September 16, 2010 at 1:00 am

Charlie LeDuff

Detroit paramedics fear they're losing the battle to save lives

Ride along with Detroit paramedics as they battle ...
Ride along with Detroit paramedics as they battle ...: The Detroit News’ Charlie LeDuff, in partnership with Fox 2 News, finds that response times for paramedics in Detroit can be dangerously long.

Detroit

Nobody knows how deathly slow the Detroit ambulance system is better than the paramedics themselves.

Take the case of Detroit Fire Department paramedic Dave Smith, who late last month, was dispatched on a heart attack call to a dialysis center on the city's east side. When he and his partner arrived, the attendants were standing at the threshold, upset.

"We called you over a half-hour ago," they shouted.

Smith made his way to a man slumped in a chair in the back of the center. After a few furious moments trying to resuscitate him, Smith's eyes wandered up and settled on the victim's face.

"Uncle Alvin?" he croaked.

"I was lost and bewildered," Smith recalled. "It's bad out here. Real bad."

Smith attended his uncle's funeral the following Thursday. He called in to work sick to his stomach.

It happens all too often in this city. You call 911. Granny fell, you tell the operator. Or a woman's been shot. Or a man has gone into cardiac arrest. Then you wait for an ambulance. And you wait some more.

No one really knows what the ambulance response time is in Detroit, but for people who work in the ambulances for a living, they say it is unacceptable.

One problem, according to a 2004 city audit of the Emergency Medical Services (EMS) system, is that Detroit is the only major American city that does not allow a firefighter or a police officer to aid a victim before the ambulance arrives. Another problem is substandard communication equipment. Since that report was issued, at least two hospitals have closed and the EMS system has been decimated by staffing cuts causing ambulances to drive farther.

"And you have to ask me why I moved from Detroit to Sterling Heights?" Smith said.

Competence questioned

Over the past month, the troubled Detroit Fire Department has found itself trying to convince an angry public that it has not abandoned them. The latest debacle was a windblown inferno that torched at least 70 homes across the city. It was so bad that an 11-year-old dressed in a T-shirt and sneakers was pulling hose for the overwhelmed Fire Department. Firefighters from Warren, Dearborn and Grosse Pointe were called in. Mayor Bing passed it off as a natural disaster.

But even before the fires, the competence of the department was called into question after a string of blunders in the past month related to its ambulance service. In August, firefighters from Engine 50 pulled two victims from a burning building. They requested two ambulances. No units available, they were told. A man cut off his toes with a lawn mower. Again, no unit available. Most shocking, perhaps, occurred when a building collapsed on six firefighters, half of whom were taken to the hospital in squad cars and fire trucks because there were no ambulances on the scene. If that is how people in uniform are treated, imagine what it is like for the average citizen in the dark of night.

Fire Commissioner James Mack Jr., who also oversees the EMS system, said the morning after the fires the department's problems aren't a matter of mismanagement but poverty.

"Everybody knows we are under budget constraints, so with those budget constraints we are maximizing the equipment that we have and the manpower that we have," Mack said.

Some city leaders aren't buying it. Consider that today the Fire Department budget is $175 million, more than it was five years ago, even after adjusting for inflation.

"What's wrong with the city?" asked City Councilman Gary Brown, who believes there is room to cut in the Fire Department's $175 million budget. "A vacuum in leadership. It's not a matter of funding. I suspect it's mismanagement."

Brown asked Mack -- who served for six years as the second deputy commissioner under disgraced former Mayor Kwame Kilpatrick -- to deliver within 90 days a comprehensive plan to bring the ambulance response time down to a targeted eight minutes, which is the national standard. That was 170 days ago and Brown is still waiting for the report.

Mack made a claim to Fox 2 News a few weeks ago that the average response time in Detroit for an ambulance to arrive on a 911 call is 12 minutes -- even while admitting that often there are no units available to get to calls.

According to that 2004 audit, the two-year average at that time was about 12 minutes. And that was before the city cut its paramedics and emergency medical technicians by nearly 40 percent.

As a comparison, the city of Grosse Pointe reports its average ambulance response is five minutes. Dearborn's is four minutes. Warren's is 5:35.

In 2005, there were 303 paramedics and EMTs working the streets and the EMS division of the Fire Department had a budget of nearly $25 million. Today there are just 188 paramedics with a budget of nearly $23 million. With that many fewer paramedics, what happened to their estimated $11.5 million in salaries and benefits?

"That's a fair question to ask," said Irv Corely, director of the City Council's fiscal analysis division.

Apparently, the money was not poured into equipment repairs. Fire Department officials admitted to the City Council in March that half of the department's 48 ambulances were broken down and that 24 were needed to adequately cover the city each day. Nevertheless, the administration budget over that period has increased nearly $1 million.

The Fire Department's finances last were audited in 2008. The auditor general found then that EMS system administrators failed to "manage revenues and accounts receivable" and "controls over cash receipts are inadequate."

Neither Mack nor Deputy Mayor Saul Greene, who is in charge of all public safety, returned repeated calls.

When asked if Mack was preparing the EMS overhaul plan, Karen Dumas, a spokeswoman for Mayor Dave Bing, said: "I would assume he is."

System failing

Paramedics have no problem talking. Wisam Zeineh, a paramedic and president of the Detroit EMS union, and his partner Richard Cadoura want you to see it. They invited a reporter to tail them on an ordinary night. A Thursday. Wet. Warm. Average. They were assigned to the Medic 8 ambulance.

The first call came at 8:26 p.m. A 102-year-old grandmother suffering from dementia had fallen in the street. Medic 8 was dispatched from midtown about 10 miles away, near the city border with Lincoln Park. "Medic 8, where are you?"

"On 75, still en route," Zeineh replied.

The city's target is an eight-minute response time. This run took more than twice that. "What if she was dying?" said neighbor Sheila Neely.

It works like this in Detroit. An emergency call goes to a 911 dispatcher. Then, it's routed to fire dispatch and then dispatched to the ambulance. A layer of bureaucracy with a precious two to four minutes wasted, according to a random check of run records.

It's like that all night long, like the buzz of a fly. Medic 8, where are you? The ambulances are not equipped with a computer ($2,800 at imobilepc.com), a dashboard GPS ($299 at BestBuy) or a road atlas ($12 at Rand McNally/large print).

While the state does not require navigation systems, most municipal ambulances have at least a road atlas. In Detroit, a city of 140 square miles, paramedics work directions from memory. Many times in Detroit, the streets don't have signs.

'It's ridiculous'

Another call. A woman was convulsing at McDonald's with her children looking on. But it was across town at Fenkell and Wyoming. When the ambulance arrived, nobody was there.

"I called like 25 or 30 minutes ago," said the manager LaJohne Graham. "The police came and took her. It's ridiculous. The cops' (job) is to arrest. And they're transporting to the hospital. It's ridiculous."

Of the dozen or so calls Medic 8 received, the average response time was about 20 minutes, the distance covered more than 100 miles and that was in the rain.

In the dead of the evening, paramedic Sherry Kurek, standing outside Detroit Receiving Hospital, recalled a run from the previous week. It took 20 minutes to reach a woman with massive heart failure on the west side because, according to the run sheet, Kurek was dispatched from the east side. When the ambulance finally arrived, the family was trying to give the woman CPR. Kurek took over from there, but the woman was pronounced dead at the hospital.

The next day, Kurek said her supervisor told her she shouldn't have wasted the time.

"He told me I did too much," she said. Unbelievably, in cases like that, the paramedic may leave the body and continue on with ambulance calls even if the police or coroner are not on the scene to remove the body.

"What was I supposed to say? I'm sorry I'm late and she's dead?" said Kurek, a lifelong Detroit resident. "I hope I don't ever need an ambulance in the city of Detroit. I know the crews would do what they could for me. But am I going to get one?"

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Detroit paramedics respond to a shooting Sept. 2 on the west side. Many say ambulance response times are too slow in critical situations. / Elizabeth Conley / The Detroit News
Detroit paramedics Wisam Zeineh, left, and Richard Cadoura wait for their ...
Detroit paramedic Wisam Zeineh rides with a patient Sept. 2 as they drive ... (Elizabeth Conley / The Detroit News)
Paramedics in the city often are not able to arrive until about 20 minutes ...