Fire Suppression

As ambulance delays mount in Chicago, city tries to cover up the problem by urging dispatchers not to talk about it over the air.

Rather than add trauma-ready ambulances to reduce the sometimes-alarming Chicago Fire Department response times in Chicago, city officials appear to be taking another tack: Trying to cover up the problem.

The Better Government Association and CBS2 recently obtained a memo in which a city official urges dispatchers to stop sounding so alarmist over the radio when ambulances aren't available to immediately respond to 911 calls.

If you don't see the video above, click here and watch it on CBS2.

In other words, soft-pedal it on the air when there's a shortage of "advanced life support," or ALS, ambulances. (They handle trauma cases including gunshot wounds and heart attacks, while "basic life support" or BLS ambulances handle less severe medical problems.)

According to the memo, dispatchers should not say: "No ALS ambulance anywhere close, you'll have to use BLS ambulance 82."

Nor should dispatchers say "We have no ALS available . . . the best we can do is BLS ambulance 86."

"Rather," the memo states, "we want to use a more measured message like '[Engine] 38 your ambulance is 86.'"

memo fire suppression ambulance
Memo sent to dispatchers (Click to view larger image)

The memo further advises, "Try to provide the needed information in a manner that makes the message clear but using a minimum of specifics. . . . Hopefully we can get the message across without highlighting the fact that no ALS unit is available."

Why would Chicago's Office of Emergency Management and Communications (OEMC) – which handles dispatching for police, fire and paramedics – want dispatchers to water down their language about ambulance runs?

Probably because the media can monitor such radio transmissions through store-bought scanners and over the web. In fact, the BGA and CBS2 helped document the city's apparent ambulance shortage in several recent stories by listening to dispatcher radio traffic online.

"It's a cover up," said Patrick Fitzmaurice, a Chicago paramedic field chief who has portrayed the ambulance shortage as a crisis that's putting lives in jeopardy. "What else could this mean? They were stupid enough to put in a memo. That shows how desperate they are."

But Melissa Stratton, a spokeswoman for OEMC, said the memo was simply a reminder for dispatchers to use approved language.

"It's an informal internal document that was distributed [in February] . . . by a supervisor on the Fire Operations Floor to call takers and dispatchers, with the intention of reminding them to use the approved protocols for radio dispatch," Stratton said via email.

Over the past year or more, CBS2 and the BGA have chronicled a series of problems related to the city's ambulance fleet – including how the vehicles are aging, breaking down and often so busy they aren't available to respond to emergencies right away. Those troubles are raising concerns for the sick and injured that rely on a quick and safe transport.

CBS2 and the BGA recently discovered more instances in which there were serious delays in ALS ambulances responding to a scene.

On Feb. 10, it took roughly 26 minutes for Ambulance 9 to reach the 12600 block of South Marquette for an elderly woman complaining of shortness of breath, according to city records and interviews. Why it took the ambulance 26 minutes to travel roughly five miles is unclear.

A BLS fire engine was on the scene within about eight minutes of dispatch – but such rigs can't transport patients to hospitals and that was still much longer than the state guidelines of six minutes from dispatch to arrival for an ALS-equipped vehicle.

Luckily, the woman survived.

"The response time for Ambulance 9 to the 12600 block of South Marquette was unacceptable," fire department spokesman Larry Langford said via email. "We are not going to speculate on the cause, and the Chicago Fire Department is currently in the process of determining why the response time exceeded its target."

Discipline of fire personnel is possible, Langford said.

Even more troubling was a March 3 incident involving an elderly person with chest pain. An ALS-equipped fire engine – with life-saving equipment, but not the capacity to transport a patient as would an ALS ambulance – was on the scene within about five minutes of the incident, according to interviews and city records. But OEMC didn't dispatch the responding ALS ambulance for roughly 22 minutes. It took another 11 minutes for the ambulance to arrive for a total of 33 minutes from the 911 call to the ambulance's arrival on the scene. This person survived as well.

At the time there was a high volume of calls coming in and no ALS ambulances were available. The double whammy mistakenly pushed the run down the queue, officials said.

"We have reviewed this particular call, and while a paramedic-equipped ALS engine was dispatched within a minute, there was a delay in the dispatch of an ambulance," Stratton said. "We are re-educating the Fire Operations Dispatcher about departmental dispatch protocols to ensure the delivery of timely EMS service and response and he will be monitored."

Last month the BGA and CBS2 reported that a woman was hit by a two-ton postal truck right by City Hall and had to wait 16 minutes for an ambulance to arrive. A 911 call for chef Charlie Trotter, who died from a stroke in November, saw a lengthy delay for an ambulance as well.

Numerous fire department paramedics relayed anecdotally to the BGA and CBS2 that delays are worsening, largely because there aren't enough ALS ambulances on the street.

The department doesn't track ambulance metrics in such a way to analyze the issue.

There are usually 60 ALS and 15 BLS ambulances available at any given time. BLS ambulances lack the equipment, medicine and paramedic staffing that ALS ambulances have. Additional fire engines have ALS or BLS equipment and paramedics on board.

The union representing Chicago firefighters and paramedics is in the midst of contract talks with Mayor Rahm Emanuel's administration, which also oversees OEMC.

The fire department is in the process of a resource allocation study to see if ambulances should be headquartered in other parts of the city to counterbalance population shifts, and is also considering converting some or all of the BLS ambulances to ALS, Langford said. The department is also scheduling paramedic classes so it can hire more paramedics.

Although the city has denied there's a real ambulance shortage, the dispatcher memo acknowledges the obvious: "We all realize that at certain times we are inundated with runs and lack of resources."

About the Author

Patrick Rehkamp

Patrick Rehkamp is responsible for fielding and evaluating tips, conducting research and interviews, forging and fostering media partnerships, and facilitating the release of BGA findings.