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San Diego ambulances respond to 120,000 medical calls a year, an average of more than 300 times every day.
Most of the time, said a high-ranking ambulance official, they didn’t need to go.
“Fifteen percent of those calls are really sick people,” said Wayne Johnson, general manager of the city’s ambulance provider, Rural/Metro. “The rest of them probably could have taken a car, in all reality.”
Rural/Metro’s ambulances go out so often, Johnson said, because they have to.
“We’re obligated under contract to respond to all 911 calls,” he said. “Regardless if they call up and say, ‘I need to refill my medicine.’ We can’t tell them, ‘No, we’re not coming.’ We have to go.”
Johnson’s comments reveal another facet of how the city responds to medical emergencies at a time when big changes appear to be on the horizon.
City officials are considering putting Rural/Metro’s ambulance contract out to bid, meaning the city could have a new ambulance provider for the first time in more than 15 years. The process could address how frequently ambulances need to respond and many of the other complex issues related to one of the city’s most vital services.
The Fire-Rescue Department, which typically serves as the city’s first responder, doesn’t meet its goals for getting to emergencies on time and the greatest risk for delays happens in some of the poorest and brownest neighborhoods. Rural/Metro’s ambulances do meet their goals, but the company has been struggling recently with more calls for service and is in bankruptcy. The company’s current contract calls for them to go every time someone dials 911 and requests assistance.
Right now, 911 dispatchers go through a detailed system to determine the severity of an emergency over the phone. The most serious problems, such as cardiac arrests, get a fire engine and ambulance with lights and sirens for the fastest response times. Other calls, such as a stubbed toe, get only an ambulance without lights and sirens and slower response times that come with obeying normal traffic laws.
The dispatch process is difficult, said Jim Dunford, the city’s emergency medical director. In less than a minute, dispatchers have to try to get information from someone who may be frightened, not know the sick person or otherwise have trouble communicating, he said. And the severity of potential injuries can change in an instant.
Because the city tries to figure out what’s happening before sending emergency responders to the scene, there’s always a risk of sending too many or too few, Dunford said.
Dunford recalled that the old “Nightline” news program had a recurring segment on 911 dispatch errors.
“Cities were barbecued left and right for failing to send resources quickly enough,” Dunford said. “Cities became afraid, adopted strict protocols and along the way it became clear that, at least statistically speaking, high sensitivity trumped high specificity.”
In other words, emergency response systems are now set up to send up to six people to respond to what could turn out to be a skinned knee. But six people will also arrive when grandpa’s breathing problems suddenly turn into a heart attack.