Deborah Payne, Rotan Lee, Ricky Badway and Danny Rumph all have something in common. They're dead. And they died after waiting anywhere from 19 minutes to more than an hour for an ambulance in Philadelphia.
The latest incident occurred just a few weeks ago, in the early morning hours on New Year's Day. According to a Philadelphia Fire Department timeline, Payne dialed 911 at 2:30 a.m.
New Year's Eve is traditionally one of the busiest nights of the year, so all the EMS vehicles were out on other calls, although a fire department engine truck was dispatched right away to Payne's address. Firefighters are allowed to administer oxygen and basic first aid, but they're not allowed to take the sick to a hospital.
And so Payne and the firefighters waited. And waited. According to the fire department timeline, an emergency vehicle finally reached Payne about an hour after her first call, only to break down. Payne died while waiting for a second EMS vehicle to arrive.
It's a story Candy Owens said sounded sickeningly familiar. On Mother's Day in 2005, Rumph, Owens' 21-year-old son, was playing a game of pickup basketball at the Mallery Recreation Center in Philadelphia when he collapsed at 10:30 p.m. His friends dialed 911. They also called Owens.
"It was horrible. I watched my son die. It was the worst experience of my life," Owens said. According to Owens, it took an EMS crew 41 minutes to arrive, traveling halfway across the city.
The national standard for response time by emergency vehicles is eight minutes and 59 seconds or less. But according to a city controller's report released last month, one-third of Philadelphia's ambulances took 10 minutes or longer to respond in 2006. And there are just 28 ambulances in full-time service for a city with a population of 1.5 million.
Demand Up, but Supply Scarce
Philadelphia City Controller Alan Butkovitz said he ordered the study of the EMS system because of some troubling information.
"We know that since 1999, demand for ambulance services has almost doubled," he said. "We had been hearing about problems from paramedics for years now."
Butkovitz said his report showed that although the recommended average number of runs for an emergency unit is 2,500 to 3,500 a year, several vehicles in Philadelphia have handled more than 8,000 runs a year. And those vehicles are subject to break down more often because they are in use almost constantly. The report also found that "poor morale among many paramedics is fueling discontent and increasing turnover." In fact, the paramedic turnover ratio is now more than 50 percent.
"Here's the deal. People wait a long time every day. Pretty much every day somebody is having a delayed response. Somebody is waiting a long time. And somebody is getting a fire truck and going without an ambulance every day," said Dave Kearney, a 20-year EMS veteran who is now a firefighter and secretary of the Philadelphia Fire Fighters Union.
Kearney said the members of a typical Philadelphia EMS crew get their first call as they walk through the door at 7:30 a.m. and they might get back to the station "once that day."
Private Services Out of the Loop
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."