Why did it take Hall Ambulance more than 20 minutes to arrive at the scene of a terrible motorcycle accident in metro Bakersfield?
You’d think that wouldn't be a difficult question.
But even after digging at it for a while, I don’t have a complete answer to what happened that Easter night.
The initial question, though, did illuminate how our ongoing ER glut is causing systemic problems for ambulance companies that should give us all pause.
First, here’s what happened the night of April 16.
About 9 p.m., Belinda Wylie’s husband shouted that someone had hit a car right in front of their house at Calle Lechuga and Via Contento. The neighborhood is just south of the Westside Parkway and east of Renfro Road.
Wylie, a nurse, rushed out to see a man who’d been riding a dirt bike without a helmet on the ground terribly injured. He had apparently hit a parked SUV.
Wylie immediately started CPR as another neighbor, an off-duty Bakersfield Fire Department captain called 911.
That call was recorded as coming in to the Bakersfield Police Department at 9:01 p.m.
The fire captain tells the dispatcher the man is very badly injured, has a weak pulse and agonal breathing (involuntary gasping) and that Wylie is performing CPR.
That neighborhood is in Kern County Fire Department’s jurisdiction so the call was transferred to the county through the Emergency Communications Center, or ECC, and dispatched out to Fire Station No. 67, 2 miles away at Brimhall and Renfro roads.
For, as yet, unknown reasons, however, that dispatch wasn't made until 9:11 p.m., a full 10 minutes after the first 911 call, according to a report of the incident provided by the Kern County Counsel’s office.
It was also dispatched as a "Priority 2" call, rather than the most serious "Priority 1" status, which requires a faster response.
The ECC dispatch also went to Hall Ambulance, which deployed its vehicle from Ashe Road and White Lane, according to John Surface, vice president of corporate operations for Hall. (BTW, Hall Ambulance is owned by former Bakersfield Mayor Harvey Hall.)
That’s about 7 miles, or 14 minutes away.
Sure enough, the ambulance arrived at 9:24, 13 minutes after the call from ECC.
But 23 minutes from the first 911 call.
“Everyone there was astounded it took them so long,” Wylie said. “I just felt so helpless.”
The motorcyclist died that night.
Wylie said he was so badly injured, there’s no guarantee he would have lived had the ambulance arrived sooner.
But why did it take so long?
“If someone had had a chance of surviving, I feel like they would have died in the street waiting for help,” she said. “I feel like we’re not protected.”
Worse, another neighbor, Blake Hiatt, tried to find out why such a basic service was so delayed and ran into a brick wall — no answers.
Hiatt contacted me and, as I said, I never was able to pin down exactly why it took 10 minutes for that initial 911 call to be dispatched.
I was told transferring such calls from city to county within the ECC is typically seamless.
Clearly there was a glitch.
Even so, per the county's contract with Hall, the ambulance was two to three minutes past its required response time that night.
The county allows Hall exclusive operation in Bakersfield and many outlying areas and in exchange, the company must hit required response times a minimum of 90 percent of the time every month.
For a Priority 2 call in metro Bakersfield, that time is 10 minutes, per EMS ambulance standards posted on its website.
Though the ambulance isn't considered "late" until 60 seconds has elapsed. Meaning the true "get there or else" time is 10 minutes and 59 seconds.
Either way, Hall missed the mark.
Surface was quite aware of that fact, he told me.
“We take late responses very, very seriously.”
Indeed, he said, Hall has routinely met its response time obligations year in and year out.
Until the last two years.
Hall didn't meet its times in metro Bakersfield for October 2015 and again for July 2016, according to EMS. That's just a pass-fail without specifics such as the number of times per month the target wasn't met.
The metro Bakersfield area is the busiest of Hall’s exclusive operating areas, with the greatest potential for harm if Hall can’t get to patients quickly.
Having “not met” on a monthly report is a big deal.
So why is this happening?
In a word: Obamacare.
The Affordable Care Act gave a whole lot more people access to Medi-Cal coverage.
Instead of using it to see a primary care doctor, many, many, many of those new Medi-Cal recipients are using the benefits to go to the ER for regular health care.
ER visits have gone up nearly 30 percent between 2009 and 2016 at hospitals across the city.
And a lot of those folks are using ambulances to get there, according to Surface.
That alone ties up ambulances, but that’s not the biggest problem.
Ambulance crews can’t just plunk patients in an ER waiting room and squeal off to the next emergency.
They are obligated, by law, to make sure the patient is handed to the next level of care.
That means crews are stuck waiting right along with patients in overcrowded ERs.
Sometimes up to three hours, Surface said.
On some busier shifts, Hall is now stationing managers at hospitals to ease patient flow so ambulance crews can get back to the streets.
“The state didn’t prepare for the increase in people with access to services by also increasing the infrastructure,” Surface said. “And these delays are affecting us dramatically.”
The problem has been brought to the state’s attention, which recently started requiring county EMS offices to track patient offload times.
How to reduce those offload times is a whole other issue.
And it's a statewide problem, said Bakersfield Fire Department Deputy Chief Tyler Hartley.
Some cities have taken interesting steps to alleviate the ambulance/ER squeeze.
The Anaheim Fire Department, he said, has created a “paramedicine” program where a physician assistant and paramedic go out with firefighters on nonemergency medical aid calls to determine if the person really needs a trip to the ER or can be helped at home.
“It’s like a house call for a nonemergency patient,” Hartley said. “They can be treated on scene and don’t have to tie up an ambulance or wait on the wall in an ER.”
Surface acknowledged innovation is needed.
“It’s a big challenge for us,” he said.
Sounds like a challenge for the entire community.