By Lora Hines, The Press-Enterprise
Original publication date: July 31, 2011

RIVERSIDE, Calif. — Riverside County’s emergency dispatch system treats all 911 calls as life-threatening emergencies and deploys firefighters and ambulances, a practice that emergency providers call potentially wasteful and dangerous.

They say this type of dispatching protocol diverts firefighters or delays them from going to emergencies that require their expertise, such as firefighting, hazardous material cleanup and collisions in which people are trapped. Firefighters sent to calls that could be handled by an ambulance crew also risk getting into collisions that could injure or kill people and damage expensive equipment, emergency officials say.

As the county enters into contract negotiations with its ambulance provider, Supervisor Bob Buster wants to evaluate emergency dispatching and bring it up to standards that have been in use across the country, including San Bernardino County, for at least a decade.

He is leading the charge to employ a system that allows dispatchers to be trained to determine how firefighters and ambulances should be prioritized depending on the emergency. They would question 911 callers to better identify the trouble and provide medical instructions as callers wait for help to arrive.

Almost 10 years ago, the city of San Bernardino switched to prioritized emergency medical dispatching to provide residents better service and improve efficiency. Dispatchers ask callers a series of questions to determine whether advanced or basic life support services are required.

Advanced life support includes fire and ambulance responses. Basic life support requires an ambulance.

“We had to go out on a call for a sore throat,” said division chief Eric Esquivel of the San Bernardino City Fire Department. “It wasn’t the best use of resources.”

National ambulance provider American Medical Response, better known as AMR, has served Inland area municipalities and counties, including Riverside County and the city of San Bernardino, for at least 40 years. Its estimated $95 million contract with Riverside County expires next year.

Buster wants to hold a September workshop to study a dispatch overhaul, which emergency services experts say would cost more than $100,000 and take a couple of years to fully implement.

“We’ve got to be a lot more judicious about the resources that we have out there,” Buster said. “We need to send the appropriate resources rather than blanket every call with fire and ambulances.”

A Santa Clara County grand jury recently came to a similar conclusion after it examined how its county firefighters and ambulances were dispatched to emergency calls. Santa Clara County also sends firefighters and ambulances to all emergency calls, despite the nature of the emergency.

“Taxpayers no longer can afford the status quo,” the grand jury report states. “It is common to see fire departments over-deploy multiple firefighting apparatus in response to nonlife-threatening medical emergencies, seemingly a waste of taxpayer dollars.”

Currently, Riverside County fire dispatchers receive emergency calls, deploy firefighters and then send the information to an AMR printer. AMR dispatchers must retype the information into their computers and transmit it to ambulances. The process takes about a minute, AMR officials said.

Riverside County receives more than 200,000 emergency calls annually. AMR responds to 90 percent of them. So, thousands of minutes are lost in the time it takes AMR to receive and send information.

“There really is an opportunity to look at the system and make it better,” said Bruce Barton, Riverside County’s Emergency Medical Service Agency director.

AMR officials said that for two years they have offered to pay the estimated $63,000 to link to the county dispatch system, enabling them to receive emergency calls simultaneously and reduce response times.

County Fire Chief John Hawkins and AMR officials recently have said they are prepared to link communications.

Hawkins didn’t return calls to discuss Buster’s desire to reorganize county dispatching. In June, Hawkins suggested to county supervisors that they consider charging AMR more money to reimburse his department for medical supplies used during emergency calls to raise about $1.3 million he needs to keep fire stations staffed.

Thomas McEntee, AMR’s general manager in Riverside County, said such a move also would force him to reduce ambulance services, increase emergency response times and lay off employees.

“I’m not sure taking ambulances off the street is the solution,” he said. “There’s a better place to start than that. My concern is response time.”

Barton said Riverside County’s emergency management service is the fourth largest in the state. It should be continuously examined and improved to handle its large call volume. Training dispatchers to prioritize emergency calls and send the appropriate level of services would be part of that, Barton said.

“That’s what we really need to do,” he said. “We need to meet patient needs and do it in the most efficient manner possible.”

In 2008, the San Bernardino City Fire Department for the first time evaluated its call prioritization and emergency medical dispatching system. It found that allowing dispatchers to prioritize calls and provide medical instruction increased availability of emergency services and improved response times to high priority medical calls.

The research also found that dispatchers almost always complied with call prioritization protocols. Less than 7 percent of calls should have received higher priority than what they were assigned.

Mona Boyce, the city’s fire communications manager, said dispatchers are trained to follow strict protocols to make sure callers receive the level of service they require.

“There’s no room for judgment,” she said. “When there is doubt, they are instructed to send everyone out.”

Emergency officials and experts, including doctors, routinely review emergency calls to determine whether protocols should be changed, Boyce said. The system continuously is measured to make sure it works the way it was intended.

“We don’t have the resources to send to every call,” Boyce said. “When you do that, ultimately, it denies someone else who might need the service.”

About the Author
Reach Lora Hines at 951-368-9444 or [email protected] 

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