By Ben Welsh, Robert J. Lopez and Kate Linthicum
May 18, 2012
When Javier Ortiz collapsed in his backyard in Echo Park, rescuers were stationed in a firehouse just a half-mile away.
But the Los Angeles Fire Department dispatcher who answered the 911 call from Ortiz's daughter took more than 2 1/2 minutes to send the firefighters -- nearly three times longer than a national standard for processing calls for help.
By the time rescuers arrived, more than six minutes had passed since the Fire Department picked up the call, records show.
Ortiz later died, and it is impossible to say whether a faster response would have saved him. But his case illustrates a significant weakness at one of the nation's largest fire agencies: Dispatchers lose precious seconds in hundreds of thousands of calls for medical aid each year.
A Times analysis of more than 1 million dispatches from the department's database found that the Fire Department falls far short of the standard that rescue units be alerted within one minute on 90% of 911 calls. And average call processing time has increased, most notably for medical calls, which account for the overwhelming majority of responses.
Five years ago firefighters were dispatched to medical calls within a minute 38% of time, the analysis found. By 2011, that number dropped to only 15%.
The Times also found that in the more than 250,000 medical dispatches last year, the department took 75% longer, on average, than the national standard.
Seconds are critical in medical emergencies. That is particularly true in cases of cardiac arrest, like the incident involving Ortiz. Potentially irreversible damage can begin after four minutes.
Fire Department officials did not respond to questions about the department's call handling times.
The department has been under attack in recent months. Some City Council members are concerned that the Fire Department's budget has been cut too deeply and 911 responses have been compromised. Fire officials, though, have tried to reassure the city that residents still are receiving high quality emergency service.
City Hall leaders were stunned in March when the department admitted that for years it published statistics showing crews arrived at medical emergencies more quickly than they actually did. Revised department figures showed slower response times, well short of national standards and the department's stated goals.
But even those numbers were challenged this week by an expert brought in by Mayor Antonio Villaraigosa, who warned that the corrected figures were unreliable and required more scrutiny. Those issues related only to how many minutes and seconds it takes rescuers to arrive on a scene after they receive an alarm from the dispatch center.
But The Times' analysis found another significant shortcoming in what experts say is an equally important performance indicator: The time it takes dispatchers to send firefighters to emergencies.
In addition to falling short of the national standard, the department took a minute longer on average than other departments studied in 2010 for the National Fire Protection Assn., which sets standards for dispatches and response times.
That study examined more than 100,000 medical calls in jurisdictions including Fairfax County, Va., a suburb of Washington, D.C., and Florida's Orange County, which includes much of Disney World. It found dispatches on average took 44 seconds.
By comparison, the Fire Department last year averaged about 1 minute and 45 seconds per call, according to The Times analysis.
"Every minute wasted with the dispatcher ripples throughout the entire scene," said Dr. Mickey Eisenberg, medical director of the Emergency Medical Services Division for King County, Wash., who has studied the importance of a fast response.
Fire Department officials declined to answer questions about what might be causing the delays. Firefighters who take calls at the dispatch center must ask multiple questions designed to elicit the nature of the emergency and to determine what type of units should respond. The answers are entered into a computer.
Generally, the dispatcher must enter an answer to every question before sending an alert to rescuers, according to current and former Fire Department dispatch center workers. Thoroughness is a priority and dispatchers are graded on how faithfully they follow the scripted inquiries, they said.
In many instances, soon after taking a call "we know what we need to send," said veteran firefighter and dispatcher Bob Ashley. But he said he has to ask several questions before dispatching emergency units.
Whether the required questioning contributes to delayed dispatches is not clear, although some other agencies say they alert rescuers as soon as callers mention certain key words, such as "heart attack."
Fire Chief Brian Cummings assured the city Fire Commission in March that the Fire Department runs "one of the best performing dispatch centers in the country."
"That processing time is very good," he said.
In the case of Javier Ortiz, however, it wasn't. It took the Fire Department's call center 2 minutes and 48 seconds to send firefighters to help, records show.
Rescuers from Fire Station 20 needed only 3 1/2 minutes to get to the hilltop home near Echo Park Lake -- a relatively quick travel time.
When they arrived, Ortiz's daughter was on the phone with the dispatcher, following CPR instructions. Firefighters took over, used a defibrillator to shock Ortiz's heart and injected him with drugs. Ortiz, a retired maintenance worker, was taken by ambulance to Good Samaritan Hospital, where he died several hours later, according to his brother, Salvador Ortiz.
Recounting the events at a table in his frontyard, Salvador Ortiz said he knows little about cardiac arrests. But his brother's heart attack taught him one thing: "More than five minutes is a long time."
Researchers say how quickly rescuers reach a person in cardiac arrest is one of the better measures of a fire department's performance. If CPR and an electric shock to the heart are not delivered within a small window of time, the odds of survival fall.
Generally, Fire Department dispatchers handle cardiac arrest calls faster than other medical emergencies, The Times found. Still, the majority of those cases failed to beat the one-minute national standard. Out of more than 2,700 severe cardiac arrests reported in 2011, only 35% were dispatched in under a minute.
That marked a decline from five years ago when 66% of cardiac calls were dispatched in less than 60 seconds.
Slow dispatches can be compounded by slow responses, when the closest rescuers are out on other calls and more distant units must be sent.
Last November, 89-year-old Scott Wilson climbed a ladder in his garden to trim tree blossoms.
The former Eagle Rock High School teacher was active despite his age, still working with North East Trees, a nonprofit organization he founded that has planted tens of thousands of trees across Los Angeles.
Suddenly, Wilson toppled to the ground. Robin Robinson, a friend who came by to collect the clippings for the church they both attended, ran inside to call 911.
She then switched to a cellphone and returned to Wilson's side.
The dispatcher had a lot of questions, she recalled. Robinson answered as best as she could. Was the patient responsive? No. What color was his skin? Blue. She didn't know the address of his home, but the dispatcher located it by computer.
As Robinson waited, the dispatcher was professional, guiding her as she performed chest compressions on Wilson.
As she pumped his chest she called out to him: "Scott, don't go. We love you, don't go."
She began to wonder what was taking firefighters so long. "I would have been here by now," she remembers thinking.
More than 3 minutes passed before the dispatcher sent crews to the emergency, according to Fire Department data. A fire engine carrying a paramedic arrived quickly.
But it took 16 minutes for the first department ambulance to arrive on scene from Station 47 in El Sereno, more than five miles away. Units at two closer stations were out on other calls at the time, according to dispatch data.
Wilson started breathing again but never regained consciousness, friends said. He died at Glendale Adventist Medical Center a few days later.
Even the high-profile case of political provocateur and Internet publisher Andrew Breitbart, who collapsed earlier this year on a Brentwood street, had a relatively lengthy dispatch and response time.
Passerby Matthew Meckwood called 911 and it took dispatchers more than two minutes to send help.
A fire engine arrived quickly, but it took nearly 10 minutes for the first paramedics to get there after they were notified, records show.
Meckwood performed chest compressions during the wait and recalled, "There was some sort of spark in his eyes and I saw him give his two last breaths." Breitbart was rushed to UCLA Medical Center, records show, and was later declared dead.
Times Web Producer Sarah Ardalani contributed to this report
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