# Ambulance refuses to transport Cleveland man shot 16 times



## OREMT (Feb 6, 2018)

http://www.cnn.com/2018/01/30/us/cleveland-no-ambulance-trnd/?iid=ob_mobile_article_footer_expansion


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## OREMT (Feb 6, 2018)

The central problem in this story is not one that I encounter in my area, so I'm curious - have any of you ever dealt with a situation like this before? Where an ambulance can't respond to a patient because of service area boundaries?


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## CALEMT (Feb 7, 2018)

Look up mutual aid. If a call drops in a neighboring city (A) and said city (A) has an available unit then they will respond a unit. You just can't freelance calls out of your service area.


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## DesertMedic66 (Feb 7, 2018)

“All EMS units were tied up at a house fire”...


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## Jim37F (Feb 7, 2018)

Misleading headline. Makes it sound like a crew was dispatched but refused the call when according to the article one was never dispatched in the first place, so there was no "ambulance refuses to transport"....


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## DrParasite (Feb 7, 2018)

Multiple issues, including the misleading headline.

Cleveland EMS DID refuse to respond.   The Cleveland officer was the one who requested Cleveland EMS to respond.... but he had left Cleveland and ended up in Euclid, so he was operating out of his area, and requested Cleveland EMS to respond out of their area.  So the real question is, what the refusal inappropriate, or was the initial request for service inappropriate.  I'm thinking the latter.  

I've worked in both the field and communications, and just because a police or firefighter end up outside the town limits, doesn't mean they call their home EMS agency to help them out; they call the appropriate agency where the incident is occurring it. It's one thing for the ambulance to be driving by an area where the incident occurs, where the border is a little fuzzy, and for them to pick up the patient and take them to the hospital.  It's a different thing to direct them to respond into another agency's coverage area, without a request from said agency, for a call.

What SHOULD have happened (which the article fails to mention) is the Euclid police officer should have contacted their dispatch for an ambulance, and Euclid dispatch should have utilized their mutual aid system (which may or may not have included Cleveland EMS, I don't know), and requested an ambulance to respond.  If Cleveland was indeed closer, than someone with authority to deviate from the protocol (if Cleveland wasn't' in it) should have called Cleveland's dispatch center and asked them to respond.

Even the statement from the Euclid Chief is misleading: "If this had happened in Cleveland near the Euclid town line, without question we would have responded," Haddock said.  So does that mean that Euclid routinely jumps calls in Cleveland that are near the border?    Is this an acceptable practice?  Or does he mean if Cleveland requests help from Euclid EMS, from Euclid's dispatch center, Euclid will send a unit?  I'm better he means the latter, but wanted to make his town look good even though the screw up seems to be caused by them


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## Benjamin123 (Feb 7, 2018)

They Should have called him a taxi
https://www.google.com/amp/s/amp.azcentral.com/amp/1000186001


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## CALEMT (Feb 7, 2018)

I saw the article on Facebook a couple days ago and was wondering when it was gonna make it on here. The comments were something else and quite funny to be honest. It showed A) nobody read he entire article and jumped straight to conclusions and B) the public has no idea how emergency services really operate. I.e mutual aid and what not.


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## BobBarker (Feb 7, 2018)

I remember one time a car ran over a fire hydrant and tried to flee the scene with its tires flat and water gushing into the air/street and other cars were almost crashing into each other trying to avoid it. When I called 911, I got bounced around 3 times because I was on the border of 2 cities. Took them over 5 minutes just to dispatch. I was pissed on the phone. I finally told the last operator to send both departments and have them figure out who's jurisdiction it is when they get here. Glad I wasn't shot on the sidewalk while they figured out the city's boundaries with each other.


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## WolfmanHarris (Feb 7, 2018)

Interestingly, provincial regulations governing Paramedic services in Ontario direct that the closest available Ambulance will service an emergency call regardless of municipal boundaries (Counties/Upper Tier Municipalities are response for EMS). This includes bordering areas and units passing through.


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## DrParasite (Feb 8, 2018)

Billy D said:


> I remember one time a car ran over a fire hydrant and tried to flee the scene with its tires flat and water gushing into the air/street and other cars were almost crashing into each other trying to avoid it. When I called 911, I got bounced around 3 times because I was on the border of 2 cities. Took them over 5 minutes just to dispatch. I was pissed on the phone. I finally told the last operator to send both departments and have them figure out who's jurisdiction it is when they get here. Glad I wasn't shot on the sidewalk while they figured out the city's boundaries with each other.


So you called from a cell phone, which may or may not have been routed to the appropriate agency (it's a cell phone, no guarantee you are connected to the right dispatch center, especially if you are on a border), and then did you give them the correct location?  or was it on the border, so you weren't sure which town you were in?  If the wrong department were to show up, they might not be able to even shut off the water, and the cops might have been tied up on more important calls.

and it's a car that ran over a fire hydrant, no life threats, yes, there is some water on the ground and repairs will need to be made, but it's not really a life threatening emergency.  maybe they were busy dealing with the person who was shot on the sidewalk to be considered with a minor water hazard with no real emergency?





WolfmanHarris said:


> Interestingly, provincial regulations governing Paramedic services in Ontario direct that the closest available Ambulance will service an emergency call regardless of municipal boundaries (Counties/Upper Tier Municipalities are response for EMS). This includes bordering areas and units passing through.


I'm guessing you have AVL or GPS in every ambulance in the province, and a centralized dispatch center with all their locations to ensure the nearest ambulance is always sent, right?

and do you not have the issue in the rural areas, where in the assigned ambulance from middle of nowhere transports to the big city, then they get sucked into the busy call volume and population areas where said hospital is located?


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## WolfmanHarris (Feb 8, 2018)

DrParasite said:


> I'm guessing you have AVL or GPS in every ambulance in the province, and a centralized dispatch center with all their locations to ensure the nearest ambulance is always sent, right?
> 
> and do you not have the issue in the rural areas, where in the assigned ambulance from middle of nowhere transports to the big city, then they get sucked into the busy call volume and population areas where said hospital is located?



Dispatch Centers are with a few exceptions run directly by the province and cover large areas though there has been a big push to download operation to the service providers. All vehicles use the provincial FleetNet radio system (along w/ OPP) and have AVL. There are issues with seemlessness in border areas but neighbouring dispatch centers will automatically do a call share to determine closest vehicle and send it. 

This hasn’t been without controversy. For instance the City of Ottawa has complained about vehicles getting pulled into the dramatically under serviced Gatineau area which is in Quebec. Conversely Renfrew County which is exclusively rural/remote has taken issue with being pulled into Ottawa, but these are exceptional circumstances. 

While rural trucks may get hit with the odd call in the city this isn’t a common problem. I work full time in an area neighbouring Toronto which is by far the busiest urban system in the province. We do border calls regularly but losing a truck to calls deep in the city is rare. 

It’s not a perfect system and our CAD technology is terribly out of date with planned major upgrades seeming to take forever, but with health care being public and a provincial jurisdiction (with Paramedic services being a municipal download of that jurisdiction with operating costs split between) the expectation is that closest resources will be sent to emergency calls throughout the province.


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## BobBarker (Feb 8, 2018)

DrParasite said:


> So you called from a cell phone, which may or may not have been routed to the appropriate agency (it's a cell phone, no guarantee you are connected to the right dispatch center, especially if you are on a border), and then did you give them the correct location?  or was it on the border, so you weren't sure which town you were in?  If the wrong department were to show up, they might not be able to even shut off the water, and the cops might have been tied up on more important calls.
> 
> and it's a car that ran over a fire hydrant, no life threats, yes, there is some water on the ground and repairs will need to be made, but it's not really a life threatening emergency.  maybe they were busy dealing with the person who was shot on the sidewalk to be considered with a minor water hazard with no real emergency?I'm guessing you have AVL or GPS in every ambulance in the province, and a centralized dispatch center with all their locations to ensure the nearest ambulance is always sent, right?
> 
> and do you not have the issue in the rural areas, where in the assigned ambulance from middle of nowhere transports to the big city, then they get sucked into the busy call volume and population areas where said hospital is located?


Yes I called from a cell phone and the intersection is literally the border of two cities. I knew the exact location of where I was. When cars are swerving to avoid the hydrant in the middle of the street and the street is starting to flood because of the amount of water coming out, it would be considered an emergency as an accident is just waiting to happen, not to mention the guy who hit the hydrant trying to flee the scene. Either fire department could shut the water off, they just needed a truck company. Guess what: Both truck companies ended up responding anyways. There is no central dispatch, which is why the call was transferred multiple times. I was more worried about them getting the water shut off and the fire hydrant out of the street so no other accident would occur. It's just not appropriate to take 5 minutes before dispatching a call because you can't figure out who's exact area it's in.


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## Lo2w (Feb 9, 2018)

Cleveland has no true mutual aid agreements with the surrounding suburbs. One small village has an agreement for Cleveland to provide Fire and EMS as the village doesn't have their own service. I believe there's also several memos of understanding in border areas of who covers what.

Euclid operates under a consolidated dispatch with around half a dozen other suburbs. Not sure what their policies are but mutual aid was requested from South Euclid. Euclid PD stated this clearly when CPD arrived. 

Cleveland dispatch is under 1 roof but divided between the 3 public safety divisions. The dispatcher heard on body cam was a police dispatcher relaying information to PD. Still hasn't come out if CEMS even had a unit available. We run 116k calls annually and have no available units frequently throughout a busy shift.


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## DrParasite (Feb 9, 2018)

Lo2w said:


> Cleveland has no true mutual aid agreements with the surrounding suburbs. One small village has an agreement for Cleveland to provide Fire and EMS as the village doesn't have their own service. I believe there's also several memos of understanding in border areas of who covers what.


the small village isn't relevant to the current situation.  If no mutual aid agreements exist, than I'm sure a simple phone call can request resources, assuming their normal mutual aid system was unable to respond (exigent circumstances and such) 


Lo2w said:


> Euclid operates under a consolidated dispatch with around half a dozen other suburbs. Not sure what their policies are but mutual aid was requested from South Euclid. Euclid PD stated this clearly when CPD arrived.


so the system worked as it was designed.  Euclid had no one, so they requested South Euclid to respond, which is (i'm guessing) their primary mutual aid agency.  So it's not like no ambulance was coming, it just wasn't coming from where the cleveland cops wanted it come from





Lo2w said:


> Cleveland dispatch is under 1 roof but divided between the 3 public safety divisions. The dispatcher heard on body cam was a police dispatcher relaying information to PD. Still hasn't come out if CEMS even had a unit available. We run 116k calls annually and have no available units frequently throughout a busy shift.


Useful information, but completely irrelevant.  the call was in Euclid, and Euclid requested mutual aid as they probably do on a weekly basis.  Cleveland PD might have asked their dispatch center to send a Cleveland EMS unit, but that request is still inappropriate, because the call wasn't in their jurisdiction.  

it's not Cleveland's fault that Euclid doesn't have enough ambulances to handle the call volume in their coverage area.... but you can bet that the Euclid guys are going to try to blame Cleveland for their lack of resources an their dispatch policies.


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## Lo2w (Feb 9, 2018)

Policy allows CEMS to dispatch a unit to another city at the city's request if a unit is available and within 15 minutes.


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## DrParasite (Feb 9, 2018)

Lo2w said:


> Policy allows CEMS to dispatch a unit to another city at *the city's request* if a unit is available and within 15 minutes.


I have bolded and underlined the important part of that policy.  If the receiving city (in this case, Euclid) doesn't make the request for assistance, than no unit can be sent as per policy.  

If the receiving city doesn't make the request to CEMS to send a truck, whose fault is it really that a CEMS truck wasn't sent?


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## Lo2w (Feb 28, 2018)

Follow up

"According to public documents from a personnel hearing, Emergency Medical Dispatcher MyLinh Lam asked Sergeant Jewel Smith at the time, "We don't go to Euclid, right?"

Sergeant Smith responded, "No.""


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## DrParasite (Feb 28, 2018)

So it looks like dispatcher asked a supervisor for guidance, was giving the "appropriate" answer as per the existing policy, and is being made the scapegoat for this PR disaster.  If she were to send the crew anyway, she could be charged with insubordination, for directly violating the supervisor's orders.

The supervisor failed to use good judgement (but even then it's questionable, since an ambulance was already responding in accordance to their mutual aid plan); but the dispatcher did nothing wrong except follow the directions of her supervisor.  They are both being hung out to dry by the city's existing policies due to the negative view that is being spun by the media (which may be appropriate, but the director or author of the policy should be taking the heat and suspension for this, not the line staff for followed what their management directed them to do).

from CBS News: "Deputy commissioner Dave Miller said town lines shouldn't matter when it comes to emergency response aide. "

From Cleveland19.com: "“They have EMS coming, but they are coming from South Euclid.  an we see if one of our guys can come over here a little faster?  I'm on the phone with them now,” officers told dispatchers." and "“EMS reports they are not responding because it's not in the city of Cleveland, be advised. Coded, EMS refuses, got it,” dispatches said."

So despite a unit already responding, the cops wanted a potentially quicker unit from Cleveland..... and on the second call, EMS is being accused of not responding to a call that isn't in the city of Cleveland...

Based on what they are saying, here is my recommended solution: If anyone requests an ambulance, send the ambulance. even if it's not in Cleveland.  Send a Cleveland unit, and notify the appropriate agency so they can send one too.  They can fight it out when they get on scene.  If all your units are tied out on non-Cleveland calls, that's ok; as the Deputy commissioner said, "town lines shouldn't matter when it comes to emergency response aide."

If I was a dispatcher in Cleveland, I'd be putting in for a transfer out of dispatch and apply to other jobs in other cities, especially if this is how they treat their dispatchers who are following their written protocols.


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## Lo2w (Feb 28, 2018)

I'm not looking forward to the mess this is going to cause us if we start responding to every request outside our area. I still can't believe the suburb gets a pass on not having enough units to cover their city. One of the things I'm loving about 3rd service is we don't get tied up on every dispatched fire call.


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