State officials are considering the city’s request to create its own EMS service provider after the City Council last month approved a “Declaration of EMS Emergency” following years of complaints of slow response times from DeKalb County’s contracted provider, American Medical Response.

But AMR and DeKalb County officials say they continue to work on improving response times to the city and have initiated a plan including adding a permanent ambulance to the city that they is already showing progress.

Nancy Nydam, spokesperson for the Georgia Department of Public Health, which oversees EMS service providers in the state, said the city’s formal request to open the Region 3 “zone” is in the hands of the chairperson of the Regional 3 EMS council.

An American Medical Response ambulance in DeKalb County, from the company’s Facebook page.

If the EMS council decides to open the zone — and no formal decision has been made to do so at this time — the council will establish a date for bids to be accepted and invite licensed ambulance services in the region to submit a proposal, she explained.

The Regional EMS Council would then evaluate the proposals based on economy, efficiency and benefit to public welfare and forward its recommendation to the Department of Public Health for approval or modification. DPH makes the final determination on the zone provider, she said.

The fight between DeKalb County and Dunwoody over AMR’s response times was capped off when an AMR employee was recently arrested for allegedly striking a Dunwoody patient while he was in an ambulance.

Councilmember Terry Nall called for DeKalb County to terminate AMR’s contract and the council is now seeking state intervention. On May 29, DeKalb and AMR entered into an agreement to place one more ambulance at Fire Rescue Station No. 21, located at 1020 Crown Pointe Parkway in Dunwoody to appease the city’s concerns.

This ambulance is in addition to the current AMR fleet of approximately 35 ambulances on the roads during most of the day with about 18 ambulances on the roads during off-peak hours, such as 2 a.m., according to DeKalb Fire Chief Darnell Fullum. The county has a population of about 700,000 people.

Nall said the added ambulance does nothing to persuade him or the council EMS response times will improve.

“We owe it to our citizens to exercise local control over the EMS portion of public safety,” Nall said. “We look forward to working with the first responders of DeKalb Fire in tandem with an EMS provider dedicated to a Dunwoody EMS zone.”

Terence Ramotar, regional director for AMR, recently met with Dunwoody city officials to discuss their concerns.

“We would all like to have a zero-minute response time, but that is not a reality,” he said.

It is a misnomer to think patients are waiting for care while an ambulance is responding to a call, he added. DeKalb Fire & Rescue typically arrives within several minutes to provide any emergency care and then the ambulance transports them to a hospital in a stabilized condition, he said.

What Ramotar said was not anticipated when it signed its contract with DeKalb County in 2013 was that there would an extended “drop time” that keeps ambulances off the roads.

Drop times are the time it takes for an ambulance to transfer a patient to a bed in an emergency room. Historical drop times are in the 15-minute range while DeKalb County’s is an hour, he said.

“One challenge in DeKalb County is the overcrowding of emergency rooms,” he said. “There is an overuse of 911 and an overuse of the healthcare system and these backups are being felt in the streets.”

Ramotar and DeKalb County officials agree that the contract signed between the two nearly five years ago is a bad contract.

“We have been working with DeKalb on the issues of the design of the contract … in the next iteration,” Ramotar said.

A DeKalb County statement said the “root cause” for AMR’s “inexcusable” response times is a poorly written contract in 2013.

“DeKalb County will hire a consultant this month to assess the current contract and recommend improvements. Subsequently, a request for proposals will be issued for new five-year ambulance services,” according to the statement.

DeKalb officials say they have been addressing slow response times by AMR for a year. In early 2017, DeKalb Fire Rescue leadership requested a mitigation plan to improve service delivery. After AMR consistently failed to meet minimum contractual standards, AMR was slapped with $1.5 million in fines.

Fullum said he understands the frustration Dunwoody officials have expressed. “We have recognized there is a challenge here and it will be addressed,” he said. “I’m never happy to hear of long response times in any part of the county.”

Fullum said last year AMR responded to 105,000 calls while the county fire department responded to 83,000 calls. All firefighters are trained EMTs, he said.

An issue he said AMR faces in responding to calls in Dunwoody includes traffic. “The density alone creates issues for travel time,” Fullum said.
Dunwoody is also in the upper corner of DeKalb County that Fullum described as being “very narrow.” When an ambulance responds to a call and transports a patient in North DeKalb to a hospital, typically to Pill Hill in Sandy Springs, there are not ambulance units available from all four directions — north, south, east and west — available as there are in other parts of the county, especially Central DeKalb County where most emergency calls originate.

Another issue facing EMS not just in DeKalb but across the country is a shortage of paramedics and EMTs, Fullum said.

Nall is convinced the best thing for Dunwoody’s 50,000 residents and the 120,000 people who work in the city every day is for the city to operate its own EMS service.

“We are still underserved,” he said.

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