Nearly two hours after Ward had called 911, Grady’s ambulance finally showed up at her door. By that time, Ward was with her grandson at the Children’s Egleston Hospital near Emory University. The doctors told her that Kawan’s episode was caused by a heart defect. Her confidence in Grady EMS was shattered.
“I didn’t expect them to take that long when I told him that his heart was racing,” she said. “I told them he was 4 years old. I told them I didn’t know how to handle it.”
The harrowing episode is all too common across Atlanta, critics of Grady EMS say. Residents as well as city leaders and other first responders have complained that the hospital’s emergency medical services (EMS), which has been the ambulance provider in the city for more than 100 years, is too often late when residents call for help.
The tardiness, they say, puts patients at risk while also draining time and resources from the Atlanta Fire Department, which is often the first at a scene. A fire unit is required to wait for a Grady ambulance to arrive before it can respond to other emergency calls.
With complaints piling up, Atlanta city officials are on the cusp of a new venture: The city is planning to start its own ambulance service in southwest Atlanta to help stem the delays at Grady EMS.
The Atlanta Fire Department has so far spent $250,000 to purchase two ambulances and begin transporting patients themselves. The department will station them in a newly built station on the city’s border with Fulton County at the end of the year, with more to come later.
“We can’t continue to wait on them,” said Atlanta City Councilman Dustin Hillis, who chairs the council’s public safety committee.
While acknowledging longer wait times for some calls and a pandemic-induced staffing shortage that has impacted operations, Grady officials say the broader criticism is unwarranted. Still, last month they implemented a restructuring of Grady’s dispatch system to try to direct more personnel to life-threatening calls, including heart attacks and strokes.
“We are constantly looking at methods to do it better,” said Grady EMS operations head Erin Vickery. “And we would do that with or without staffing challenges.”
The pandemic has affected not only Grady, but the entire EMS industry, experts say. The Atlanta fire department and other EMS companies in Georgia and across the nation have likewise faced struggles in staffing and equipment. And there appears to be no end in sight.
“If there’s one thing we learned, things cannot operate how they did before,” said Pete Quinones, CEO of Metro Atlanta Ambulance Service. “The people aren’t there. The parts aren’t there.”
A series of response breakdowns by Grady over the past year have frustrated Atlanta City Council members, who have been receiving a steady stream of complaints from constituents about the hospital’s ambulance service.
Because Atlanta has no direct authority over Grady, the city has turned to the head of Atlanta’s EMS operation, Atlanta Fire Chief Roderick Smith, for solutions. Several city council members have expressed their concerns about Grady publicly to Smith, urging the fire department to start ambulance service in southwest Atlanta to address the problem.
Currently, the fire department only does transport at the Hartsfield-Jackson International Airport.
“We can only control what we control,” Councilman Hillis said.
In May of last year, an 85-year-old woman, who had been seriously injured in a car crash near Midtown, was left stranded for close to an hour without a Grady ambulance in sight. That episode made the local news on Fox 5.
When Hillis grilled the fire chief at a council meeting two weeks later, Chief Smith acknowledged there was a problem.
“There are some uncomfortable conversations we’re having with Grady, but we’re setting clear expectations,” Smith said.
Credit: Atlanta Fire Rescue
Credit: Atlanta Fire Rescue
Several months later, then-city council member Joyce Sheperd confronted the fire chief at a meeting with a complaint from a constituent. Sheperd said the woman told her that Grady took 45 minutes to arrive and transport her sick father to a hospital.
In February, a man in neighboring South Fulton City suffering from a stroke had to wait an hour and a half for a Grady ambulance to arrive at his home. In April, Atlanta firefighters transported a bleeding 60-year-old man to Grady Hospital themselves, loading him on a fire truck. The department praised the firefighters on Twitter for their decisive action.
“Due to massive blood loss, AFR members quickly decided to transport the patient in the fire engine to Grady Memorial Hospital instead of waiting on an ambulance,” the department wrote.
The delays have caught the attention of Atlanta Mayor Andre Dickens, who said he’s spent the first months in office getting up to speed on the issue. At a press conference this summer to discuss the need to increase fire department funding, Dickens said any problems need to be addressed.
“We can’t have any delays in service when people are in an emergency,” he said.
Atlanta isn’t the first local fire department in the metro area to launch its own city ambulance service. Years of complaints about slow response times in DeKalb, which has a contract with American Medical Response ambulance service, led the county in 2018 to create its own ambulance service. DeKalb’s fire department started with just three ambulances, but added six more in 2020 to help fill gaps in service.
Atlanta’s plan to move ahead with a city ambulance service has accelerated in recent months.
In April, the city purchased two new ambulances at cost of $123,000 each, according to Atlanta Fire Deputy Chief Royce Turner. The city expects to have them operating by October. The fire department is also outfitting five pick-up trucks with medical equipment so they can respond to EMS calls.
“We can't continue to wait on them."
- Atlanta City Councilman Dustin Hillis, who chairs the council’s public safety committee
The ambulances will be based at a new EMS station on Campbellton Road, near the city’s southern border with Fulton County — an area that has historically had gaps in ambulance service. The station will be completed by October and is funded by $4 million in bonds approved last year.
Hillis and Turner say the plan is to eventually station Atlanta Fire ambulances throughout the city, although there have been no concrete plans for expansion. The city hopes to account for gaps in Grady’s coverage, whether that means a geographic gap, a predictable increase in call volume due to a large event, or lack of Grady ambulance availability.
“We always try to match the services to the demand,” Turner said.
While response time standards vary from provider to provider, the National Fire Protection Association’s guidelines for life-threatening situations call for a response within nine minutes.
Grady assured the community it would meet nine-minute response times for emergencies when it took over ambulance service in south Fulton County in 2018.
Metro Atlanta Ambulance Service — which is the 911 responder for Cobb, Bartow and Paulding counties — strives to arrive within ten minutes for life-threatening calls, Quinones said.
Critics say Grady has been falling short, and its own data suggests that criticism may be warranted. For the first five months of this year, Grady’s monthly average response times for life-threatening calls have ranged from 10.5 minutes to 13.6 minutes. The monthly average for non-life threatening calls was more than 17 minutes.
Grady’s response data, however, is incomplete. It doesn’t capture the time from when the 911 call was answered to the time the call was assigned to an ambulance, which could add several minutes to the response time, experts say. The industry standard nine-minute response includes that crucial period in its calculation.
In recent months, Grady EMS has tried to refocus on the most critical calls and put additional resources to respond, according to Vickery, the EMS chief. In May, Grady restructured its dispatch protocols to ensure paramedics and advanced emergency medical technicians (EMTs) only get dispatched to life-threatening emergencies.
They make up 70% of the hospital’s emergency responders, which means non-life-threatening calls have fewer personnel to respond and may take longer, she said.
Basic EMTs, which account for a smaller fraction of Grady EMS’ workforce, will be assigned to the rest of the calls. These calls can run the gamut, from a sore throat to a car accident without immediately life-threatening injuries, and account for roughly half of the total calls Grady receives.
Vickery said the new system is a trade-off that will decrease response times for life-threatening calls such as heart attacks or stroke.
“Fifteen years ago, we lived in a world where everybody got the same sort of response if you call 911. We realized that we no longer operated in that environment,” she said.
Grady’s staffing challenges have made maintaining prompt response times more difficult, Vickery said. Grady has offered a raft of financial incentives in order to try to attract emergency responders, including hourly wage increases and retention and training bonuses.
Even with these incentives, attracting new personnel has remained a challenge, Vickery said.
“They’re just not out there,” she said.
Grady is not alone. Across the emergency services industry, leaders say they are struggling to maintain staff and equipment.
The Atlanta Fire Department has been hemorrhaging firefighters during the pandemic. In the first three months of 2022, more than 80 firefighters have left the department, including 48 who resigned, according to city records.
“Fifteen years ago, we lived in a world where everybody got the same sort of response if you call 911. We realized that we no longer operated in that environment."
- Erin Vickery, Grady EMS operations head
Any time a Grady ambulance is delayed, the already-stretched fire department has a unit stuck at the scene until the ambulance arrives to transport a patient. The fire department had its average response time go up by about two minutes over the 12-month period ending in February, according to the department’s data.
The fire department has had to make adjustments. It recently informed Grady it will no longer respond to some less-severe 911 calls. And the two organizations are negotiating a deal in which the fire department will no longer have to wait for an ambulance to arrive if the caller’s injuries are minor.
“You’ll have multiple engines waiting and a fire will be called in, and our fire engines can’t leave the patient to go to the fire, meaning there’s an extended wait period to respond to the fires,” said Nate Bailey, president of Atlanta’s firefighter union.
Throughout the pandemic, the Atlanta fire department has also had issues maintaining its airport ambulance fleet due to supply chain shortages and has faced criticism over lengthened response times.
Ambulance companies have likewise seen a worker exodus the past two years, and some leaders wonder how the industry will recover.
Thomas Kamplain, who operates the Georgia Institute of Emergency Medical Services, an EMS training academy in Covington, said the institute is graduating about half the number of EMTs it did pre-pandemic. And while wages for EMTs have risen from roughly $12 per hour to $17 per hour, so have wages for jobs throughout the economy as the tight labor market pushes incomes higher.
“I’m not wanting to say that you can’t say that (Grady) is not culpable either because they can do better as well,” he said. “But you’ve got to look at everybody.”
Quinones said the shortage is affecting more than the workforce. A scarcity of parts has also caused disruptions, he said.
His company sidelined 15 ambulances due to a shortage of repair parts that are backlogged months. Metro has had to continually rehabilitate aging parts, he said.
“We don’t know how long this shortage is going to last,” Quinones said.
— Staff Writer J.D. Capelouto contributed to this story.