For more than 15 years- I have contended that MAST-EMS- the ambulance/paramedic servicing Kansas City and several smaller Missouri suburbs- does not staff enough units to adequately cover the city.
This Saturday morning from 3 to 3:30am- there were no less than FOUR (4) calls in KC-MO that required EMS units from other municipalities to run in place of MAST- who had no units available to run them.
There were no major incidents occurring at the time and no extenuating circumstances.
Three of those mutual-aid EMS calls went to Johnson County-KS's MEDACT- the other went to Claycomo-MO's EMS.
As far as is known- no patients died as a result of an extended response time from those outside agencies- but one MAST-EMS unit responding to a stabbing on KC-MO's East Side took 15 minutes after the initial 3:11am dispatch time to arrive on that scene.
What do I consider adequate staffing?
Cities such as Grandview and Raytown-MO have at least 2 in-service EMS units for their approximately 30000 residents. Using a rule of thumb of 1 EMS unit per 20000 residents- MAST should have a minimum of at least 22 units in service for the estimated 460000 residents in their service area.
I have never logged more than 18 EMS units in service overnight at ANY given time in KC-MO since I began monitoring for Kansas City news media in 1991.
I have brought this to the attention of the news media outlets that have employed my services to no avail.
Granted this issue is not as "juicy" as things such as the alleged acts of the mayor's wife- perhaps someone dying due to lack of prompt EMS service will bring this seemingly more important and on-going issue to the local news media's attention.
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2 comments:
I work for MAST. My comments are not authorized by MAST, nor do I speak on behalf of the company or its board of directors. I speak only for myself. I'm not in management. I'm a paramedic with MAST.
I take tremendous pride in the work I do, the work our company does, and the service we provide to the citizens of KCMO, Parkville, Riverside, and the many other towns we serve. I love my job, I love my work. And it's insulting to me to read a post so ill informed like this.
There's a few things glaringly wrong with your presumptions.
1. Staffing. Where is your "rule of thumb" coming from? Not research. In fact, no research has ever found any benefit to any particular response time. The MAST response time of 8:59 seconds FROM TIME CALL RECEIVED is among the fastest, best, and most difficult to achieve of any urban EMS service in America.
Many places have a 10:59 or 11:59 response time from time of dispatch. Meaning, as much as a minute can go by before an ambulance is notified. We don't cheat like that. It goes from when the caller speaks to our call center. As such, our times of 8:59, 90% of the time, are already significantly faster than many other cities of it's size.
Further, is there any benefit? You can make dramatic claims about people dying, but fact is, nobody doing good quality research has ever seen any improvement in patient outcomes. Many other factors play into this, particularly in trauma -- scene time, hospital availability, hospital capabilities, etc... not just getting there. There's a lot more to EMS than just getting on scene fast. Nobody in the entire metro can run a trauma better than MAST. We see more shootings, stabbings, wrecks, industrial accidents, falls, assaults, in a single month than most services see in two years. The violence of this city is such that we get a lot of practice. The trauma centers here are fantastic. The people of KC are blessed to have 8 level 1 or Level II trauma centers spread out in the metro.
2. Raytown, Independence, Grandview, North Kansas City, Gladstone frequently call MAST for mutual aid. You fail to log and mention the many times when this happens. It is something studied, carefully controlled, and monitored at MAST. Currently, the ratio of assistance from other agencies coming to help is the same as that going out. Meaning, for everyone one time we call Raytown, they call us once for help in their city.
It is precisely because they have only two ambulances, versus the dozens MAST has, they need to call us.
3. Cost. How much do you want to pay? We could put an ambulance on every single street corner in the city. To cover the entire service area, with an 8:59 response time 90% of the time costs the city of Kansas City and MAST a great deal of money.
KCFD, which has an average of 4-6 minute response time, covers a smaller area than MAST and does for for 10x the cost.
We could do a 4 minute response time. We could staff 60 ambulances. Do you want to pay $130 million a year for it? That's what KCFD costs. They're a top notch fire department. But having that many fire companies, stations, and response time costs a LOT of money.
4. Compliance. MAST is compliant with city demands. Like I said in number one, we have pretty stringent response times. The city ensures the integrity of the times to make sure no manipulations are done, and they ensure that we're meeting the required performance objectives. I don't know what the current figure is, but MAST has been hitting its response times for over 24 consecutive months. I think it's nearing almost 3 years of compliance. That's the longest in company history.
Our cardiac arrest survival rate,
driven in part by excellent response times, is among the best in the nation. It's better than systems that are dramatically more expensive than MAST.
In other words, we kick ass and do it for a great value.
5. Improvements. There's always room for improvements. I strive personally to keep abreast of research, training, and skills. The company is always looking for ways to deliver a better product (911 EMS) and do it for a great value. We're not a profit-making institution. I can tell you this: nobody is getting rich off MAST. I won't be quitting any time soon to sit on a beach.
We're not like AMR or Rural Metro. We're not out to make money off suffering. What little cash flow we have goes right back into our facility, tools, vehicles, and training. Those big white ambulances you see, replacing the little red and white ones, are the newest ambulances we've purchased in decades. Some of those red and white ambulances are 10-20 years old. And the white ambulances are the most bare bones ones we could get that would still do the job.
It's not a frills place. This isn't some rich suburb where everyone has fancy private insurance. We don't do frills or fluff or extra stuff.
6. Long story short. There's time when, like you said, there's just not enough ambulances available. You just cannot anticipate a 911 call. They're random acts. You try and plan for the times when people need them, but for whatever reason, some nights are busy and some nights are not. I worked earlier in the week and we had 28 ambulances sitting around, nothing to do. I ran one call in 10 hours. The kind of cost to have 28 ambulances, 56 people, sitting around waiting. Waiting and waiting.
But what do you want to pay? Really that's what it comes down to. As far as the city government of KCMO said, they want to pay for an 8:59 response time 90% of the time. They could change their mind and say, ok, we want that 8:59 95% of the time.
That isn't what the people of KC or the city government has decided.
MAST is not out there just running some black market EMS under the table. The organization is open to outside scrutiny and inquiry, and invites the media, public or anyone to tour the facility, see what we do.
And the people I work with take tremendous pride in our work. We're are in the places that most people don't want to go, seeing the worst moments in people's lives. Mundane stuff, horrifying stuff. It's a dangerous job, and an under appreciated job.
I personally just don't see that staffing is inadequate on a regular basis. On the contrary, it seems very generous much of the time. To call it understaffed based on your perceptions, using some fabricated rule of 20000 is entirely inappropriate. It's insulting to me, and spits in the face of the work we do.
Thank for for the rebuttal Anon 01:53am.
I was a KC-MO firefighter prior to working for KC news media. I've rode with your supervisors in a citizen-observation capacity and know fairly intimately MAST-EMS's inner workings and know/knew personally several MAST paramedics, EMT's and dispatchers.
As I do people in the fire service- I have the ULTIMATE respect for what you do and PLEASE take note that- in the post- I did not at any time question the service- dedication or training of MAST-EMS people.
So realize what I said and say about KC-MO's paramedic service are NOT simply glaring "presumptions." I document emergency calls from many agencies- unlike any news service in the city or- for that matter- any news service in the region.
So from those perspectives I will attempt to address each of your counter-points with what I perceive.
1. The "staffing" issue.
Yes- MAST is one- if not THE premier urban paramedic services in America. I couldn't think of any other American city that I'd rather have need of EMS in rather than ours. I'm quite familiar with 9-1-1 calls to your dispatch center and the fact most are dispatched right when that call comes in to the center- often literally on-the-air as the information is being typed into the CAD computer there.
Indeed- I KNOW what kinds of calls your service runs. I will admit- not being on the receiving end of your patients- I can't speak with any ultimate authority if any delayed response times killed ANYONE- as first-responders are usually on-scene with some EMT training quickly. That was probably typical news media "shock-value" wording on my part- which may or may not be unfair and or untrue.
Yet those I've known and know who work for MAST have heard my bullet-point (sorry) of not enough paramedic units on the street at those times I have specified (overnight- weekends) and agreed with my assessment that the city is generally EMS-unit understaffed as well as my "rule of thumb" of one paramedic unit per 20000 residents.
Do we have to WAIT for a patients' demise due to this issue before it's addressed publically?
2. The "mutual-aid issue.
Again- during my watch- which is overnight weekends- I'm intimately familiar with who goes where and when. Mutual-aid works when there are other agencies available but it cannot be relied upon in bad and of course worst-case scenarios. I don't think the reciprocal aid theory applies to Johnson County's MEDACT-EMS however- as I've heard our use of them much more than the other way around in my 20+ years of documentation. At any rate- a municipality cannot soley rely on mutual-aid responses to cover short staffing- it's a disaster in the making to do so. I use the number of in-service ambulances communities such as Raytown and Grandview have to make my point of why I think KC-MO is short-staffed. The ratio of ambulances to actual citizens in those communities are actually MUCH LOWER- 1 to 15000- than KC-MO's of about 1 MAST unit per 25000 residents.
3. Cost.
Oh yes- the REAL issue! It's getting the biggest "bang" on the lowest buck. We all do it in many facets of our lives. Yet should that dicate how we PROTECT and SAVE lives in emergency services? You can be the best fire department or paramedic service on Earth and 5 inhabited planets- but if there aren't enough of you to go around when needed that won't do anyone in need a lick of good. And please- let's not be absurd with "an ambulance on every corner"- etc.. My contention was one paramedic unit for every 20000 residents- around 22-23 units on the street at any given time- including overnight weekends.
4. Complience. Okay- we as covered as city officials say we NEED to be. I also contend KC-MO doesn't have enough cops or firefighters on the street at times. I guess if a citizen or visitor suffers because of short-staffing- we can sue the city officials then because it was up-to-their snuff.
5. Improvements. I'm hip to these as I stay informed to them as- if nothing else- a concerned citizen. A big improvement would be more MAST trucks and employees- as I state in my post.
6. Long story short. I stick with my contention 100%. You cannot anticpate a fire or a heart attack- but you damn well had better be adequately staffed when they occur because TIME is of the essence. The response issue is something city bean-counters have come up with- it has nothing to do with public knowledge of the actual situation. We thought our sewer system was fine- until the truth came out. Twin Cities residents also thought the I-35 bridge over the Mississippi was fine until it collapsed last August. In short- often the public doesn't KNOW the facts. That's the job of the free press- to inform them what's actually going down.
I am very sorry- and I sincerely mean that Anon-01:53am- that you are personally insulted by my contentions.
No where in my original post did I insult the ground troops- I simply stated that we need more of them.
I'll buy you a coffee- say thank you and give you a pat on the back whenever you say the word.
Cheers-
"Groucho"
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