Statements to ACC Mayor and Commission

April 3, 2018 – First of all, I want to thank you for your concern about the Commission candidate who experienced having to tell his emergency twice through our dispatch system and then have a delayed ambulance response. I understand this is a big deal for ONE individual and his family, but there are 100’s, probably thousands, that have had this experience in the past and will continue to experience this in the future as long as the current business model of abandoning zones to run non-emergency transports continues.
I wanted to begin to address the position paper given to you by the EMS “Oversight” Committee about why, in their opinion, response times don’t matter. Does anybody else find it suspicious that after years of refusing to release their response time data that National EMS and the “Oversight” Committee have suddenly taken the position that response times don’t matter?
First of all, most of the “bullets” on that position paper had to do with red lights and sirens (RLS). I find this odd for several reasons. One, National EMS responds to medical emergencies with red lights and sirens, as they should. Secondly, we have known about this data since the 1980’s which is why we tell medics when responding to heart attacks to cut their lights and siren a couple of blocks from the scene. Lastly, if you are returning to the hospital with an extremely time critical heart attack patient who needs a life-saving procedure at the hospital, then it gets a little more complicated, and the driver has to exercise good judgement. I have told National EMS and the “Oversight” Committee before, “We are not asking you to drive faster, or to drive unprofessionally. We are asking you to be closer, so stop abandoning your coverage zones for non-emergent reasons.”
Another interesting component of their paper was the quote from the article, The Great Ambulance Response Time Debate. What the “Oversight” Committee failed to point out is that the person quoted asking the question, “Do response times really matter?” is the Associate Director of a for-profit Emergency Medical Service speaking to a conference of for-profit EMS providers. Also, the “Oversight” Committee didn’t include in their handout the very next line in the article. It reads, “Obviously, there are certain high-acuity calls that require a timely response, i.e., cardiac arrest, shock, myocardial infarction, to name a few.” End quote. These are EXACTLY the kinds of calls Bob and I have been talking about when we have said National EMS is playing Russian roulette with our citizens.
I want to close tonight by touching on one of those high-acuity calls, severe trauma. There are mountains of research from the United States military that are directly applicable to civilian use. There are even organizations like The Committee for Tactical Emergency Casualty Care whose sole purpose is to “speed the transition of military medical lessons learned from the battlefield to civilian medical response.” In 2009, Secretary of Defense Robert Gates mandated adherence to the “Golden Hour” rule in battlefield trauma. A 2015 study documented the effect. According to the U.S. Army Institute of Surgical Research and the Texas A&M Health Sciences Center College of Medicine, “The first hour after a medical trauma has long been viewed as the difference between life and death. Cutting the average transport time in half also cut the fatality rate nearly in half equating to 359 lives saved.” That’s 359 potential Gold Star families who don’t have to endure that tragedy directly due to the fact that we are focusing on the “Golden Hour” and the “Platinum 10 Minutes.” We have a moral obligation to our citizens to hold fast to what we know works.


March 6, 2018 – Good evening everybody. My name is Sam Rafal. It’s hard to summarize the last 3 years in 3 minutes, but I will try. An Athens-Clarke County police officer tells me that he does not feel secure in the knowledge that if he were to be injured in the line of duty that an ambulance would be there in a timely fashion. Another police officer tells me the same thing. And another. And another. Then one says “we’re just waiting for the right person to die”. Has the right person died yet? Then a firefighter tells me exactly the same thing the police officers are saying. Then my wife comes home from her new job at a Clarke County Elementary School and tells me that out of the blue a coworker tells her that, “This is a great school. We have great teachers, we have wonderful kids, but this is not the place you want to be if you ever need an ambulance.” What!?! If an Athens-Clarke County elementary school is not the place to be if you need an ambulance, where do you need to be? Then at a so-called Oversight Committee meeting I asked the owner of National EMS, in the presence of my son, “If my son, or a member of my family has a life-threatening emergency, can you assure me that the 911 ambulance designated to cover our zone won’t have been pulled to run a non-emergent transport?” The question seemed to upset him and he responded angrily, “No!” So, what am I supposed to do? Accept that?! Uhh, I don’t think so.
A few weeks ago, I was in a meeting with the assistant city manager, the mayor of Winterville, and Bob Gadd. We added Chief Scarbrough to the meeting via the telephone. I asked Chief Scarbrough, “Does the EMS Oversight Committee care about response times?” His answer was honest, clear, and direct. “No, they don’t.” Folks, that’s a problem. That’s a very, big problem….AND it explains everything. Every conversation I’ve had on this matter with police officers, fire fighters, teachers, elected officials. It also explains the total lack of transparency from National EMS in regards to response time data.
Personally, I do not believe Chief Scarbrough buys into the philosophy that “response times don’t matter”. I further believe the best-case scenario for running a professional EMS system in Athens-Clarke County would be a fire department-based EMS service.
Lacking that, we need to challenge National EMS to stop abandoning state mandated EMS response zones to run non-emergency transports or find a company that will. We need to ask the contract holder to rebid the contract annually (or at least bi-annually) and to consider companies like Grady EMS, a company that serves 12 counties in Georgia running an ambulance service with protected 911 ambulances. We believe that your opinion would carry weight on this issue. Lastly, we do not believe that the Athens-Clarke County government should be a contributor to a contract with a company that is not willing to give reasonable and important information to the people they serve. Thank you.

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