Delays Spur Ambulance Policy Changes 

By Chris Paschenko
The Daily News
Published January 5, 2008

DICKINSON — Recent policy changes to the county’s ambulance service could help ensure 911 emergency calls aren’t delayed by its paramedic crews answering lucrative nonemergency transport calls. 

When a private ambulance company stopped answering calls in Galveston County in June 2005, it became the fourth such service to leave the county in 10 years.

This left small cities without reliable ambulance service, and the cities formed a mutual-aid agreement with Galveston Emergency Medical Service, which is publicly operated without taxpayer subsidy by the Galveston County Health District. 

Dickinson officials are concerned the agreement, which is designed to provide backup ambulance response to participating entities, has at times left the city with unacceptable delays for emergency ambulance service. 

Dickinson Fire Marshal Norman Hicks recently told the city council and administrators about an incident that left the city without timely ambulance response, because the Dickinson service was assisting another jurisdiction. 

The delay, Hicks said, was the result of Galveston EMS using 911 emergency ambulances to answer profitable, nonemergency, hospital or care-facility transfer calls, while relying on Dickinson to answer its emergency calls. 

Hicks described one such occasion from Nov. 29, in which Dickinson’s ambulance answered a mutual-aid call in San Leon and attended to a woman having breathing difficulties. 

No Ambulance For Overdose 

With Dickinson’s only ambulance out of town, a Dickinson resident called 911, reporting her 18-month old grandchild possibly overdosed on prescription blood pressure medication. 

Hicks said Galveston’s ambulance service was not on an emergency call when Dickinson was asked to go to the medical emergency in San Leon. He said the Dickinson unit called dispatch to inquire on the status of the Galveston ambulance, which serves the San Leon area. 

“The unit was advised by dispatch that Galveston County Medic 6 was not showing to be on an emergency call at the time,” Hicks said. 

“While Dickinson Medic 1 transported the patient to St. John Hospital, another emergency call was received in Dickinson.” 

The health district said none of its 911 ambulances answered transport calls that day, but it was unclear why the county’s ambulance didn’t take the call. 

With the Dickinson service unavailable, dispatchers rely on the mutual-aid agreement to find the nearest ambulance to the emergency call, which Hicks said happened to be in Texas City. 

Hicks said firefighters trained in emergency medical response went to the woman’s home, but wouldn’t have been able to take the child to the hospital. Exactly how long it would have taken an ambulance to arrive at the home is unknown. 

Dickinson first responders checked the toddler’s vital signs, and the woman took her grandchild to a nearby medical center, where she was placed under observation for about six hours, treated and released. 

Policy Changed 

The district tracked ambulance transfer calls from Oct. 1 through Oct. 19 and found it had to use paramedic-equipped, emergency 911 ambulances 57 times to answer nonemergency transport calls. 

After meeting with Dickinson administrators Dec. 14, officials with the Galveston County Health District made immediate changes to try to rectify the issue, said Michael Carr, director of emergency medical services for the Galveston Area Ambulance Authority. 

The district enacted a policy that its two 911, paramedic-equipped ambulances that cover the mainland would only answer emergency calls. 

It also moved a supervisor, Trey Frankovich, from within the district to manage transfers, and it is advertising for a dispatcher’s position to handle transfer calls. 

Efficiency Sought 

Frankovich, who has 19 years with the district, said some transfers — much to the dismay of hospitals and other care facilities — were being delayed from four to six hours. 

“We’re bringing in extra units and handing off some of those transfer calls to outside agencies,” he said. 

“It should be a dramatic difference. We’ve had no complaints on the length of calls, and they’re not being delayed more than two hours.” 

Carr, who has been with the district 29 years and worked 12 as an ambulance paramedic, said the district added an additional peak-time ambulance before the holidays, bringing the number of transfer-only units to five. Two of those are staffed 24 hours a day, and the remainder work in 10-hour shifts. 

Dickinson officials questioned whether the money spent on a supervisor and dispatcher would be better used adding more ambulances. 

Frankovich disagreed, saying better managed transfers have led to more efficient use of ambulance crews and resulted in fewer scheduling delays. 

“We’ve moved to a proactive mode and fixing things on the go,” Carr said, “whereas in the past it was less efficient.” 

He noted some hospital-to-hospital, or hospital-to-home transfers were delayed two hours before the district sought help from outside agencies. 

Dickinson Adds Ambulance 

When asked if one ambulance was sufficient to handle Dickinson calls, regardless of a mutual-aid agreement, Hicks said the city has budget constraints, but it has staffed an additional ambulance that operates from noon to midnight. 

“We’re trying to implement that ambulance to full time, but for now we’re just using it for peak time,” Hicks said. 

Dickinson City Manager Julie Johnston said the city council will likely discuss the mutual-aid agreement during its Tuesday meeting, but the matter isn’t listed as an action item on its agenda. 

Kurt Koopmann
Public Information Officer
Galveston County Health District
Office (409) 938-2211
Cell (409) 392-0007

kkoopman@gchd.org