OKLAHOMA CITY – Restoration of the “closest ambulance” rule would save lives and eliminate confusion about which ambulance service should be dispatched to the scene of an emergency, particularly in rural areas, a legislative panel was advised recently.
The “closest ambulance” rule was a victim of ‘the law of unintended consequences’, and as a result people have died, members of the state House Committee on Public Safety were told.
“One day I got a call from a woman and the first words out of her mouth were, ‘Why were you not there?’” said Anthony Adams, Emergency Medical Service (EMS) director for the City of Lindsay.
“She said her sister had been in respiratory distress, so she called 9-1-1 and asked them to send the Lindsay EMS, as it was only four miles away. But she was told ‘no, they were required to send the call to Chickasha’.” The distance from the Chickasha fire station to her sister’s location was 22 miles.
“We were never notified,” Adams said. “Her sister died.”
State Rep. Cynthia Roe, R-Lindsay, said the mother-in-law of one of her coworkers, who lives on the border between Garvin and Murray counties, “was on the floor and couldn’t get up.” The coworker called her two sons and alerted them that their grandmother was in cardiac arrest.
“It took 13 minutes from the time of the 9-1-1 call for the dispatcher to figure out which ambulance district her mother-in-law was in, and it took another 10 minutes before the ambulance arrived,” Roe said.
During the committee meeting, Roe received a message from Rep. Brad Boles, R-Marlow, who told of a similar incident.
One of Boles’ constituents is a senior citizen who has a history of heart problems. The man lives in Grady County three-quarters of a mile from the McClain County line. The ambulance service in Tuttle was called “and it took 45 minutes for them to get there,” Roe said.
Within the past couple of months, the same man was “having a heart event” that was so severe that ultimately he had stents installed, Roe said. The man called a family member who drove him three-quarters of a mile across the Grady County line into McClain County “so he could call Newcastle and get their ambulance within a very short time.”
“We have several areas at all three of our locations where a number of people will load their family members into a car and drive them across county or district [ambulance] lines because another ambulance service is closer,” said Jackie Wadley, owner/operator of a private ambulance service that has operations in Purcell, Wynnewood and Stratford.
He said one person who required an ambulance lives within 14 miles of one of Wadley’s stations, but the ambulance service which covers that particular geographic area is 31 miles away.
“Many of our calls are time-sensitive,” Adams said. Response times of 30 to 40 minutes to arrive at a scene “are not ‘coverage’,” he said. “Time and distance equal life.”
House Bill 1888, the Rural Ambulance Service Districts Act enacted in 2010, eliminated the “closest ambulance” rule, which affected rural areas adversely “because it increased EMS response times,” Adams said. HB 1888 “has been directly responsible for many deaths.”
An ambulance service has a duty to act within its licensed service area in a timely fashion, said Dale Adkerson, program manager of the EMS Division of the Oklahoma State Department of Health (OSDH). It also must provide mutual aid to another ambulance service when called upon, if it can do so without jeopardizing its primary service area, he said.
A licensed ground ambulance service must be staffed and available to respond to any request 24/7 and be “out of the chute” within 5 minutes – meaning personnel in the ambulance – on 90% of all emergency calls received, Adkerson said.
There is no administrative or statutory requirement to be at the location of the emergency within a specified period of time, he said. However, that does not preclude an EMS, a city or a county, from setting its own requirements, Adkerson said.
Wadley said his company provides ambulance service to Wynnewood under contract; his contract with Stratford is paid from a city sales tax; and his service to Purcell is financed from an assessment on municipal utility bills.
Some EMS districts are financed through ad valorem taxes and are known as “522” districts, which were authorized by State Question 522 approved by Oklahoma voters in 1976.
Because some ambulance services and taxing districts have ‘hard borders’, Representative Roe said, “the closest ambulance may not be the one that responds” to an emergency because the call originated from a location that is not within the boundaries of their geographic service territory.
A list provided by Adkerson indicates Oklahoma has 66 “522” EMS districts. They include Cotton County, Grady County, Greer County EMS District, Hobart School District, Jackson County, Lone Wolf School District, Mountain View-Gotebo EMS, Southwest Oklahoma Ambulance Authority in Hollis, Tillman County and the Waurika School District.