Ambulance Chasteners

Firefighters and medics in the rural east Valley community of Apache Junction want to get their patients to the hospital in a hurry. So when the local ambulance company is slow to respond, the firefighters transport the patients themselves.

But now the state has told Apache Junction to knock it off, saying the fire department isn't licensed to run an ambulance service.

In what's perhaps the most visible uprising of local cities unhappy over slow ambulance service, Apache Junction plans to apply for the state certification needed to form its own ambulance company. Meanwhile, Southwest Ambulance--an arm of the huge Rural/Metro Corporation that has that market locked up--is threatening to take the fire department to court. Southwest wants thousands of dollars in lost revenue and legal fees it says the fire department has cost the company.

More and more, people in outlying areas of the Valley are outraged and frustrated over what they believe are extreme delays in Southwest ambulances arriving at emergency scenes.

Two years ago, Virgil Strait, a retired mechanic, watched his 37-year-old son, Josh, die of a heart attack in their Apache Junction home.

The fire department got there within a few minutes. But Strait says the Southwest Ambulance crew got lost and arrived late.

"I was frustrated--I had a lot of concern about my son," says the 67-year-old Strait.

It's not clear whether Josh would have lived if the ambulance were on time. But after that incident, the Apache Junction Fire Department decided to spend $30,000 on two new rescue trucks so firefighters could transport patients to the hospital themselves.

Firefighters and paramedics elsewhere also complain of slow response times by Southwest Ambulance. As a result, they, too, are clamoring to create their own ambulance services. But they continue to believe the company will do whatever it can to monopolize business in outlying areas of the Valley in its pursuit of profits.

The Bureau of Emergency Medical Services, part of the Arizona Department of Health Services, requires ambulances in the Valley to respond to Code 3 medical emergencies, such as heart attacks and strokes, within 10 minutes. Ambulances are required to be at the scene within 20 minutes for all emergency calls. State regulations allow a 1 percent margin of error, measured over a year's time. That means that the ambulance is supposed to be on time in 9 out of 10 cases.

But it's that one time that firefighters say can make the difference. Says Apache Junction Fire Captain Paul Gomez, "How would you feel if that were your daughter or son, representing that 1 percent?"

Gomez is one of those who feels like David going up against Goliath, because in many outlying areas of the Valley, Southwest Ambulance is the only game in town. It has contracts for most cities in Maricopa County, except Phoenix, where the Phoenix Fire Department runs its own ambulances. Southwest also serves Pinal County, which includes Apache Junction, and Graham County. On any given day, the company has roughly 60 ambulances in service.

Three years ago, the near monopoly in the local ambulance industry was solidified when Southwest merged with the multinational Rural/Metro Corporation. These days, the only competition comes from Professional Medical Transport; but with only 12 ambulances, PMT is considered a blip on the ambulance service radar screen.

For Southwest Ambulance, it's certainly a lucrative enterprise. The company charges $359.77 as its base rate to transport a patient in its Advanced Life Support (ALS) unit. For Basic Life Support (BLS), not as serious a classification, Southwest charges a little less, $335.39. Add to that about $5.50 per mile and the fees can easily top $400 for just one trip to the hospital.

Southwest says 95 percent of its business comes from non-emergency transfers, such as taking a patient from a nursing home to a clinic for tests. But it insists those transfers don't get in the way of responding to emergencies.

Roy Ryals is Southwest's director of emergency services and a paramedic himself. He says delayed response times are "few and far between," a claim the state EMS Bureau agrees with.

But critics contend that the state gives most of the weight to the records supplied by the ambulance company itself, not to the information supplied by the person making the complaint.

Some cities like Apache Junction are making such complaints, saying that patient care is being compromised. Apache Junction fire officials cite several recent cases in which they say Southwest took too long to get to an emergency scene:

* On January 25, a fire crew ended up taking a possible stroke patient to Valley Lutheran Hospital when a Southwest Ambulance failed to arrive after 15 minutes--five minutes longer than the required response time. A Southwest Ambulance had been dispatched from Greenfield and Main, a station about 20 minutes away from the emergency scene.

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Kathleen Lee