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.


July 26, 2016

Dear Mayors Denson and Ferrelle,

Please excuse the length of this email, but I can’t stay silent any longer. As a concerned citizen, I read with interest the July 26, 2016 Online Athens article regarding the police and fire personnel who acted together to save the life of a member of our community. As an American Heart Association CPR instructor for the last 30 years, I can tell you that it’s these kind of stories that keep me going. As in so many medical and traumatic emergencies, it’s the rapid response that makes all the difference in patient outcomes. As a result, it was dismaying to read the quote from the article, “Stuart had stopped breathing, and was lying on the sidewalk with his eyes open,” Hicks recalled. “Sgt. Rivera and his team literally saved Stuart’s life. Although it took the ambulance 15 minutes to get to the scene, the team of police and fire/rescue were calm, professional, and skilled.”  This excessive EMS response time is an all too common occurrence in our community, but please don’t take my word for it. Talk to our police and fire personnel and give them the freedom to respond candidly. Give them an opportunity to take a survey where they can freely express their experience and concerns.

I’ve told police officers before (and I will tell them again) that I will run through a brick wall to help them if they are ever injured and I am in a position to help. So I am deeply saddened by every conversation I’ve ever had with an Athens-Clarke County or UGA police officer regarding EMS response times in our community. There is a deep and universal concern about our EMS response times and how it negatively impacts our citizens. The concern runs deep enough to hit home and they fear that if they, or a colleague are ever injured in the line of duty that there would be a life-threatening delay in emergency medical care. Like the fireman who tells me that he tells his coworkers that, “If me or my family are ever injured in a wreck in Athens just get us to the hospital by private vehicle or any way you know how, and I will absolve you of all liability.” Or the police officer who told me that he and his colleagues are concerned enough about terrible EMS response times that they are beefing up their trauma kits to self-administer first aid in the event they are shot or stabbed while on duty. This officer was considering moving to another police force. Again, don’t take my word for it. Survey our police officers and firemen. Give them anonymity. Ask them some basic questions and give them the freedom to respond candidly. Simple, direct questions like: Rate your satisfaction with our EMS providers’ response times to emergency calls. (Very Satisfied, Satisfied, Dissatisfied, Very Dissatisfied)  Have you experienced delayed EMS response times to emergency medical calls? (Yes/No)  If you answered yes to the last question, please feel free to comment. And lastly, If you were injured in the line of duty do you feel confident that our EMS providers would respond in a timely manner?”


Earlier this week a Charter Communications technician came to my house to fix our internet. Before he could leave our driveway the landline was ringing with a survey regarding the service. We owe it to our public safety personnel (and the citizens of our community) to determine if there is an issue in this critical area of public safety. Again, it’s not really important what I think. The opinion of those who put their lives on the line every day to make our community safer, should be valued.

Respectfully yours,

Sam Rafal

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