A state subcommittee charged with evaluating DeKalb County’s emergency response system postponed Oct. 4 making any recommendation on establishing a new EMS zone in Dunwoody until after the first of the year. The postponement allows the county to continue to address concerns raised by city officials, including slow ambulance response times as well as the contract between the county and a private ambulance service provider.
The subcommittee members did agree, however, that DeKalb County EMS has serious issues that need to be resolved and ordered two additional ambulances be stationed in Dunwoody as soon as possible to try to ensure quicker response times in the city. Doing so puts the number of ambulances stationed in the city at three.
“There is a problem in DeKalb,” said Clayton Deputy Fire Chief Richard Elliott, chair of the subcommittee.
“If not, we would not get to the point where we are today,” he said. “I think DeKalb has admitted there is a problem.”
The next meeting of the full Region 3 EMS Council is Nov. 8.
The subcommittee plans to meet again Feb. 7 and determine if there is a need for a new EMS zone in Dunwoody. The full council then meets Feb. 14 to consider the recommendation.
In May, the Dunwoody City Council declared an “EMS Emergency” calling for its own EMS zone. They said the county’s contracted ambulance service provider, American Medical Response, was not meeting the national standard response time of under nine minutes on most 911 calls and was often taking much longer.
That declaration led the Region 3 EMS Council, which advises the state Department of Public Health about setting ambulance contracts and zones, to form a subcommittee to look at EMS service throughout DeKalb and make a recommendation on Dunwoody’s request for its own EMS zone.
At the Oct. 4 meeting, the subcommittee members seemed pleased with the efforts DeKalb and AMR were taking and did not appear eager to support a new EMS zone. But they all agreed something needed to be done to improve EMS services, particularly in Dunwoody, while at the same time they supported a “holistic” effort that included improving services throughout the county.
“It has been well documented there are obvious serious concerns about response times in the city of Dunwoody,” said Marietta Assistant Fire Chief Chris Whitmire. “I respect what Dunwoody said and they want and deserve improved service, but I think for now it’s best to work with DeKalb.
The city of Brookhaven has also noted slow AMR response times. Rather than supporting Dunwoody in creating a smaller EMS zone separate from DeKalb County, however, city staff is collaborating with county officials to put a ambulance station at a former QuikTrip on Buford Highway. Brookhaven recently purchased the shuttered QT located across from Northeast Plaza and is working with county and AMR officials to station three ambulances there.
The major issue now being addressed is the contract approved five years ago between DeKalb County and AMR.
The current contact was “doomed to failure,” said Cobb County Medical Director and ER physician Eric Nix at the Oct. 4 meeting.
Currently, AMR bills patients directly for their service, rather than billing the county. The contract includes the provision that AMR pay the county $750,000 a year, which Dunwoody officials argue should be invested in EMS services.
The contract also mandates AMR respond to 90 percent of its calls in under nine minutes, something Dunwoody officials have complained for several years does not regularly happen in the city. Reasons for slow response times include heavy traffic and extended waits at hospital emergency rooms where ambulances must wait oftentimes more than an hour for a patient to be admitted, keeping the ambulance from responding to other calls, according to AMR officials.
DeKalb has assessed fines of nearly $1.9 million against AMR for the slow response times in the past year.
DeKalb’s contract with AMR expires Dec. 31. A new request for proposal is being drawn up now with the aid of AP Triton, an EMS consultant the county hired after Dunwoody declared an “EMS Emergency.”
DeKalb Fire Chief Darnell Fullum said at the Oct. 4 meeting that AP Triton plans to meet with all of DeKalb’s municipalities on Oct. 18 to gather their input to be included in the new RFP.
“We know there needs to be a new contract,” Fullum said.
Fullum said the new contract would include standard response times for calls that require a paramedic with an advanced skill set, and “tiered” response times for calls that are not life-threatening.
Dunwoody officials were angered at the subcommittee’s meeting last month when an AP Triton representative said response times were not that important in determining patient outcome. All members of the subcommittee came out to say response times do matter, as did Fullum.
“We know responding quickly is important. But we also know the public trusts we will be there,” Fullum said. “Response time are an important part of any system.”
DeKalb Fire currently sends a fire engine and ambulance to a majority of 911 calls, Fullum said. “Response times have to be a part of [the contract], but with non-life-threatening calls where the response time can be a little longer will be appropriate as well,” he said.
Another provision in the new contract will likely include allowing cities to pay extra to “enhance” their EMS services, Fullum said.
“That has to be part of the agreement,” he said. “Right now, the AMR contract is silent on that … and this will be clearly defined in the new agreement.”
Sandy Springs, which has its own fire department, also contracts with AMR for ambulance services and considered this year paying $650,000 for two new ambulances in the city.
With AMR’s contract with DeKalb County expiring on Dec. 31 and an RFP not slated to be finished until early next year, the county will likely have to extend its contract with AMR. For how long remains unknown.
County attorney Viviane Ernstes told the subcommittee the county is in the beginning stages of the RFP process, including negotiations with AMR or other providers. But she said the Oct. 18 meeting with the cities is crucial to finalizing a contract to be put out to bid.
“The meeting with the cities will have to happen first,” she said.
Dunwoody Mayor Denis Shortal addressed the subcommittee at the close of the meeting reiterated the city’s position that the concern over EMS service in the city is not a new one and has been raised to county officials for several years.
He asked for but did not receive a definite timeline for when the two new ambulances would be stationed in the city, other than the knowledge that question would be raised at the full Region 3 EMS council meeting on Nov. 8.
“The situation has been allowed to go on,” Shortal said. “It’s time to correct it.”
In an interview after the meeting, Dunwoody City Councilmember Terry Nall, who has led the city’s effort in seeking its own EMS zone, said having three ambulances stationed in Dunwoody gets the city back to where it was in 2013, before DeKalb contracted out its ambulance service to AMR.
He was not impressed with the county’s recommendation that city’s pay extra for enhanced EMS service.
“They should not be asking cities to pay extra just to have a recognized national standard on response times,” he said.
“We all pay taxes to Dekalb and we insist, we demand, we expect higher levels of service from the ambulance service,” he said.
DeKalb County Commissioner Nancy Jester attended the meeting and in an interview she said the contract between DeKalb and AMR is “substandard” and predates her as well as many other commissioners and city administrators.
“Nobody on the commission is happy with the current contract,” she said. The new contract will have “bells and whistles,” she said, including a provision to allow cities to pay for an “upgrade” in EMS services.
“We’re going in the right direction and I feel very optimistic,” she said.