Unlike fire departments in many other major cities, the Philadelphia Fire Department has no agreement to call on private ambulance companies when its ambulances are already tied up and delayed answering new calls.
The fact that a system the size of Philadelphia's doesn't have such a back-up program — known as mutual aid — surprises Jim McPartlon, president of the American Ambulance Association.
"In any progressive and quality EMS system, response times should be adhered to and if that can't be adhered to they should have mutual aid." he said.
In Payne's situation, a private ambulance company was just blocks away.
"What if a 9/11 happened here? Would they seriously not put out a call to private companies and just try to do it all themselves?" said Butkovitz, the city controller.
In the 1990s, a growing number of large ambulance companies, such as American Medical Response, started competing with fire departments for the often lucrative emergency response and patient transport market. Fire departments had traditionally handled all 911 calls, and after treating and stabilizing a patient, they left the transport up to an ambulance service.
The "ambulance wars" heated up when fire departments in some communities started fighting back, taking over the entire paramedic business from private companies.
Fire officials insist they are best situated to provide the most effective and professional response.
"If somebody is breaking into your house, do you want the security guard from Wal-Mart showing up to help or the police? Do you see what I'm saying? Do you want to take your chances with some fly-by-night ambulance company?" Kearney said.
But that's not the way Owens sees it. She said she would have taken the chance on anybody if they could have saved her son.
"I feel like it's disgraceful," she said. "Nobody cares in this city anymore. They give you the same excuses. It's manpower. Well, it's been manpower for years now they should call a back-up company or give us another option."
But Philadelphia Fire Commissioner Lloyd Ayers argued that it's just not that simple.
"Our hearts are saddened by the death of Ms. Payne. That's the first thing. We all feel we do the best we can," he said.
Ayers said a great deal of the demand on his maxed-out system comes from the large number of poor citizens who don't have health insurance and use 911 to get to an emergency room for nonemergency care.
"Our first priority is making sure we can answer the demand that's on us," he said. "We are now looking deeply at the resources we have available to us. But we need to educate the public to let them know what 911 is for."
As for a mutual aid system, Ayers said that "nothing is off the table" but added that there are "legal issues and union issues" that have to be worked out.
"I hear a lot of complaints, obviously, but you should see the stack of letters from folks praising us at the highest rates," he said. Even the city controller's report showed that despite all the problems the public indicated a 90 percent satisfaction rate with city EMS services.
No one can say for sure whether a faster ambulance response time would have saved the lives of Payne, Lee, Badway and Rumph.
But it seems everyone agrees that the Philadelphia EMS system desperately needs some emergency care of its own.
City officials have said it will cost $20 million to buy and staff 20 more ambulances to ease the strapped system. That's money Ayers said he would gladly accept if were offered to him.
Until the city can get more ambulances and staff, however, private citizens like Owens are taking matters into their own hands. She started the Daniel E. Rumph II Foundation in her son's name to raise money to buy defibrillators and install them in recreational facilities across the city.
"We need help in this city," she said. "We need all the help we can get."