Ambulance response times in violation of Tulare County contract


When the Three Rivers Ambulance disbanded in 2010 after more than a half-century of service, those involved with this all-volunteer, nonprofit, community resource knew that emergency response times, especially in the outlying areas of Three Rivers, would never be the same. But the beloved local volunteer ambulance had no choice; its EMT I and II responders could not meet new state regulations that required all ambulances be staffed by highly trained and better equipped paramedics.
In that same year, the Tulare County Board of Supervisors negotiated an agreement with Central California Emergency Medical Services Agency (CCEMSA) in Fresno. CCEMSA oversees emergency services in Tulare, Kings, Madera, and Fresno counties.
The agency negotiates ambulance contracts and develops strategy ensuring that all the areas of the counties are served within prescribed response times. The 2010 contract called for an ambulance to be stationed at Lemon Cove and response times to Three Rivers be 15 to 20 minutes. 
Eight ambulance companies divided up the hundreds of calls and rotated crews to cover busy areas. According to reports delivered annually to the Tulare County Board of Supervisors, the majority of the providers made their prescribed response times on more than 95 percent of the calls. 
A source close to the former local ambulance said for a time Three Rivers received mostly dependable service and had very few calls that were longer than 20 to 30 minutes ­— and some of these were in the farthest reaches of the community. 
Apparently, that record of dependable response times was affected when American Medical Response pulled out of Tulare County in 2016. 
The company cited that they were plagued by labor issues and the fact that the majority of Tulare County patients had no insurance or policies with high deductibles. The company also claimed they were never paid for many of these transports nor could they refuse a patient transport under the CCEMSA contract.
The 30 percent of the calls American Medical Response handled, CCEMSA claimed, could be covered by the other seven providers dividing these up, so each were taking a few dozen more calls. CCEMSA assured that Tulare County would not notice a decline in service.
But in the past year, the outlying areas — like Three Rivers and Elderwood — have noticed a decline in service especially in the critical response times. The death of Brieann Hendrix, 36, a resident of Three Rivers, is one case in point.
On Saturday, Aug. 12, Brieann suffered a seizure and she became unconscious. Her family called 911, and the first responders — Tulare County Fire Department personnel — were on the scene in 15 to 20 minutes. 
The firefighters, who are also trained EMTs, tried to revive her. During that critical 20 to 30 minutes from the time of the 911 call, a person on the scene reported that the patient had a “shockable rhythm,” meaning it might have been possible to restart Brieann’s arrested heart with a medical intervention of medication or defibrillation. 
By the time paramedics arrived with the ambulance and necessary equipment, it was too late and Hendrix could not be revived. The witness reported that the ambulance did not arrive until more than 40 minutes after the 911 call.
Other response times for Three Rivers have been reported recently of more than 40 minutes and some more than 50 minutes. The ambulance assigned to cover Three Rivers is no longer parking at the Lemon Cove Fire Station as was the protocol in the past several years, but instead is parked at the intersection of highways 198 and 65 or in Exeter.
“Tulare County Health and Human Services Agency officials are researching ambulance response times as a result of these recent inquiries,” said Kuyler Crocker, District 1 supervisor.
Crocker also said that the County does not provide ambulance service but they do monitor their contract with CCEMSA. A phone call Wednesday to reach Dale Dotson, CCEMSA EMS operations coordinator, for comment was not returned.    

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