LAS VEGAS -- An adrenaline-pumped race against time through the traffic-clogged streets of southern Nevada. A typical firefighter makes this life or death dash as many as 15 times a day, every day. The stakes are as high as they get.
Eighty percent of the calls have nothing to do with fires. They are rescues and medical emergencies. Firefighters generally arrive at the scene within four to six minutes of getting the call. They decide whether to transport the person to a hospital or turn them over to the private ambulance service that usually arrives minutes later. In the field, there is no rivalry. The public and private crews work together to save lives. At a higher level, however, it's us versus them.
"We work together. We put the patient first. That is what we are both about. The bottom line though is that this is a for-profit company, and they meet 90 percent of their obligation. So, they have a larger profit margin. That we know and that we can prove," said Jeff Hurley, president of the North Las Vegas Firefighters Union.
"Behind the scenes, they have been talking to politicians and making in-roads to take advantage of the economic situation, to say they can do it, and we cut firefighters," said Dean Fletcher with the Las Vegas Firefighters Union.
If firefighters sound a bit paranoid, it's not without reason. Across the country, struggling governments have privatized rescue and transport duties as a way to cut costs. Firefighters think that's exactly what is happening in southern Nevada. They say American Medical Response and MedicWest, southern Nevada's two ambulance companies, are quietly lobbying to squeeze them out.
"I can tell you, point blank, we have no interest in trying to privatize the fire department out of EMS. We value that relationship,"said John Wilson with AMR.
Emergency Medical Services Corporation is the parent company for both Wilson's AMR and MedicWest. According to news accounts in other cities, including Dallas, Cincinnati and Los Angeles, the company openly solicited local governments to take over duties from fire departments.
The core issue for firefighters is response time. Every minute that goes by equates to a 10 percent greater chance that people will die. Firefighters are expected to respond within six minutes at least 90 percent of the time. It's twice that figure for AMR, 12 minutes 90 percent of the time. If they arrive late, they can be fined.
Firefighters say they have trouble getting information from the private companies about how many units they deploy at any given time. So for the past year, they have been documenting late arrivals on their own, reporting what they see in the field and then backtracking through the paperwork later.
"There are multiple times we see them arrive in 20, 25 minutes, 24 minutes. We don't know. We can't control them," said Hurley.
"It is 4,687 times for the first six months. That is documented through the Ambulance Oversight Committee, that AMR and MedicWest have basically told the committee, 'We were late this amount of times.' So, it isn't the union saying it. It is their records that we are using," said Fletcher.
More than 4,600 cases in six months where the ambulances did not arrive within 12 minutes have been reported by the companies to the oversight committee. But, firefighters say it's worse than that, alleging the companies play deadly games to make it look like they arrive in 12 minutes, so they can meet the standard of 90 percent.
They showed 8 News NOW records from 911 calls where AMR's dispatch switches the designated ambulance two or three times in the middle of a single call. They say that restarts the clock. We were also shown cases where the company dispatchers change the address they are seeking, so it looks like a new call, and they can arrive in time. On some occasions, the unions say, the companies call off the fire department by claiming they are already on the scene even when they aren't.
"There was gamesmanship going on. Cancel the fire department. They were never on the scene. They were never en-route. Their vehicle never left their headquarters, and they canceled the fire department," said Hurley.
In one instance, a nine-year-old boy was in respiratory arrest. The ambulance company called in to say it was already on the scene and told the fire department it wasn't needed. The firefighters kept going anyway. When they arrived, they found no ambulance on the scene.
Hurley speculates the boy could have died if they had heeded the call from the company. The fire department now has a policy in place that they cannot be canceled from a call by a private company.
The problem, the unions say, is staffing levels. The ambulance companies maintain their profits by managing, sometimes minimizing, the number of crews on duty at any given time. This became a problem back in September when AMR had to admit to dispatch that it was at level zero -- meaning it had no ambulances available to respond to 911 calls.
AMR did have crews on the streets, just not enough to respond to emergencies for a period of more than four hours.
Wilson says this is the way the system was designed to operate. The fire departments are first responders with primary responsibility for covering all bases. The companies augment the departments.
"That's what makes the system so fantastic. It's a public-private partnership that works. Thirty percent of the time, we're on the scene first," he said.
Wilson says that for 16 years, AMR has consistently met the 12 minutes standard, and that the average response time for his ambulances is seven minutes. Firefighters point out that back in 1999, when Wilson worked for a rival company, he made the very same allegations about AMR's gamesmanship and lack of transparency to the newspaper.
Back then, the agreement called for ambulances to arrive in nine minutes. Today, it is 12 minutes, which AMR says is better overall.
"At the end of the month, they are going to be right there at the 90 percent mark, but they aren't going to do any better, because as soon as they do better, it costs them more money," said Fletcher.
"Their pattern has shown if you made it 30 minutes, they would be there 90 percent of the time," said Hurley.
The I-Team spent several days riding along with local fire units. The I-Team went on perhaps 20 calls for paramedic service. Not once did we ever see a private ambulance get there first. As John Wilson mentioned, however, that isn't what the private companies are necessarily supposed to do.
Firefighters say there is now a more important reason why they need to handle emergency transports without handing them off to ambulances: an astonishing turnaround in the past year.
The I-Team will have that part of the story Friday on 8 News NOW at 5.
