When 911 Does Not Mean Immediate Help
October call came close to ‘system failure’
(11/12/2009) Alone at home in Montauk on Oct. 22, Mary Stewart, a 90-year-old, felt weak and had mild chest pain, so she dialed 911. A dispatcher answered her call. Tones sounded over the emergency services radio
 Durell Godfrey
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frequency and then came an announcement: “Elderly female, weak, Stewart residence. . . . “ It was 1:34 p.m.
An East Hampton Town police officer was on the scene in five minutes, but no ambulance personnel responded.
The call was reactivated three times over nine minutes. Then the mutual aid system for the East End was activated, and Amagansett, the nearest neighboring district, was asked to help. When its volunteers did not reply, the call went out for a crew from Springs.
Next, at 1:51 p.m., came a call to East Hampton, then one to Bridgehampton, and then to Sag Harbor.
Twenty-four minutes after Mary Stewart had first called for help, at 1:58 p.m., Bridgehampton confirmed it had volunteers available. They reported to the firehouse near the Candy Kitchen, climbed into an ambulance, turned on its lights and siren, and sped toward Montauk.
Thirty-six minutes after Ms. Stewart’s call for help went out, the Bridgehampton ambulance passed Town Pond in East Hampton Village with another 16 miles yet to travel.
The Bridgehampton ambulance arrived at the house at 2:28 p.m., 54 minutes after the initial call. It left for Southampton Hospital at 2:40 p.m.
Calls for Help
A three-part series
Part one: Mutual Aid
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Ms. Stewart’s situation was not unique. Across the South Fork, fire districts have come to rely on one another when their own emergency crews are unavailable. Montauk is by no means the district with the highest rate of mutual aid calls for 2009. In Springs nearly 1 in 10 calls so far this year were answered by volunteers from a neighboring district.
Ms. Stewart said she was not sure precisely when the ambulance pulled into her driveway that day, but that “it was a long time.” She had more than enough time to change out of her pajamas. “Then, I’m sitting, and waiting, and waiting, and waiting,” she said. “I just sat and waited.”
She said she wondered why the Montauk volunteers, many of whom she knows from around town or from previous emergency calls, never came. The crew from Bridgehampton told her no one else was available. Still, she said, “when somebody calls, and it’s supposed to be an emergency, you come, right?”
The ambulance taking her to Southampton Hospital left her house at about 2:40 p.m.. arriving at the emergency room at 3:17 p.m. It turned out that she had acid reflux caused by medication. A day later, she was released from the hospital and went home.
“What’s a Bridgehampton bag doing here?” Calvin Stewart Jr. of East Hampton recalled asking his mother when he noticed that an emergency medical technician’s supply kit had been left behind at the house.
He said he was “more surprised than she was” that she had waited so long. “She always spoke so highly of them” after previous calls for assistance, he said. He also wondered why an ambulance had come so far out of its district.
Members of the Montauk Citizens Advisory Committee said at a meeting on Nov. 2 that it was unacceptable to have an ambulance from Bridgehampton responding to a call. The length of Ms. Stewart’s wait was “extremely rare,” Richard White Sr., a member of the Montauk Fire District Board of Commissioners, said this week.
“It’s not something we like to have happen, but it’s better than having nothing at all,” he said of the mutual aid system. “The system works.”
The system came about as an alternative to standards set by the Suffolk County Regional Emergency Medical Services Council. Based on the council’s recommendations, a bill proposed in 2004 would have required ambulance companies to respond within nine minutes 90 percent of the time — or risk losing county liability insurance and state certification.
The Montauk Fire District’s 25 ambulance volunteers are on a pace to answer about 700 emergency medical calls this year. As of Tuesday, 4.8 percent of their calls had been answered by other districts this year.
According to records provided by the East Hampton Village dispatchers, who handle 911 calls for the districts from Bridgehampton to Montauk, 9.5 percent of Springs calls went out of district. Springs Fire District representatives did not respond to repeated requests for comment.
Amagansett needed mutual aid 3.8 percent of the time, while East Hampton, which handles the largest number of calls on the South Fork, had 3.6 percent. Sag Harbor needed help 3.3 percent of the time. Bridgehampton had mutual aids of 1 percent.
A 30-member board, the emergency medical services council has representatives from out-of-hospital emergency medical care providers, doctors, and county officials. It is responsible for coordinating emergency medical services in Suffolk.
When the council proposed setting a time limit for emergency calls in 2004, it encountered strong opposition from South Fork officials, who said it was unrealistic given that their fire districts are larger than those in western Suffolk. Many volunteers saw it as a push toward replacing them with paid emergency medical technicians.
While the South Fork balked, and the bill failed, the system did change. Some fire districts, notably Southampton Village, have hired paid personnel with advanced training to help provide service, and districts farther west, like those in Islip township, hired commercial ambulances to be on call.
On the twin forks, volunteers formed the East End Ambulance Coalition, whose members came up with an alternative: Calls are reactivated over the radio every three minutes. If volunteers within the district have not responded within six minutes on an advanced life support call (heart attacks and strokes, for example), or nine minutes on a basic life support call (such as Ms. Stewart’s), the dispatchers radio neighboring districts for help.
By all accounts, a call has never gone all the way around to the five South Fork ambulance companies without being picked up — something some ambulance officials would consider a “system failure.” Depending on whether the call is for basic or advanced life support, it would take 21 to 24 minutes to go around.
Mary Mott, the president of the East Hampton Ambulance Association, has called the system “response without borders.” Helping one another out is what the system is all about, said Bridgehampton Fire Department Chief John Healey, whose department oversees the ambulance company that responded to the call at Ms. Stewart’s house.
On Monday, he said it was no “big deal” that his department’s volunteers had to travel to Montauk for a call. “It happens seldom. I don’t think we’ve been to Montauk in years. I don’t think it happens enough to cause concern,” he said.
“Is it system failure or just because it’s a volunteer organization?” said of why the call took so long to answer.
“Yes, it’s a problem, but it happens so infrequently,” said Mr. White, who has been in the Montauk Fire Department for 45 years and volunteers as an ambulance driver. “For Mary Stewart, it was the biggest problem, and we realize that,” he continued. “If it had been me, it would have been the biggest problem, too.”
With no data available on average response times and little supervision of the day-to-day operations of each corps, it is up to each ambulance squad to ensure that its system is fail-safe, said Ed Stapleton, the chairman of emergency medical services council.
Reached by phone at the State University at Stony Brook, where he is an associate professor of emergency medicine, he said, “I think it’s important for every corps to look carefully at their situations, and do what they can to ensure a 24/7 response.” He has called for “stronger medical direction” of each of the 105 autonomous emergency services entities in the county.
Mr. White did not offer an explanation as to why no one signed on to Ms. Stewart’s call last month, except to say that it is more difficult during a workday to get crews together. He said he has responded as a driver to calls that are “mutual-aided” to another district because a Montauk E.M.T. does not respond.
While the company has squads of six people on call every night, as do most ambulance corps on the East End, it does not have anyone standing by during the day this time of year.
Summer months are a different story. Because the company answers 70 percent of the year’s calls during the 12 weeks between Memorial Day and Labor Day, officials started a program called Good Sammy Day six years ago. Volunteers sign up for day shifts and commit to staying in the district, listening for calls, and responding.
Capt. Ken Glogg, during an interview this summer, said the idea was to ensure that there was always at least one basic emergency medical technician available during the day.
“A regular trip is a minimum of three hours, and that’s on a good day with no traffic,” Mr. Glogg said. State law prohibits all drivers from using emergency lights and sirens on the trip back from the hospital.
“Sometimes you just don’t have two and a half hours — you have kids, you have appointments, it could be one of 100 reasons you can’t go,” Mr. White said.
“If we had more volunteers the chances of that happening are less and less” of calls going unanswered, he said. “We do the best we can with what we’ve got.”
With Reporting by Janis Hewitt