YORK COUNTY, S.C. -- Bubba Ramsey knew something was wrong within five minutes of lying down for bed that August night in 2011.
His heart began beating rapidly. He got out of bed. It didn’t slow down. His wife called 911. That was at 10:31 p.m., according to EMS call data obtained by The Herald.
“It kept on, and kept on, and kept on and they (EMS) didn’t come, so she called them again,” he said.
Ramsey said by the time the Piedmont Medical Center ambulance arrived at his home between Sharon and Hickory Grove in western York County his heart rate was “over 200.”
When the paramedics began treating him, “they done a good job,” said Ramsey, who now takes medicine to prevent such episodes.
But the time it took to get to his house concerns him.
“If I had been in real trouble, I probably would have been dead before they got there.”
Just how long it takes an ambulance to arrive on scene – especially in rural western York County – has become one of several questions York County leaders, EMS officials from Piedmont Medical Center, and the county’s volunteer EMS rescue squads are asking as they develop new guidelines for EMS providers in the county.
Proposals include lowering response times and changing the way urban and rural response times are defined.
Piedmont EMS and county dispatch officials say that in Ramsey’s case, the lengthy response time was the result of a rare occurrence – all the ambulances on the road were tied up with calls, some outside their normal coverage area.
Steve Cotter, Piedmont EMS director, assures that despite some calls exceeding targeted response times, the hospital’s ambulance service meets and exceeds expectations set forth in the hospital’s contract with the county. The contract obligates Piedmont to provide EMS service countywide.
Piedmont EMS also meets the company’s own internal benchmarks for response times, which are more strict than what the county requires, he said.
But Ramsey’s concern illustrates a perception among some western York County residents that ambulance coverage isn’t adequate in their communities, that help might not get there on time.
That perception is in part fueled by a general feeling that it takes longer to get anywhere in the county’s western reaches. But it also stems from an observation by some that a Piedmont ambulance designated for Sharon doesn’t always appear to be in the area – a claim Cotter says isn’t true.
An ‘extended response time’
On the night of August 30, 2011, Ramsey’s wife called 911 twice, and they waited more than 35 minutes before help arrived, Ramsey said.
Records from York County’s 911 dispatch center show a paramedic arrived at his house 21 minutes after the 911 call. The ambulance that took him to the hospital arrived 26 minutes after the 911 call.
Gary Loflin, director of York County EMS, said the time it took for a medic to get to Ramsey that night was an “extended response time.”
Unlike some calls, which may take too long without justification, this one had a reason, he said.
Of the nine Piedmont ambulances deployed that night – a typical number for non-peak hours – the only unit available was from Fort Mill, Loflin said.
The Fort Mill ambulance was dispatched to Ramsey’s house at 10:31 p.m., seconds after the 911 call.
At the same time, a roaming EMS supervisor with first-responder capabilities, but without the ability to take patients to the hospital, left Rock Hill toward Ramsey’s home and would arrive 21 minutes later, being the first on the scene, Loflin said.
But an ambulance still needed to go to Ramsey’s home, Loflin said.
At 10:36 p.m. a Rock Hill ambulance, closer than Fort Mill’s unit, came free and headed toward Ramsey’s home. Dispatch canceled the Fort Mill unit.
EMS 6, the Piedmont unit with a home base in Sharon, finished up a call in York. Because EMS 6 was closer than the ambulance coming from Rock Hill, dispatchers canceled the Rock Hill unit and sent EMS 6 toward Ramsey’s home.
That was at 10:48 p.m. The ambulance arrived at 10:57 p.m. and took Ramsey to the hospital.
The county and Piedmont set goals for response times – defined as the time when an ambulance is dispatched to the time it arrives on scene – and use them as one measure of care.
In its contract with Piedmont, the county requires 50 percent of all calls to meet response time goals. In western York County, that’s 20 minutes. Piedmont has its own goal for response times in western York County: 90 percent of calls must have response times of 15 minutes or less.
Any calls surpassing the goals automatically trigger a special review, said Cotter, the EMS director.
But response times when viewed alone aren’t adequate in measuring patient care, Cotter cautioned.
For example, the ambulance that arrived at Ramsey’s got there 9 minutes after being dispatched – well within the either measure, records show. That time doesn’t reflect how much time lapsed since the 911 call.
A situation with all ambulances deployed at once, or multiple units being dispatched, is “rare,” he said, and also would trigger a special review.
The complexity of each call is another reason why there are several factors to consider when evaluating patient care, Cotter said.
Every aspect of the service – from how long it takes to get a patient to the truck, to how long it takes a crew to prepare the ambulance for service after finishing with a patient – is analyzed for efficiency, he said.
“We’re very responsive. Everything that we do is measured in that way.”
To prevent calls from exceeding response time goals would require putting more ambulances on the road, which would increase cost, he said.
“No system in America is designed for 100 percent performance,” he said. “You cannot afford it. Eventually somebody or some entity is going to pay for it.”
Appearance of not being there
For years the county has contracted with Piedmont to provide EMS services countywide. Volunteer rescue squads have helped.
While rescue squads in Fort Mill and Lake Wylie have grown, others in western York County have struggled to stay in operation, or have shut down.
That’s what happened to Hickory Grove’s EMS squad which used to run an ambulance in the county’s western zone.
In 2008 Piedmont, obligated to ensure EMS service countywide, designated an ambulance in Sharon to serve the western side of the county , Cotter said.
Piedmont leases space in the truck bay from the Sharon Fire Department, but two western York County fire chiefs say that ambulance isn’t around much.
Sharon Fire Chief Oliver Dowdle said it seems that Piedmont “keeps that ambulance pulled back toward York a good bit.”
The bay at the fire station is often empty, he said.
Hickory Grove Fire Chief Kenny Gilfillan wonders why the Piedmont ambulance isn’t around more often.
Gilfillan, who used to run the Hickory Grove volunteer EMS squad, says Piedmont’s presence in western York County was one reason the volunteer squad shut down.
“When they (Piedmont) put the ambulance over there, on call, they could already be through Hickory Grove by the time (Hickory Grove’s volunteer EMS squad) could get the ambulance out,” he said. “We were just wasting fuel, gas and our time.”
Now, he said, people have been “fussing” that Piedmont’s ambulance isn’t more visibly present. “Piedmont was supposed to be staying over there,” he said.
Gilfillan has stories of people who’ve had seemingly long waits for an ambulance in western York County, including Ramsey’s.
Cotter said a lower call volume in Sharon and the county’s rural west means EMS 6, the ambulance designated for that area, might not always be there.
“Just because it’s not sitting in the bay or out in front of the station, does it mean it’s not there? No,” Cotter said, adding that when EMS 6 is staged, it could be in one of 20 different places.
County dispatch records show that from May to October, Piedmont dispatched ambulances to calls in Sharon, Hickory Grove and Smyrna more than 300 times.
EMS 6, the designated ambulance for Sharon, answered the most calls, followed by EMS 5 which is usually stationed in York. Two ambulances and several quick response units also answered calls in the area.
Cotter said doubts about Piedmont’s commitment to western York County are fueled by the few incidents where response times are longer than usual, and are not accurate reflections of how the system as a whole works, he said.
But being aware of the perception, he says he’s changed his ambulance deployment plan to have more of a visible presence in the western part of the county.
He doesn’t see that it’s made any difference in response times, he said.
Sharon Mayor Beverly Blair said, “it’s a blessing” to know an ambulance is serving them, but she understands why some might be concerned not seeing the ambulance around town.
“They just wish they were here all the time,” she said.
“By the time someone can get out here, of course we would love to have them here day in and day out and not go anywhere else,” she said.