”
“No. It’s my phone.”
“So you do not have an emergency?”
“Well, it’s my phone.That’s my emergency.”
“What do you mean, sir?”
“Only one phone is ringing when calls come in.”
“Ok, any kind of phone trouble you are having, you need to contact your phone company, ok?”

“We attempt to answer at least 95% of our calls in 15 seconds or less,” said 9-1-1 center director George Williams. “But what really gives us problems sometimes, are those calls we shouldn’t be getting.”

And like these operators, he, too, has heard everything.

“It’s not an emergency,” he said, smiling, “if you’re on Airport Blvd and you want to know the address of a good restaurant.”

Which brings us to this call:

They claim the county discriminated against them because they were pregnant and Channel 2 Action News has learned a federal agency agrees.

“We can’t help that this is the reason God put us here to be able to give birth and our jobs should not be put on the line,” Leeneeka Bell told Channel 2′s Lori Geary.

Que’ana Morris said she was also terminated and told Geary she was shocked when her supervisor said “Once you rectify your problem which is your pregnancy then you can come back.”

Both ladies were pregnant with complications during their training. Both said their pregnancies led to their firings.

The Equal Employment Opportunity Commission did a full investigation and after more than two years it agreed that Fulton County discriminated against the two women.

Letters show the findings from the federal agency.

“It was as if I had a voice when I couldn’t go directly to them to beg and to plead, ‘Hey this is going to happen.’ That voice came through the EEOC,” Morris said.

Both women said they not only lost their jobs but also their benefits, including health insurance, when they needed it most.

“I was worried about ‘How do I pay for pregnancy? How do I pay to deliver a baby?’ Nobody, no woman, should have to experience that,” Morris added.

The women said their firings sent a clear message to other women in their workplace.

“I think a lot of people got scared if they were thinking of becoming pregnant. The story was ‘Look what happened to the other two,’” Bell said,

Now, the two women plan to file suit against Fulton County. If they win, taxpayers will foot the bill.

“It’s unbelievable. The employer, a government agency, in this day and age, is going to make a woman choose between having a baby and having a job,” attorney Lisa Millican said.

Late Thursday afternoon, Geary received a statement from a Fulton County representative saying, “Fulton County is a progressive and inclusive employer that fully complies with relevant federal laws as well as our own internal policies and procedures. At no time did Fulton County take any prohibited action against the employees in question.”

Both women said they plan to file suit in the next few weeks.

Both ladies gave birth to healthy girls that are now 2 years old.

Read the story here.

From June, operators in England will get an extra 60 seconds before they need to dispatch crews to serious but non-life-threatening callouts.

Trials showed the extra time meant fewer double dispatches, where two crews are sent, freeing up resources.

This in turn meant the crews could get to the patient more quickly.

To date it has been standard practice to send two crews, to ensure there are enough staff on hand to deal with cases and to ensure the patient is reached quickly.

Eight-minute target

But by gathering more information before dispatch, the pilots showed improvements could be made without harming the overall response time.

Under the system, the most serious calls – category A – will be split into two groups.

Life-threatening cases where somebody has had a cardiac arrest or is unconscious and not breathing will be known as Red One.

Crews still have to be sent immediately to these calls.

But for the rest of the category A calls – Red Two – operators will get up to 60 seconds to decide what sort of response should be sent.

The overall target for reaching the patient will stay at eight minutes for all category A calls.

During the pilots held in London and the West Midlands, the new system reduced the number of vehicles sent out – because of fewer double dispatches – and cut the number of cancellations when vehicles were en route.

It also meant that patients were reached more quickly for both Red One and Two cases as there were more crews available.

Peter Bradley, the national ambulance director, said: “Making this small change will mean more ambulances and rapid responders will be ready to go and help patients – rather than be stood down while on their way to somewhere they aren’t needed.”

Read the story here.

And his voice may sound familiar to you.

A frantic call came into the Prince George’s County 911 Call Center late last week.

“My granddaughter drowned. She’s not responding please help.”

It was David McGowan who picked up the line.

When that blue light lights up saying you got a call it could be anything.

McGowan, only on the job for five months and still technically a trainee, was suddenly thrust into the middle of a life-and-death battle.

His biggest and perhaps only weapon was his steady baritone voice. And he used it to try to calm the desperate grandmother, as together they walked through the paces of performing CPR on the two-year-old girl.

Right by McGowan’s side at the 911 center, and ready to jump in if necessary, was Dave’s trainer, veteran 911 operator Ray Delano.

Delano never had to say a word.

“David has a great voice,” Delano says. “He has a great calming technique.”

A stong voice that many baseball fans know well.

“I was the stadium announcer for the Baltimore Orioles up until I started here,” McGowan says.

For 14 seasons, Dave McGowan was the voice of Camden Yards and the Baltimore Orioles. He retired from baseball in January and says he looked for a job where he could help people.

It looks like he found one, but he probably never thought he would actually save a life.

“She said the baby is breathing and I felt great and I said, ‘You know what? I made the right career choice,’” McGowan says.

Read the story here.

Des Moines police Officer David Murillo is running against four other candidates for the Republican nomination for sheriff to replace Jim Lee.

Murillo said the 911 response to a woman frantically looking for help for her 4-year-old son shows why dispatcher training should be an issue in the campaign.

“911 what’s the address of your emergency?” asks the dispatcher.

“5013 Lakewood Drive, Norwalk,” said the woman.

“OK, you’ve reached West Des Moines, stay on the line I need to transfer you to Norwalk,” said the dispatcher.

“What’s the problem there?” asked the next dispatcher.

“My four year old has been sick all day and he’s unresponsive and he’s not responding to us,” said the woman.

“Is he breathing?” asks the dispatcher.

“What?” said the woman.

“Is he breathing? Is he breathing?,” said the dispatcher.

“Yes, yes, he’s not responding to anything. We’re in the shower and,” said the woman.

“OK what is your name?” said the dispatcher.

“Melissa,” said the woman.

“Alright Melissa, we’ll get you some help down there OK,” said the dispatcher.

“Thank you,” said the woman.

“You’re welcome, bye,” said the dispatcher.

Murillo said the call ended without the dispatcher providing additional assistance.

“As a candidate for sheriff that’s not good enough for me and it shouldn’t be good enough for anybody that resides in Warren County,” said Murillo.

Murillo said the first dispatcher from West Des Moines continued to listen to the call and called the woman back.

“Ma’am this is the West Des Moines Fire and EMS, what’s your name?” asks the West Des Moines dispatcher.

“Melissa,” answers the woman.

“OK, Melissa I’m going to give you some instructions until Norwalk EMS gets there OK,” said the dispatcher. “Lay him flat on his back on the ground, and remove any pillows. Yup. and remove any pillows.”

“I want that dispatcher to stay on the line and give medical care and attention until the squad, the ambulance shows up,” said Murillo. “It’s not the fault of the dispatchers. They’re not getting the training they need and to me as a Warren County resident. That’s simply not good enough for my family.”

KCCI attempted to contact Warren County Sheriff Jim Lee several times Wednesday, but our calls were not returned.

Lee is retiring after 30 years.

Seven people are running to replace him: Preston Gebhart, Eric Haworth, Steve Spain and Stephen Stark, Dave Murillo, Brian Vos and Rick Champ.

The primary on June 5 will narrow the field to one Republican and one Democratic candidate.

Read the story here.

It’s a situation a local mother found herself in not too long ago and if it weren’t for her little girl, she might not be around to tell the story.

“I still get teared-up about it because she saved my life,” Kendra Brown of Holt said. “I honestly don’t know where I would be because the officers said I was having troubles breathing.”

Brown’s daughter, Emma, is a bundle of energy. Like most four-year-olds, play is a priority. She loves swings, slides and her mother’s cell phone.

But no one knew that very phone would save another thing she loves, her mom.

Last November, Kendra was home alone with Emma, when she collapsed with an adrenaline seizure. Emma didn’t see her mom fall but worried when she couldn’t find her.

“I looked inside, I looked everywhere,” Emma said.

She found Kendra lying facedown in the basement, so Emma took action. She dug into her mom’s pocket, grabbed her cell phone and dialed for help.

“I pressed red and then I pressed green,” she explained.

East Lansing dispatcher Rebecca Nelson was on the other side.

“She was very calm, she stayed calm through the whole thing,” Nelson said.

In her ten year career, Nelson says Emma is the youngest caller she’s ever had with a real emergency.

During the 11 minute call, the four-year-old asked for Meridian Township Officer Charles Glumb by name. Glumb is a family friend.

Nelson kept Emma talking, trying to figure out where she was and what was wrong with her mom.

“Can I talk to her,” Nelson asked in the 911 recording.

“She’s not waking up,” Emma responded. “I, I need some help here,” she added.

“Yup, I’m going to get you that help,” Nelson replied. “What’s your last name Emma?”

You can hear Emma following Nelson’s lead throughout the conversation. She helps first responders determine out her home address, but Emma’s worry for her mother was growing.

“She’s all alone and I’m scared,” Emma says on the 911 tape.

“It’s okay, don’t be scared Emma, I’m right here,” Nelson responded.

Emma starts to cry. “She fell on the floor, she’s not waking up,” Emma said.

Kendra was unconcious when firefighters, medics and Officer Glumb arrived, but soon she was breathing again, thanks in no small part to a pint-sized hero.

“Emma went upstairs to unlock the door, to let the police and fire in, Emma kept talking to the dispatcher until we got there,” Glumb said.

“She did a good job just staying on the phone and really more than anything that’s what we want, is to keep that open line for the updates as we use our other resources to find out where she’s at,” Nelson added.

Glumb was so impressed he nominated Emma for a citizen’s award for lifesaving.

“No one told her to do it, I felt she was a very brave, couragous girl,” he said.

Kendra has now heard the 911 call. She says it was tough to listen to, but she couldn’t be more proud.

“I heard her start to get scared and that just broke my heart,” Kendra said. “But I have an amazing, strong four-year-old.”

Kendra says she has talked with Emma about 911 and emergencies, but never imagined she’d need those skills so soon.

Dispatchers say Emma’s story is a great reminder about the importance of being prepared for emergencies. They want you to talk with your children about 911 early on, including what it’s for and how to use it.

They also recommend practicing those calls.

Nelson says you should make sure your children know your full name, first and last, as well as your complete address.

“God gave her to me for a reason,” Kendra said, of Emma.

In a tale come full circle, a mother who lives for her children, now owes her life to her child.

Read the story here.

When they arrived, Marks, 56, was sitting calmly in a wheelchair just outside the entrance. His complaint: he was having joint pain from gout and wanted his medication refilled.

“I can’t walk,” he said. “I need to go to the closest emergency room.”

The paramedics checked his vital signs. Marks told them he called 911 after the county clinic wouldn’t see him for free because he had other insurance. Then the paramedics did what Marks wanted — sent him by ambulance to St. Francis Medical Center.

During an eight-hour period at L.A. County Fire Station 41 last week, paramedics responded to a handful of calls but only one actual emergency — a man who reportedly had a seizure while driving on the 105 Freeway. Several other calls, they said, could have been handled differently if there were other options. The call from Marks was one.

“Really, what are we going to do for gout?” Capt. Ernie Clayton asked.

The incident illustrates a chronic problem — unnecessary 911 calls that result in costly trips to already crowded ERs, which divert resources from true emergencies. Increasingly, uninsured patients rely on 911 as their only way into the healthcare system.

Now, four decades after public safety agencies began launching fast-response paramedics, counties around the nation are overhauling the 911 system to save money, improve care and reduce ER overcrowding, an especially acute problem in the Los Angeles area. Federal health reform is driving the changes, as hospitals try to reduce readmissions and the healthcare system prepares for more patients.

In San Francisco and San Diego, paramedics have worked with law enforcement to reduce the burden of alcoholics on the 911 system. Paramedics in Maine, Minnesota and Colorado are beginning to treat patients in their homes, doing preventive and follow-up care and helping manage chronic illnesses.

“The emergency room is expensive and not always a pleasant experience for patients,” said Maine’s community paramedicine coordinator, Kevin McGinnis. “It is much better to treat them where they are.”

Although the discussions in Los Angeles County are just beginning, officials said they hoped to make changes to the 911 system in the next few years. This is the perfect time, they said, because there is federal money available for new efforts to deliver better care in a more cost-effective way.

“People are calling 911 not because they are really, really sick or really, really injured. It’s because they have no other option,” said L.A. County Fire Department Chief Deputy Mike Metro. Fire departments cannot continue to add engines and paramedics to meet the need, he said. “We have to have the ability to make different decisions.”

Paramedics in L.A. County responded to 543,715 calls in 2010 — a little more than one call every minute. About one in five patients taken to the ER might have been better served elsewhere, according to Cathy Chidester, director of the county’s Emergency Medical Services Agency.

Under current emergency response rules, there is little flexibility. After receiving initial aid, 911 patients have only two choices — either go to the emergency room or stay behind. In L.A. County, more than three-quarters take the ambulance ride, which can cost up to $1,500, even when their complaints are as minor as a cough or a headache. By law, emergency rooms must take patients regardless of insurance status.

Officials are exploring whether ambulances could take certain 911 cases to clinics rather than hospitals. They are also exploring whether paramedics could treat some people at their homes and refer others to primary care doctors or advice lines. And they are considering mobile health vans in some cases.

“This is a skilled workforce,” said Mitch Katz, director of the county Department of Health Services. “Their basic choice is to transport a person to the emergency room or not. That is not a very nuanced choice.”

Katz said the goal is that all patients “go to the right place and the right time to see the right person.”

California officials also are looking for ways to make the process more efficient and expand the role of paramedics, said Howard Backer, director of the California Emergency Medical Services Authority. Paramedic teams — staffed to provide service 24 hours a day — are qualified to do several medical procedures, such as insert breathing tubes and conduct electrocardiograms.

With additional training, Backer said they could help fill the primary care gap in California. “There are EMS personnel everywhere,” he said. “It’s natural to look at how we can do the most with the resources we have.”

Changes won’t be easy. California law restricts where ambulances can take 911 patients, and insurance, private and public, reimburses only when they are transported to hospitals. Clinics also would need to have the right hours, staffing and expertise to take the patients.

Then there is the concern about errors in judgment. What happens if a patient is taken to a clinic but really needed to go to an ER? What if a 911 patient is treated at home but really needed to see a doctor?

“It all comes down to liability,” said Patrick Hanrahan, an L.A. County firefighter-paramedic. “We don’t want to be left on the hook.”

Hospital personnel already talk with paramedics in the field, so under a new system, nurses and doctors could help quickly determine the best place for a 911 patient to be treated, said Jim Lott, executive vice president of the Hospital Assn. of Southern California.

“This is long overdue,” Lott said. “The communication is there, the technology is there, the expertise is there. There is no reason why this kind of triaging can’t be done effectively.”

Another problem is that paramedics and ambulances often get stuck with their patients waiting for ER beds to open; creating new protocols could make the process work more smoothly. “If you have ambulances waiting at the emergency room … the people who need the care are not getting it,” said Brian Bledsoe, who teaches emergency medicine in Nevada and has written several EMS textbooks.

At Station 41 in Willowbrook, paramedics said they have responded — with lights and sirens — to babies who wouldn’t stop crying, people who couldn’t sleep and alcoholics who drank too much. “In their eyes it’s an emergency,” Clayton said. “We know better. But once the call is made, we have to care for them.”

On the day Marks called from the urgent-care center, paramedics from a nearby station headed to a Watts motel for a call about a man with a gunshot wound. But the victim, Terrance Montgomery, said he was shot and had been treated nine days earlier. The motel owner said she called 911 because Montgomery owed her money and she wanted him off the property.

As he was loaded into the ambulance, Montgomery, who is uninsured, said he hadn’t seen a doctor since leaving the hospital the previous week. “This is going to be my follow-up,” he said.

Later in the afternoon, paramedics went to the home of 90-year-old Nathan Shands, who had been vomiting for a few days. His granddaughter said she couldn’t get him into the car, so she called 911 to take him to the hospital. She hadn’t expected so many people to show up.

“She just wanted transport to the hospital,” Clayton said. “She didn’t understand 911 response.”

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