Shortages and shutdowns at Indianapolis EMS causing ambulance delays

IEMS records show ambulances were taken out of service for 248 shifts over six months, in many cases due to a lack of medics to staff them.

In a medical emergency, every second counts.

13 Investigates discovered something happening inside Indianapolis Emergency Medical Services that medics say could delay your ambulance. It means when you need help, some ambulances may be parked - out of service.

Our investigation shows you why insiders are sounding the alarm over shortages and shutdowns.

Dinner at a Castleton restaurant turned into an emergency when 82-year-old Marilyn Moehlenkamp suddenly passed out.

"I have a guest who slumped over at her table. I need an ambulance," the restaurant manager said on the 911 recording of the call. "I don't know if she's having a stroke."

IFD Engine 9 pulled up within minutes. But it took 20 minutes for an ambulance to arrive.

An Advanced Life Support ambulance with the right equipment was parked just a few blocks away at a nearby firehouse, but it was taken out of service two hours earlier. Indianapolis EMS didn't have the manpower to staff it. The closest ALS unit was miles across town.

Moehlenkamp's family told 13 Investigates it was chaos in the restaurant. The responding crews were not certified in Advanced Life Support and did not have the right equipment.

"It was pretty much a mess," echoed a former medic with inside information at IEMS.

The medic is one of dozens to call it quits at IEMS since the city took over ambulance service. He's also now blowing the whistle on what went wrong on that Castleton call and ongoing problems. 13 Investigates agreed not to use his name or show his face as he sat down to sound the alarm over ambulances shut down, medics spread too thin, and public safety put at risk.

"You shouldn't be having to wait, you know, 20 minutes for an ambulance to get to a cardiac arrest," he said in disgust.

But that's exactly what happened in that Castleton emergency.

"The truck they were sending was not at all close. I mean, you're talking Castleton. That truck was responding from the area of 30th and Shadeland," he explained.

Minutes ticked by - 14 minutes, to be exact - while Moehlenkamp's anxious family waited for another ALS crew. Six minutes passed before a Fishers ambulance arrived and transported her to the hospital, where she later died.

13 Investigates has learned three ambulances and 11 medics ultimately showed up before they finally had the right manpower and equipment.

"That's unacceptable," said the whistle blower, explaining in part why he is speaking out.

So what does IEMS have to say about the run?

13 Investigates went to IEMS headquarters to meet with agency chief Dr. Charles Miramonti.
Miramonti spoke with 13 Investigates as his top administrators listened in.

"A lot of this comes down to a CAD - computer-aided dispatch - that's crazy outdated," said Miramonti, blaming the city's old dispatch system that can't always identify the closest ambulance.

"Is it ever acceptable that it would take one of your units to get on scene 20-30 minutes?" questioned 13 Investigates Reporter Sandra Chapman.

"No, it was never and would never be acceptable for 20-30 minutes to get on scene," he answered.

13 Investigates dug through thousands of EMS records and informed the chief of a pattern that could contribute to the delays.

The six-month review of internal documents reveals IEMS routinely shutting down ambulances.
Dozens of units were shut down 15 or more times each between January and June last year.
Those medics were taken out of service 112 times during day shift, while 136 trucks were shut down at night.

That means an ambulance may not be close by when you need it.

"I have heard that from the street providers that are on the ambulances themselves," said Mike Reeves, president of the union that represents Medics. Reeves says IEMS knows it has a problem - a 19 percent turnover rate among staff.

Despite high turnover, Miramonti adamantly denies it's compromising patient care on the street.

"Has it impacted our patients? Are we providing a lower rate of service to our city? Absolutely not," he insisted.

The chief says patients are getting some of the best care in the country. But 13 Investigates uncovered disturbing daily end of shift reports from IEMS supervisors who reveal medics working under extreme pressure and hazardous conditions.

In one case, the emergency lights quit working on a truck. The supervisor writes, "We were getting killed on the street, so I left them in service."

Another supervisor says "We are in a bit of a staffing hole" and "dropping more trucks," while another reveals he is "down to three trucks"

"Can I sit here and say definitively that we haven't had issues over the last year or two years as far as staffing and deployment? There's no way. Of course we have. Of course we have," Miramonti conceded.

It's not just shortages supervisors are writing about. Crews are working sick and tired. In one report, a supervisor praised a medic "sick with (a) 102-degree fever." According to the supervisor, the medic "sucked it up and stayed on duty. Very much appreciated."

It was a disappointing revelation for Miramonti.

"That makes no sense," he said.

13 Investigates also found the cost of too few medics quickly adds up.

"I have seen the overtime reports coming out and I look at them and I think, 'Oh my goodness, we're that short'," said Reeves, who is concerned about union members' safety.

IEMS spends about $200,000 a month on overtime. That's more than $2.4 million a year. (IEMS says half of the overtime spent or $100,000 is built in to the budget.)

"It's incredibly unsafe," added the whistle blower. "You've been up for 24-36 hours and you're not thinking straight. You're going to miss things, patient care-wise or driving," he said, noting that most medics are hardworking and doing their best to prevent mistakes.

13 Investigates questioned Miramonti about staffing and overtime.

"The overtime here is astronomical, because you don't have enough people and these folks are saying they're working tired and that it's dangerous," said Chapman.

"I'm aware that some of our folks, I don't think that it's fair to say that our people as a whole feel that way," responded Miramonti. "As we've asked folks to go from two or three runs a day to six, seven and eight runs a day, we get push back on that."

Miramonti says the agency's overall response times are still better than the national average, with crews arriving within nine minutes to a call more than 90 percent of the time. Part of that success is attributed to the built in response of the Indianapolis Fire Department. More than half the time, IFD arrives on the scene first and within four minutes of a call. The firefighters that are paramedics and EMT's start the life-saving process.

That's what happened the day Aridith Curbeaux thought his mother was having a heart attack.

"She said her chest was tightening, (I said) 'Screw that mom, I'm calling 911'," Curbeaux told 13 Investigates after his mother's emergency.

13 Investigates was just blocks away at Station 15. We drove to the scene, stopping at traffic lights along the way and arrived just five minutes after the dispatched call went out. IFD was on the scene attending to Aridith's mother, but no ambulance was in sight.

"I actually thought the ambulance was going to be here first. I wasn't expecting the fire department was even going to come," he said, praising firefighters for getting his mother calmed down.

IEMS failed to meet the nine-minute standard on that call, too. It took medics 10 minutes to travel from Methodist Hospital downtown to get to Aridith's mother.

"Firefighters can't put someone on the back of a fire truck and take them to the hospital," 13 Investigates said, drawing attention to the delayed responses.

"That's correct," said Miramonti, who says fixing the staffing problem requires a different hiring and training approach.

But the chief warns that doesn't mean putting more trucks on the street.

Right now, IEMS is down 18 medics from 2011. The agency just hired a new recruit class - 37 new employees are expected to hit the street March 3.

The city expects a new GPS dispatch system will deploy crews more efficiently in December. In the meantime, Miramonti says they're moving ambulances around to fill gaps in coverage.