Call 911and pray: a tale of four street corners

This was the title of an article that appeared in the September 2001 issue of Good Housekeeping Magazine.   It describes how inconsistent EMS delivery is across the country, and adverse events that resulted in lawsuits against EMS agencies.

“It depends not just on what state or municipality you live in, but because individual EMTs’ skills vary significantly – sometimes what block your house is on and which crew is assigned to cover it,”  stated Gregg Margolis, now associate director of the National Registry of EMT’s in the article.

The EMS world changed forever a few weeks after this issue was published.  The events of September 11, 2001 prompted discussion about the need for regionalized systems to respond to large incidents.  But ten years later, EMS response patters are still hindered by artificial response boundaries and inconsistent care for small incidents.

Here is what would happen today if someone collapsed at an intersection in a fictitious community similar to where I grew up:

South Side of the Street: A BLS engine from a medium-sized paid city fire department would respond from the nearest station 1 mile away.  A private Plural Retro Ambulance would also respond from a street corner post, and the call would be run by a Plural Retro paramedic.

Northwest corner: An AED equipped police officer would respond, along with  municipal paramedics in a chase truck.  Their base is 3.8 miles away.  A private, paramedic-staffed Twin Town Ambulance would also respond from a posted street corner.  The municipal paramedics would be in charge and ride on the ambulance during transport.

The nearest volunteer fire station  in this town is .3 miles away, but they are not dispatched to EMS calls.  Members may be at the station with an AED and not know someone collapsed near by.

Northeast corner:  A BLS response vehicle from a volunteer fire station 2 miles away would be dispatched.  The station is not staffed 24 hours, and members usually respond to the station from their homes.  The same paramedic Twin Town Ambulance that would respond to the other side of the street would be dispatched, but now they would be in charge of the call.

These communities have two things in common:

1. The needs of the patient who collapsed.  They would want excellent care delivered from the closest responders, regardless of what community they respond from.

2. How independent they are. Responders in one jurisdiction would not know what is happening in the other, even if they were close by. Sight of the big picture has been blurred by decades of tradition.

So which corner is someone most likely to survive on?  No one knows because it is not tracked.  The fire departments are in charge of the fire departments and the paramedics are in charge of the paramedics.  When things go well, everyone smiles together for cameras.  When they don’t, finger-pointing gets in the way of real solutions.

My vision of EMS is that excellent care would be consistently delivered across town, county, and state lines.  Future posts will explore how to do this.


  1. This is a very, very real concern in many places and I’m glad to see someone trying to address it.
    In my tiny town, a lot depends on who is home when the call happens. There are very few EMTs in the volunteer fire dept. Three, to be exact. One of whom rarely goes to calls. The other two are in the same family. If they happen not to be home… the patient waits for the ambulance from the nearby town, and, depending on where they live, that wait can be over twenty minutes.
    This is not good enough.
    What scares me the most is that the people in the town don’t know this.
    The fire dept (meaning the fire commissioners and line officers) seems to be heavily invested in not letting anyone find out. They don’t want to “look bad.”
    I think the public has the right to know WHO responds to them when they call, where they respond from, and how long it might take. They deserve to know- and understand- the training and experience levels of the responders. And they need to find these things out before they call, not after.
    If I were in charge, there are some things that would be very different. One thing I’d like to see is better cooperation on a county-wide level, with the priority being good patient care.

    This is just one aspect of the issues of how EMS looks from the patient’s perspective. I look forward to seeing what you have to say about it, and about other concerns. One of the things I am particularly interested in is having a better understanding of what the patients sees, hears and feels during an emergency, and then finding ways to make that a better experience. Especially in an area where more than one agency responds to each call, I know it can get very confusing- and crowded. I have done a fair amount of explaining about why they get the fire dept and the ambulance, but there’s more to it than that.

  2. I had a conversation similar to this with some friends who are in EMS a while back. There are about 50 different models of EMS delivery in use in the country. Which one is best? I guess that depends on where you live. If you live in a medium to large size city, then you should expect a fairly quick response from paid providers. Those providers might be BLS, first responders, paramedics, or some combination.

    It gets far more difficult in rural or even semi rural areas. Even with a paid service, it might be close to an hour before an ambulance arrives. It might be an hour or more from their arrival until you see a hospital and that might be a small hospital with limited capability. You might see volunteers responding, you might see fire fighters or police officers first.

    A lot of people love living in small towns or even out in the country not in a town. That’s a nice lifestyle, but it comes with trade offs. One of those is that if your house catches fire, it’s probably going to burn to the ground before a fire truck shows up. If you need the police, it could be a while before they can get to you. If you need an ambulance because of a critical medical problem, there is a pretty good likelihood you might die before they get there.

    I’m semi amused when former city dwellers complain that the volunteer ambulance in their sleepy new town took so long to get to their house which is five miles from the main road. Then they complain more when they get to a small community hospital that doesn’t have all of the amenities and capabilities of a big city hospital.

    One size fits all EMS response is never going to happen unless the people who are going to pay for it are willing to have a lot of staffed ambulances that spend most of their time waiting for calls to come in and very little time actually responding to those calls.

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