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.”

Read the story here.

Several neighbors grabbed their phones to dial for help, including Jillian Ihloff.

“What if they were right there and a bullet went through the wall?” said Ihloff.

All the mother of two could think about was, “Oh my gosh, my babies!”

She immediately called 911.

“It just rang and rang,” she said.

And while she waited, “I thought, ‘OK, I wonder if something really bad has happened,’” said Ihloff.

Two minutes later someone answered. Ihloff can’t believe it took that long.

“You just have that extreme fear of not knowing where exactly it’s coming from, what is going on and I haven’t gotten a hold of anybody. My babies are in the other room,” said Ihloff.

We took what we recently uncovered to the city of Tulsa. They say this time, an operator called in sick.

“In this particular case, had there been a fourth call-taker on duty that call would’ve been handled. But for the rest of the evening that fourth call-taker would’ve been unnecessary,” said Terry Baxter, the director of the 911 Center.

Baxter says the city staffs the call center based on trends of when it’s expected to be busiest.

But 2NEWS looked through call records over the past year and found operators answer police calls in an average of 26 seconds. That’s more than two and and a half times as long as the national standard set in place by the National Emergency Number Association, the organization 911 centers across the country look to for high standards and integrity.

It’s a story 2NEWS first started looking into a year ago, when we uncovered the problem with overtime at the 911 Center and brought it to the city.

At the time, 2NEWS found some operators almost doubling their salaries with overtime. It was mandatory in some cases because of under-staffing.

Because of our investigation, city councilors started asking questions and more information came out. The shortage wasn’t just an overtime issue, it was leading to delayed calls.

The mayor promised change.

The city has since hired 15 more operators and increased salaries. So far 10 people have finished training. Baxter admits even when all 15 are on the floor, “That may not be enough to really do what we would like to do,” he said.

In Ihloff’s case, she called back 15 minutes later after hearing gunshots a second time. This time, she was on hold for four minutes. The national standard is 10 seconds, that’s 24 times higher.

“That’s not good enough. It’s not good enough,” said Baxter.

Baxter admits improvements will take time.

“It’s a personal liability if it’s not a legal liability because I feel horrible when something happens and we can’t be there as fast as we know we could because we just didn’t have the people to handle it,” said Baxter.

It’s a concern Tulsa City Councilor G.T. Bynum shares. Now he’s demanding changes after we showed him the results of our recent investigation.

“I continue to hear from people about this. I hear from constituents. I hear from former colleagues on the City Council, certainly Channel 2 has been very active on this and making me aware of concerns you all have heard about,” said Bynum.

Bynum has asked city leaders to speed up plans on having other operators answer non-emergency calls outside business hours. For example, right now the center answers animal welfare calls after 5 p.m. Getting someone else to answer those calls instead of having 911 do it, would drop emergency dispatchers’ call load.

It’s progress Ihloff is anxious to see, as she continues to think about her children.

“I’m their mom. I’m there to protect them and to do whatever I can to protect them every second of my life,” said Ihloff.

The 911 Center is hiring a training coordinator who will train operators to the national standard.

They also hired a quality assurance person to monitor operators. Baxter hopes to have everyone trained by the end of summer. It takes months to train people on the system. Plus, they say they haven’t had a lot of applicants so far.

We should mention that on average, we did find over the past year, 911 Center operators answered fire calls in less than 13 seconds on average and medical calls in less than nine seconds.

The center says the problem lies in not having enough operators for police calls.

Its hazardous materials permit database included the warehouse and chemicals, but is so arcane that it’s impossible to point and click through it using a computer mouse.

The chemicals also were disclosed by the owner on an annual hazmat form required under a federal law inspired when a chemical gas leak killed 5,000 people in India in 1984.

But those sources aren’t married with others that identify flagged buildings in the city’s emergency dispatch system, called upon multiple times every day to send police, firefighters and ambulances to scenes of danger around the city. No single database contains a complete picture of all the information that might be relevant in emergency response, whether it’s the presence of chemicals, a disabled person or a lack of exits, city fire officials said.

In the case of the Canton fire, that meant it took 11 minutes from the time the fire was reported to the time a hazmat unit was called to the scene. The fire caused no injuries, but environmental officials had to dilute runoff from the scene to protect neighbors, animals and the environment from caustic acids.

Fire and emergency management officials want to share more data and make it available to as soon as possible. They see a chance to do it in a planned upgrade of the city’s dispatch system. But it will be difficult, they said, because of the city’s tight budget. There isn’t much left to invest in technology when money woes mean rotating fire company closures.

“There is absolutely the potential to get to that perfect world where the [dispatch system] is populated with useful information. The gap between here and there is money and resources,” said Deputy Chief Raymond O’Brocki, Baltimore’s fire marshal. “It sounds great to be able to do that, but then if you juxtapose that with the closing of fire houses, I think the average citizen would say, ‘Keep my fire house open.’”

The fire broke out about 8:30 p.m. April 22 in the Canton shop of Eastern Plating Co. The company anodizes metals, a process that uses powerful acids to protect materials from rust or prepare them to be painted. The work requires mass quantities of sulfuric, chromic and nitric acids and sodium hydroxide, a powerful base.

It grew to a three-alarm blaze, and strong gusts that Sunday evening led firefighters to evacuate homes downwind along Toone Street. Days after the fire, the neighborhood of rowhouses was littered with ashes.

Neighbors said they were unaware of what went on in the warehouse. Its only windows to Baylis Street were painted onto the brick, and there was no signage alerting of dangerous chemicals inside.

Firefighters don’t need to know immediately what hazards might be in a building, they said. They are trained to read fire conditions and respond. Firefighters also are trained not to blindly trust forms declaring what chemicals might be present in a burning building.

“First arriving units have to make very swift decisions on what to do,” said Rick Hoffman, president of Local 734 of the International Association of Fire Fighters, the union representing Baltimore firefighters. “As we get information, maybe from passersby, the owner of the building or neighbors, we gain our own knowledge and then we start making better calls.”

But having more information as early as possible can help inform how fires are fought, preventing environmental and health risks, and even deaths, firefighters said.

Increasingly, such information is being included in dispatches in fire departments across the country. Baltimore County‘s dispatch system alerts emergency workers of hazards not only in the buildings they are responding to, but any in nearby structures as well, spokeswoman Elise Armacost said. New York City has been praised for its technology, which is capable of processing information on 50,000 emergency calls per hour.

Baltimore lacks more advanced technology despite deadly and disruptive chemical-related fire emergencies in the past.

When a train derailed inside the Howard Street Tunnel downtown in 2001, a chemical called tripropylene burned for six days, while caustic hydrochloric acid leaked out of another freight tank. In 1998, five workers died at a chemical plant in Wagner’s Point when aluminum inside a metal alloy reactor exploded, causing a massive blaze. Accumulated sugar dust inside machinery in the Domino Sugar plant in Locust Point cause an explosion at that facility in 2007.

Firefighters did not have immediate information on the chemicals in the Eastern Plating warehouse because, at first, the fire was reported in the 1000 block of Baylis Street, two blocks from its actual address at 1200 Baylis. But even if the address had been reported correctly, 1200 Baylis was not flagged for dangerous chemicals in the dispatch system, said Battallion Chief Patrick Walsh, who leads the departments communications and information technology division.

He could not say why the building wasn’t flagged.

Sources used to flag buildings include phone calls or visits from concerned residents or business owners to their local fire hall, as well as reports from fire code enforcement inspectors, Walsh said. That type of information is added to the dispatch database on a daily basis, he said. But that doesn’t cover all the information in the arcane fire code enforcement database, which isn’t accessed as often, he said. Fire code inspections take place once a year, he said, and the Eastern Plating warehouse was inspected in February.

“You should know what’s in the buildings in your district,” said David White, president of Fire & Safety Specialists Inc., a fire consultant in College Station, Texas. “We know how to put out the fires, but sometimes water is not enough.”

There are other sources of information that city firefighters use that also aren’t linked to the dispatch system. Fire companies are encouraged to make routine visits to nearby homes and businesses, at least once every three years or so. They write up reports on any hazards of note, keep a file in the fire house and send a copy to fire headquarters.

Firefighters hadn’t done such a walk-through of the Eastern Plating warehouse since 2007, fire department spokesman Chief Kevin Cartwright said. The report from that inspection included information on hazardous materials and a layout of the building, he said. But such documents are not stored digitally; they are kept in manila folders.

Under a 25-year-old federal law, the Emergency Planning and Community Right-to-Know Act, companies like Eastern Plating are required to disclose large quantities of dangerous chemicals to the Maryland Department of the Environment. The forms often are provided to city fire or emergency management officials, but the Fire Department seeks out state environmental officials for the most up-to-date information in the forms while fighting a fire, fire officials said.

The forms require companies to disclose any hazardous chemicals in their inventories, any physical or health hazards they pose, the amount used each day, and where and how they are stored. Eastern Plating filed its form for 2011 on Jan. 1, said MDE spokesman Jay Apperson.

The Mayor’s Office of Emergency Management has been gathering the forms as it receives them and building them into a database to share with fire officials for use in the dispatch system. But there are no official plans to do that even as city officials work on signing a contract for a new dispatch system, potentially by the summer.

“Every fire that you have, you try to get better at receiving timely and accurate information as quickly as you can,” said Robert Moloney, the office’s director. “It’s all about providing the person who is in charge on the scene with the timeliest and most accurate information possible for them to make decisions.”

Putting more information at firefighters’ fingertips depends on both technology and money. With the existing system, Walsh said, information like the chemical disclosure forms aren’t added because it would have to be done by hand, and it would be difficult to remove or update once it has been entered. And the time it would take to add it means money, he said.

To save money, Mayor Stephanie Rawlings-Blake has proposed closing three of the city’s 55 fire companies. The move would not close any fire houses or require any firefighter layoffs. Union officials support the plan because, unlike permanent closures, there is still a chance that local fire companies familiar with nearby buildings are the first to respond, Hoffman said.

But fire officials see the benefit of more information, if not a means to share it.

“I think there’s a lot of potential there if they get a [dispatch] system that is user-friendly,” O’Brocki said. “I just don’t know there is a lot of money there in a tight budget to have the kind of upgrades done that would be needed to marry all of these databases.”

Read the story here.

There were nearly 1,000 calls to 911 last school year for kids contemplating suicide — an increase of more than 10% in just one year, Education Department officials said.

And advocates say the spike could actually be even larger since that number doesn’t include calls for other behavioral problems.

The city’s own study found that the majority of students sent to the ER psych wards — between 61 and 97 % — did not require hospitalization.

Tara Foster, of Queens Legal Services, called the practice of calling EMS for kids with behavior problems “troubling.”

“We are seeing a rise of the use EMS-ing children,” she said. “These are very, very drastic measures to be taken.”

The spike in calls comes amid budget cuts to school counseling services. Since 2008, the number of guidance counselors in city schools has fallen 8%, while psychologists fell by 6% and social workers fell by 11%, teachers union officials said.

In the last few years, the number of mental health programs in schools has dropped from 268 to 216, officials acknowledge.

Sonya Turner, mother of a seventh-grader Cashmiere, 15, said Junior High School 151 in the Bronx ignored both bullying and her daughter’s learning disabilities for a year, then they called 911 on the girl, Turner said.

Hospital officials said her daughter was fine, but the check-up comes at a price — an estimated $1,300.

“To me it’s tragic that something like this had to happen,” said Turner.

RALEIGH, NC — With 911 misdials still occurring at a troublesome rate, the city’s top emergency communications official has issued a plea for the public to pay more attention when dialing.

The problem stems from the recent switch to 10-digit dialing. Local calls must now begin with the 919 area code, a change that means more 911 mistake calls because the digits are so similar.

“Unfortunately, we are almost three weeks downstream from this implementation, and are seeing few signs of improvement,” Barry Furey, director of the 911 center, wrote Friday in an email to Raleigh CAC leaders.

About twice a day, an ambulance is sent to the Viera VA Outpatient Clinic, many times to pick up someone who went there instead of calling 9-1-1 or going straight to a hospital emergency room. More often than not, fire-rescue department records show the patients report chest pains, trouble breathing or other emergency symptoms that the VA clinic is not equipped to deal with.

“You don’t want to come to the VA clinic and risk your life, passing emergency rooms along the way,” said Tiy Sanchez, a VA administrator in Orlando.

According to veterans’ advocates and medical professionals working with patients daily, some are going to the Viera veterans’ clinic first because they say they can’t afford an ambulance bill as high as $600 and they believe that cost won’t be covered by their veterans’ benefits or private insurance unless they go to the clinic first.

“I think if it’s anything serious, they should call 9-1-1, then worry about the details later,” said Ron Butt, a Vietnam vet who now works with local disabled veterans. “With the economy, it’s intimidating to dial that 9-1-1.”

Some are worried because the decisions patients are making threaten their own safety and unnecessarily tie up county ambulances in a densely populated area. Last year, public records show ambulances took 293 patients — who county responders determined needed emergency care — from the clinic to hospitals, most to Viera Hospital about 2½ miles away. Stations in neighboring areas are affected too, because they are called in to cover when the Viera station responds to the clinic.

“Our primary goal is to have the 9-1-1 system available for those who truly need it,” said Orlando Dominguez, Brevard County Fire-Rescue’s Emergency Medical Services Division chief. He said that agency is working with the VA to reduce the number of calls. But, he stressed that the department shifts rescue units around to cover the Viera area as needed.

“Yes, obviously you have a unit committed to the VA, but it’s not any different than going to a home,” Dominguez said.

According to Brevard County Fire-Rescue records, county ambulances responded to 550 calls from the clinic last year. Of those, 293 people needed emergency transport. That averages at least two calls per day — and about one transport per day — for the Monday-to-Friday work week that the clinic is open. The clinic sees an average of 1,100 patients per day.

“Some veterans choose not to follow what is in their best health interest in a way to save money, just as other people in the community do when it comes to making medical decisions or following medical advice,” said Tony Ingram, social work supervisor at the VA clinic.

Ambulance bills can be pricey. For emergencies, the average is $600. For non-emergency cases, such as delivering a patient to a nursing home, the average ambulance fee is about $350.

If the ambulance picks them up at the clinic, the Department of Veterans Affairs picks up 100 percent of the bill. If not, the veteran may have to file extra paperwork and negotiate to get the bill paid, depending on their personal circumstances. They know they might end up paying part or all of the bill themselves.

“I think the economy plays a part in that,” said Dr. Thomas Howard, chief medical officer at the VA clinic.

Butt, who volunteers with the Disabled Veterans of America chapter in Melbourne, and medical professionals noted that while the economy is a factor, in some cases, veterans are probably in denial, too, about the seriousness of their symptoms, not realizing their chest pains are a heart attack.

The VA is trying to educate patients on two fronts.

First, in many emergency cases, a veteran’s health benefits will cover ambulance services — for instance, if the patient was seen by VA within the past two years and has no other private insurance. It doesn’t matter about the location as much. Each case is different, Sanchez said. “It’s not a simple yes or no,” she said.

Second, they’re reminding patients that delaying treatment can lead to serious, permanent damage or even death.

The Viera clinic has hung “Save Your Life” signs warning veterans to call 9-1-1 in emergencies rather than waiting.

“I do educate them that their well-being is the most important thing, and they should not drive past a hospital in a medical emergency to come to the VA,” Ingram said.

Ingram said the majority of people transported via ambulance don’t have urgent symptoms.

“Most veterans come to the clinic because they are sick, and then after being evaluated by the medical provider are determined they need hospitalization or more care than can be provided by our outpatient clinic,” Ingram said.

The county fire-rescue records show 550 calls in 2011, 502 in 2010 and 451 in 2009.

The VA reimburses the county for each emergency run. The bill was $179,380 in 2011. So far, the county has collected $73,321, with the balance still being processed by the VA.

Read the story here.

But sporadically in Gaston County, there are instances when every single Gaston Emergency Medical Services ambulance is tied up. It happens an average of 20 to 40 times a month. And should someone else require aid during those periods, no paramedics would be immediately able to respond, meaning critical minutes could be lost in them receiving care.

“That’s obviously not a position we ever want to find ourselves in,” said GEMS director Mark Lamphiear. “It’s not frequent we find ourselves in that position, but obviously it’s more often than we want it to be.”

The spans when there are no GEMS units available is just one of the glaring signs that Gaston County is struggling to handle its load of 911 calls. For the 2011 fiscal year, Gaston’s volume of emergency medical services calls per 1,000 people ranked among the highest in the state.

The national time benchmark for paramedics getting to a scene is nine minutes or less. But GEMS gets to emergency calls within that nine-minute interval less than 50 percent of the time. And it arrives within 13 minutes only about 70 percent of the time.

Much of the problem is that countywide call volume is increasing faster than the county has staffed-up to meet demand. But in another tight budget year, there are no indications that issue will be rectified any time soon.

“Let’s be brutally honest,” said Gaston County Manager Jan Winters. “If you’re the person who needs (a paramedic), it’s extremely important. We do care about it, we’re concerned about it, and we want to do more. But we’re limited by our ability to pay.”

Struggling to meet demand

In January 2011, there were 65 separate periods when no GEMS paramedic units were free to respond to calls. That number dipped in ensuing months, before climbing back to 40 times in July, and 46 times in October.

No GEMS units were available on 37 occasions in December, and 36 in February.

Lamphiear emphasized that no call ever goes ignored.

“We always respond to every call we get,” he said. “The question is, are we later than we should be? There may be some calls we’re later to respond to than we should be because we’re tied up.”

Gaston County’s 911 calls are categorized on six levels, from basic ambulance transports to life-threatening situations. Less serious calls ranked 1-3 are largely handled by rescue squads around the county. GEMS paramedic units mostly respond to the most serious calls, ranked 4-6.

Depending on which units around the county are on calls, available units are constantly being moved to put them in more strategic positions, Lamphiear said.

“We always preemptively move trucks to try to minimize response times,” he said. “We do it based on our knowledge of where calls are coming in and who’s busy. We try to cover the county equally.”

But increasing 911 call volume has made that difficult. In 2011, Gaston County received 3,438 EMS calls for every paramedic it employs. GEMS has a total of 116 employees, the vast majority of which are paramedics.

Officials estimate the increasing call volume and longer response times could be due in part to the county’s aging population, and escalating road congestion.

“We certainly don’t enjoy the staff-to-call ratio that most of the areas around us do,” said Lamphiear. “Our paramedics are running their tails off. It’s not that they mind that, but at some point, there’s a breaking point.”

Relief unlikely any time soon

GEMS has struggled to hit its desired response times for the last five years, Lamphiear said.

“We’ve held our head above water by operating more efficiently,” he said.

One boon has been the use of three quick response vehicles that have been purchased in recent years for the Crowders Mountain, Cherryville and Riverbend townships. The vehicle is staffed by one paramedic and allows more immediate medical care and transport for the county’s outlying areas.

Lamphiear’s only new request for the next budget year will be a fourth quick response vehicle for the South Point Township.

“It allows for basic, paramedic-level care to be provided to the corners of the county sooner,” he said.

But Winters said it’s uncertain whether that request will be filled.

Gaston County has worked hard to address problems with its emergency medical service in recent years, Winters said. When there was a rash of paramedic departures and a struggle to fill vacant positions, the county raised the pay scale for its paramedics in 2006 in order to hire and retain top talent.

Since 2006, the county has created 17 new paramedic positions for GEMS. Public safety in general is the only area where the county has increased its staffing in that time, Winters said.

“In every other area, such as DSS and human services, we have less employees than we did 10 years ago,” he said. “The bulk of our cost is still in personnel.”

Because of the mandated services the county must provide, areas such as library service and parks and recreation have surfaced as the only things left to cut, Winters said.

Addressing the shortage of paramedics here may be hard to do now, he said.

“We know there’s no growth in the tax base and the economy is still not very strong,” said Winters. “So it’s difficult to be talking about expanding programs, even though we know this is a critical program.

“The question is how much are we willing to pay for it, and the commission is really struggling to find that balance.”

The question that won’t be answered until then is how that policy will work once companies are no longer required to make runs from fixed locations and ambulances are sent on calls based on where they are on the road — not where a fixed base is located.

Critics of the policy say it could create delays in less busy parts of the county as ambulance companies concentrate on more populous areas where they are more likely to get calls.

County 911 Consortium Director LLoyd Fayling said the decision to keep the policy in place came after research by an attorney for the consortium and despite a proposal from the county Medical Control Authority, which suggested allowing for preferred treatment of companies that have contracts with individual cities and townships.

“For the most part, if there’s an incident in their community (the company with a contract) is going to be the closest,” Fayling said.

That’s because those contracts promise certain base staffing levels and response times for communities.

But in cases in which another company has an ambulance that is closer — and new vehicle locators being installed in private rigs will allow dispatcher to see that on a video display — the closer vehicle will be dispatched, Fayling said.

The decision comes at a fluid time for private ambulance companies in the county, which the 911 center will dispatch directly, once vehicle locators are in place.

Originally planned to launch in April, the new system is now expected to be ready by early summer.

Fayling said state law spells out that the closest ambulance should always be dispatched, and Jason McDonald, director of operations for Mobile Medical Response Inc., said keeping with that system only makes sense for patients.

“Why invest in this technology” if the information isn’t used to dispatch the quickest response, McDonald said. “We’ve always advocated that the closest unit be sent.”

But that hasn’t been a universal opinion.

Several communities have contracts with ambulance companies that provide cities and townships guaranteed bases and response times and Medical Control in making its recommendation said as long as those companies are able to respond within at least 13 minutes of every call, they should be given the first opportunity to respond in that area.

Medical Control has said data shows that average response time is not a detriment to patients.

The cities of Fenton and Flint currently handle their own emergency dispatching and are not affected by the decision.

Joe Karlichek,vice president of Stat EMS, said his company has supported local contracts and allowing companies that have them the first chance to respond to calls for help.

By establishing themselves in communities, Karlichek said, residents get consistent coverage from ambulance companies, but with the new system, companies will have less reason to staff bases and more reason to roam where most calls come from.

“This county is going to run into delays in communities that will be unnecessary” as a result, he said.

Jim Grady, director of operations for Patriot Ambulance, which has bases in Burton, Clio and Davison, said companies will respond differently to the new system for dispatching but brick-and mortar bases will still be around.

Some bases might end up being staffed less often, he said, if an ambulance makes a run to a Flint hospital, for example, and becomes part of the grid of available units after making its run.

“You take a Friday or Saturday night where the whole city (of Flint) is erupting (and that ambulance) may never see their base for the rest of the night,” Grady said.

The move to direct dispatching of ambulances based on location is part of an effort to cut response times.

In the current system, when a call for help comes into 911, dispatchers use a database to determine which ambulance company has an established base closest to an emergency.

Medical Control is the agency responsible for oversight of the EMS system in the county. It was established by state law for that is purpose and is administered by Genesys Regional Medical Center, Hurley Medical Center, McLaren Regional Medical Center and the county Board of Commissioners.

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The city’s emergency services department will conduct a feasibility study to streamline ambulance and 911 dispatch services. An integrated emergency communications services system would be put in place to bring under one roof the city’s ambulance communication centre and the Greater Sudbury Police’s 911 dispatch for police and fire services.

“It’s the belief of fire, police, EMS and the CAO that Sudbury could become a model community for the delivery of an integrated emergency communications service,” Tim Beadman, chief of emergency services, said. “Given our size, our geography and our call volumes, we need a model to bring these services under one roof in order to get the right resource to the right call. These are opportunities that every public sector is looking at these days in an effort to find efficiencies.”

The two agencies operate independently from separate locations, employing different staff, systems, operating protocols and standards. Not being able to has a negative impact on information sharing and contributes to operational

An overlap of fire and ambulance responsibilities frequently results in dispatch of resources from both services, Beadman said.

A number of other municipalities have adopted more streamlined models for dispatch ranging from physical co-location to partial consolidation to complete integration, according to the report. Emergency services department staff have suggested the city should investigate the assumption of operational governance for ambulance dispatch services, similar to what was done in Toronto and Ottawa.

The regions of Peel, Durham, York and Halton, as well as the County of Simcoe, have undertaken a joint feasibility study and the findings recommend taking steps to have the province hand over governance and operational responsibility for land ambulance dispatch services in the Greater Toronto Area to the municipalities as a single dispatch centre model.

The plan also calls for the province to assume a legislative, regulatory and continued funding role only.

The Ministry of Health and Long-Term Care is responsible for all aspects of ambulance communications, including the answering and processing of incoming requests for service, as well as the dispatch of ambulances to emergency and non-emergency calls.

In Sudbury, the city’s emergency medical services call volumes represent about 90 per cent of the work assignment for the central ambulance communications centre. The goal is to integrate EMS dispatch with the city’s current dispatch system for 911, meaning the city would assume operational governance with 100-per-cent provincial funding for ambulance dispatch.

The City of Timmins is home to the only dispatch centre with responsibility for all three emergency services, according to the report.

“The feasibility study will look at operating dollars, capital dollars required, staffing models – this just sets in motion the process, and we will bring back to council a business plan for consideration,” Beadman said. “Once it has been debated and approved, it will be presented to the provincial government.”

The cost of the feasibility study would be in the neighbourhood of $100,000, coming from the operating budget and a contribution from the land ambulance reserve fund, according to the report.

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“I am proud of 911 dispatch and the way they handled themselves during and after the storm, in spite of all the issues we have going on with the radio system and being located in the temporary room,” said Roy Turner, 7th District commissioner. Turner also works as a paramedic with Cumberland County EMS.

Eric Ritzman, P25 radio system manager, explained to the county commissioners that E-911 dispatchers had been temporarily relocated in the Emergency Operations Center (EOC) conference room the week the storm struck because new computer systems and upgrades in the dispatch center were being installed.

“They handled the situation very well for being in such a small area,” Ritzman said.

“I was proud of all our people up there and out in the field,” Turner said.

Jeff Brown, 8th District commissioner, said he has always gone and worked with Keith Garrison, Emergency Management Agency director, when there are severe storms or large-scale emergencies.

“I basically go in there and volunteer for Keith since it’s only him and one other person. I act as his gopher and help him out and get whatever he needs. These guys were inundated with calls. To see that dispatch room work was amazing. I am proud of them and what they do,” Brown said.

He explained that Garrison and the EOC track the pattern of the storm and they and dispatch make contact with all of the homes in the path of where the storm struck.

“Most people don’t realize that, but they know where the storms have struck and they track it and make communication with those homes one way or another — either by phone or door-to-door contact. Most people don’t realize how well it’s managed,” Brown said.

Dr. Mark Fox attended the meeting and said, “This is a big part of why the EOC concept is so important. There are so many people from all the different agencies out there, but we need one person, either the chief or one representative, to be there at the EOC to keep things running smooth.”

Turner said, “We also owe the Rescue Squad and all the volunteers a big thanks. These are the people who make sure their families are okay and then leave them to come out and help. They do a lot for us and the county.”

“Were there any problems?” Nancy Hyder, 2nd District commissioner and emergency services committee chairperson, asked.

“Well, it (radio system) didn’t work too well, but neither did the cell phones,” said Terry Carter, 6th District commissioner. Carter also works for the Cumberland County Fire Department.

Ritzman explained that the cell towers were too busy in the same way the radio system was because there too many calls going on at once.

Ritzman said that the tornado struck while the county has been waiting for two antennas to be repaired on the P25 emergency communications system.

“We are waiting for the antennas to be installed and then the tests to be run on them. It will be about a month before they are here. We had some communication issues, but there are plans in place for the next event,” Ritzman said.

In general, commissioners and county emergency responders who attended the meeting, said they were impressed with how well everything went during the storms and tornado in Rinnie in spite of the issues with the radio system antennas and the cramped temporary quarters of E-911 dispatch.

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