Responding to the city of Dunwoody’s alarm over long ambulance response times, a state board Aug. 9 decided to quickly study the creation of new EMS zones to speed up arrival times in DeKalb County. That could mean localized service in such cities as Dunwoody and Brookhaven.

Meanwhile, the county is rethinking its ambulance service model, with a consultant reviewing options for keeping it privatized, bringing it in-house, or a combination of the two.

An American Medical Response ambulance parked outside Dunwoody City Hall during a state board’s Aug. 9 meeting about controversies over the company’s emergency response times. (John Ruch)

All of the review comes amid complaints about private contractor American Medical Response, which officials say regularly fails to meet contractual response times and has left sick and injured Dunwoody residents waiting for 30 minutes or more. But a big question is whether anything can happen before AMR’s contract with DeKalb expires on Dec. 31—and what happens then.

In May, Dunwoody declared an “EMS emergency” over poor ambulance response to such situations as an 18-month-old suffering seizures and a woman with a head injury who later died. On Aug. 9, the Region 3 EMS Council, which advises the state Department of Public Health about setting ambulance contracts and zones, met at the notable location of Dunwoody City Hall to consider the city’s request for its own EMS service zone. The EMS Council approved forming an “ad hoc study committee” of its members to review possible new zones, essentially giving Dunwoody the consideration it asked for and the first step in possible city-provided EMS service or other county-created alternative.

Dr. John Harvey, the EMS Council chairman, said that response times are a difficult issue in a busy urban area and metrics are “not as easy as getting a stopwatch and measuring how fast somebody can run to something.” But, he added, DeKalb and Dunwoody’s situation is a “serious issue.”

“It was a very successful meeting for us,” said Mayor Denis Shortal, who testified to the EMS Council, praising the EMS its decision to speed the review along. The committee is to be formed and meeting within about two weeks.

Dunwoody Mayor Denis Shortal testifies to the Region 3 EMS Council about the ambulance response time issue. Behind him are, from left, City Manager Eric Linton and City Councilmember Terry Nall, both of whom also spoke. (John Ruch)

Councilmember Terry Nall, who has driven the city’s protests about ambulance response times, was also among those testifying. He also praised the EMS Council’s decision after the meeting, though cautioning it was just “the first leg of a multi-leg race” and that the county could be “behind the eight ball” on the current contract’s year-end expiration. County officials did not have immediate comment on the contract expiration.

DeKalb Fire Rescue Chief Darnell Fullum is one of the EMS Council members. He called the county’s contract with AMR “poorly crafted” and with “a lot of areas that are lacking.” He noted the contract went into effect in 2013, the year before he started the job.

Fullum said the county has hired the public safety consulting firm AP Triton to review the ambulance service, propose alternatives and work on a request for proposals for whatever the final service might be. The firm’s report is expected by the end of August.

However, Fullum said there are some clear ideas already for improvement, including developing a “tiered” system of prioritizing calls instead of treating them all as worthy of the same response. He described one possible public-private hybrid option as a system where in-house DeKalb ambulances respond to high-priority calls and private ambulances to lesser emergencies, or vice-versa. And in the meantime, he said, the county may add still more ambulances to the fleet after a previous increase after Dunwoody’s May emergency declaration.

DeKalb County Fire Rescue Chief Darnell Fullum, center with badge, speaks about the AMR contract as he sits on the EMS Council during the meeting. (John Ruch)

A big question going forward, Fullum said, is whether the county would pay “subsidies” for additional ambulances, as some other local cities do. Right now, the county doesn’t pay AMR at all; instead, the company gives the county money for every response. Dunwoody officials say that set-up is backward and creates the wrong incentives.

An AMR official attended the meeting, but did not testify and only briefly commented to the EMS Council that the company was reviewing its service. AMR has previously said that among its challenges are long paperwork times at hospital emergency rooms.

AMR has been controversial both nationally and locally for long ambulance response times. After similar complaints in south Fulton County cities, the state in May approved changing the EMS contract there to Grady. AMR caused further concern by saying it wanted to pull out of its lame-duck contract there earlier than expected. At the Aug. 9 EMS Council meeting, member Steve Moyers, a representative for Fulton County, reported that south Fulton is seeing a “smooth transition” to Grady EMS.

Nall said that Dunwoody is not the only concerned city that might be helped by the DeKalb review. The city of Brookhaven previously said it is reviewing local ambulance response times and reported some longer than allowed under the county contract. Nall said Brookhaven officials have “dissatisfication” with AMR but are letting Dunwoody take the lead.

An internal city memo obtained by the Reporter shows that Brookhaven has struck a deal with DeKalb Fire Rescue and AMR to station an ambulance at a QuikTrip gas station on Buford Highway that the city recently purchased for possible development. “This will be a year‐long pilot program to determine the impact on response times,” said City Manager Christian Sigman in the June 29 memo. The deal has yet to be voted on by the Brookhaven City Council.

“There is no deal, but we are exploring that potential,” said Brookhaven city spokesperson Burke Brennan. “If it, or something like it, happens, it should help response times in north DeKalb.”

In a written statement, Sigman said Brookhaven is also in discussions with the county and AMR.

“We are working closely with DeKalb Fire and AMR to develop solutions to improve response times in Brookhaven,” Sigman said. “We are monitoring Dunwoody’s efforts and there may ultimately be a nexus in our efforts to improve response times in northern DeKalb County. I applaud AMR and DeKalb County in their active engagement in developing solutions to this basic public service.”

Response time ‘emergency’

AMR’s contract treats all of DeKalb as a single response zone and the company promises that ambulances will arrive within 8 minutes, 59 seconds in at least 90 percent of the calls—an industry benchmark that varies widely in practice.

Top Dunwoody officials told the EMS Council that the contract is not working by either numbers or by a sense of safety.

City Councilmember Terry Nall, at podium, speaks to the EMS Council during the Aug. 9 meeting. (John Ruch)

Nall said the Dunwoody public is “very scared” and wondering whether they should even call 911 “versus stuffing an emergency patient in the car and hauling it to the hospital.”

City Manger Eric Linton said the contract was “designed for failure” with its lack of metrics and the lack of incentives with the company paying the county for calls.

Police Chief Billy Grogan reviewed a city-hired consultant’s statistics on AMR response times within the city, saying they were “unacceptable and putting lives at risk.” He said that in January through April of this year, 31.9 percent of ambulance response times were over the 8 minute, 59 second mark. The average was 10 minutes, 55 seconds; the “90th percentile” of worst response times averaged to 18 minutes, 38 seconds.

After the May emergency declaration and AMR putting more ambulances on call in the city, just over a quarter of responses were still longer than the benchmark, Grogan said.

On May 16—days before the emergency declaration—police and firefighters called AMR for a pedestrian hit by a car on Tilly Mill Road, Grogan said. The call went out at 7:45 a.m. and the ambulance did not arrive until 8:48 a.m.—and no other ambulance was available in the entire county, Grogan said.

Dunwoody incorporated in 2008 to ensure more local control and independence from DeKalb government, and there has sometimes been ongoing political friction. Shortal emphasized that such cases show the ambulance concerns are not from a “snap decision, whim or political motivation.”

Deputy Chief Joseph Lumpkin of DeKalb’s public safety office agreed with the reality, saying that “we recognize this is a flawed contract. This contract does not do what we want it to do.”

–Dyana Bagby contributed

Update: This story has been updated with comment from the city of Brookhaven, and to correct the name of American Medical Response in a photo caption.

John Ruch

John Ruch is an Atlanta-based journalist. Previously, he was Managing Editor of Reporter Newspapers.