Report: Oklahoma Ambulance Systems "Critical and Unstable"

Oklahoma's emergency ambulance systems have funding problems and manpower shortages so severe that lives are jeopardized because heart attack and accident victims can't get to hospitals quickly enough, preliminary findings of a state task force indicate.

An interim "Critical and Unstable" report from the governor's Emergency Medical Services Task Force paints an unsettling and often bleak picture for the future of statewide ambulance services -- unless changes are made.

Initial findings were released to the state Board of Health; a final report is due Oct. 1.

A worst-case scenario, health authorities said, is the eventual collapse of the emergency medical system. In that case, rural 911 callers would be given basic care instructions and told to take the best available transportation to the closest hospital because no ambulances are available.

"This is a very real threat in the most rural parts of the state, where transport times are already very long and resources stretched very thin," said R. Shawn Rogers, emergency medical services director for the state Health Department.

Ten ambulance services -- in sizable towns such as Wynnewood and Vinita and the smaller hamlets of Kemp and Quapaw -- recently have closed. Other towns that have lost ambulance services are Picher, Commerce, Barnsdall, Kremlin, Garber and Wakita. Others are in jeopardy.

Oklahoma has 160 ambulance services.

"We definitely have a crisis on our hands in emergency medicine," said Jimmy Johnson, president of Life EMS, a private ambulance that serves Enid and much of Garfield County in northwestern Oklahoma. Johnson is a task force member.

Some Oklahoma ambulance services are hospital-based while others are taxpayer subsidized or are private, for-profit businesses.

Medicare cuts for emergency care, uninsured patients, a rapidly aging population and funding shortfalls are among the reasons for the problems.

Uninsured or under-insured patients account for more than 30 percent of ambulance runs in Oklahoma City and Tulsa, said Rogers, who is overseeing progress by the governor's task force.

The past fiscal year, according to state records, Medicare was billed $94 million for ambulance runs to assist Oklahoma senior citizens on Medicare.

But ambulance companies only received $52 million from the federal government for those Medicare patients.

Support for medical services Rogers said most 911 calls in Oklahoma are for ambulance assistance, but few communities support emergency medical services to the same extent they support other public safety agencies such as police and fire departments.

A shortage of paramedics and emergency medical technicians, or EMTs, also contributes to the problem, Rogers said. Those ambulance personnel make about $22,000 a year.

Rural Oklahoma is in a particularly precarious position, the task force reported.

"EMTs and paramedics know that Oklahomans are stoic folks, by and large. When they finally call for an ambulance, they are usually at death's door, and every second counts," Rogers said.

"The dispatch phone rings, and the clock starts. For the citizens of Wakita in Grant County and Garber in Garfield County, the clock runs a lot longer since the loss of their ambulance services," Rogers said.

"A person having a heart attack in either city used to be able to count on an ambulance arriving almost immediately -- within five minutes in Wakita and six minutes in Garber," he said.

Now the Medford ambulance takes about 15 minutes to get a crew and drive the 16 miles to Wakita, and Life EMS from Enid takes about 20 minutes to make the 19-mile drive to Garber, Rogers said.

"Lost minutes mean lost lives," he said.

A best-case scenario, health authorities said, would see regional ambulance systems in Oklahoma with minimum response-time standards.

Those regional services still would have strong first-responder systems providing immediate life-saving interventions.

Then, experienced paramedics with strong medical direction would soon follow to treat further and transport to a hospital.

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