Officials of Cape County Private Ambulance Service Inc. say they are concerned about "procedural and process problems" in the way city dispatchers handle 911 calls for ambulance service in Cape Girardeau.

Dr. John Russell, president of the ambulance service, and Michael R. Craig, its operations supervisor, said problems have been occurring regularly since the Cape Girardeau Fire Department began its first-responder program five weeks ago. Under the program, firefighters respond to some 911 calls for medical assistance.

Russell and Craig said there have been instances where 911 dispatchers have called out the fire department before transferring calls to the ambulance service, thus slowing response time.

In some cases, dispatchers gather information from the caller to apparently determine whether the situation requires a first-responder before putting the caller through to the ambulance service dispatcher, they said. Craig said there also have been instances where the caller has not been put through to the ambulance service dispatcher.

Ambulance service dispatchers are trained in the use of the Emergency Medical Priority Dispatch System, which Russell described as a state-of-the-art system whereby callers are asked questions to determine the nature of the emergency and appropriate response.

Once an ambulance heads to the scene, the dispatcher, by using a detailed flip chart, can provide the caller with information such as how to give CPR, how to determine whether a person is breathing, or how to apply direct pressure to severe bleeding.

"Our dispatchers have the ability to treat a person over the phone until help arrives, but we can't do that if we can't talk to the person who called," said Russell.

Russell said the ambulance service's contract with Cape Girardeau County requires use of the Emergency Medical Priority Dispatch System.

Under the system, callers are asked their location, a call-back phone number, what the problem is, the age of and number of people needing assistance, and whether the person is conscious and breathing. A determination is made at that time whether a red-lights-and-siren response is required.

Craig said he has documented 14 cases since May 28 where delays have occurred in contacting the service. In most of those cases the callers were not allowed to talk with the ambulance dispatcher, he said. Craig said there are other instances of delays that have not been documented.

In two of the cases, the city dispatcher failed to notify the ambulance service of the call. On Tuesday, Craig said he was at the ambulance service office when a call was received by the 911 operator about a possible stroke victim on South Sprigg. The fire department was paged for a medical assistance, he said. Craig said he heard the call to the fire department on the police scanner and sent an ambulance. "But we were never called," said Craig.

On Monday, ambulance service staff heard the fire department called to a medical assistance, and the ambulance service dispatcher called central dispatch to inquire about the incident, he said. A log of the incident that Craig had showed that the city dispatcher said they "got so excited they forgot to call an ambulance."

In another case, a caller became frustrated with having to give the same information to the ambulance dispatcher that he had given the 911 dispatcher, and hung up, saying he would drive the person to a hospital himself, Craig said.

Craig said all the central dispatcher has to do is push a button to put the caller in contact with an ambulance service dispatcher.

To determine whether a first-responder is needed, all the central dispatcher has to do is listen in on the conversation, Russell said.

"There is no reason for the dispatcher not to send the calls to us immediately. We're going to be asking the questions; they just need to keep on the line," said Russell.

Craig said the ambulance service also has the capability of notifying the fire department promptly of any calls.

"We have a philosophical difference over who should determine whether the fire department goes out," said Russell.

Cape Girardeau Fire Chief Robert Ridgeway disputed the contention of ambulance officials that response times are being hampered by the fire department's first-responder role. He said he does not believe anything has changed in 911 dispatching.

"His dispatchers are not perfect and the city's dispatchers are not perfect, but they do a good job," said Ridgeway. "The most important thing is to get people help quickly."

The fire chief said he is not aware of any instances where ambulance personnel have not been called to medical emergencies. Said Ridgeway: "I know there has not been an instance where we were dispatched and he (ambulance service) was not. We have no transporting capability.

"I would like to see his proof. I am not aware of any time we have gone when the ambulance hasn't. The city of Cape Girardeau has been receiving 911 calls for years, and we are not doing anything differently; except the fire department is running first-responder."

Russell and Craig said they are not opposed to a first-responder role for the fire department, but problems need to be worked out. Russell said that about two weeks ago he met with Ridgeway to discuss some of the problems, but they have not yet been resolved.

Another meeting was planned with City Manager J. Ronald Fischer.

"The idea of a first-responder role for the fire department is great and needed, but we are not real pleased with the current implementation, and it is having a negative impact on the ambulance service's ability to respond because of dispatching problems," said Russell.

"At the street level, ambulance and fire personnel have been working very well together. The problem we have had is at the dispatching level."

Ridgeway said that last spring a letter of agreement was signed between the fire department, Cape County Private Ambulance and Dr. Charles Pancoast, medical director for emergency services in the region. "We all agreed in writing that operational discrepancies will be dealt with by operational directors and department heads," said Ridgeway. "If he (Russell) felt there was a problem that delays his vehicles, he should have gone to Dr. Pancoast."

Ridgeway said it is important to keep in mind that the fire department and ambulance service are not competitors. "We're there to help each other and provide rapid, quick care until the transporting agency arrives," he said. "It's working fine on the street and it's a darn shame someone in administrative positions doesn't go out and see it."

The fire chief and ambulance service officials also disagreed on the success of the first-responder program and when fire trucks should respond to a medical emergency.

Ridgeway said Wednesday that since starting the program the fire department has "seven documented saves, with a save classified as a person entering biological death ... getting ready to go into irreversible brain damage, in the month we've had it."

But Russell and Craig contended that figure is too high. They said they can only document one, possibly two, "saves" by fire personnel.

"We certainly have not been involved in that many," said Craig. He said that in a year's time the ambulance service handles only about 40 full cardiac arrests in the entire county.

Ridgeway said the fire department has a list of the type of incidents it will respond to - a criteria that was drafted in cooperation with the ambulance service.

Craig said it is unusual when the fire department doesn't show up. In most cases, Craig said, "if it's a 911 call, they roll on it."

Not only that, but Craig said in those cases firefighters arrive in trucks with lights and sirens, rushing to scenes even when the medical emergency is not life threatening.

As part of the Emergency Medical Priority Dispatch System, Craig said the ambulance service has been cutting back on its high-speed, light-and-siren responses because such responses are dangerous and should only be made when necessary.

Since starting this system, Russell said there has been a 10-15 percent reduction in calls requiring red lights and sirens, and that less than half the ambulance service calls require that kind of response. In less than 5 percent of the calls received, the ambulance service uses red lights and sirens going from the scene to the hospital.

By not being able to talk with 911 callers all the time, the ambulance service has to assume the worst and respond with lights and sirens in cases where it is not necessary, he said.

Russell said there is a philosophical difference between the fire department and ambulance service on how to respond that is not unique to Cape Girardeau.

"The firemen are trained that when the bell rings they get there as quickly as possible," but in most medical situations "rarely does one or two minutes make a difference in the outcome."

He said: "There are a number of cases we are running non-emergency that the fire department is running red lights and siren ... that is an inappropriate response. Every time you go red lights and siren on the street the chances of an accident go up."

Russell said if anyone has trouble using 911 they can still reach the emergency service directly from anywhere in the county by calling 335-3305.

Said Russell: "We don't want anybody from anywhere in the county to feel like they can't contact the ambulance service. Our doors are always open, and the phone is always answered."

Russell and Craig said the whole situation is frustrating because they are concerned about being able to provide callers with appropriate information and to respond in timely fashion. They are also optimistic problems can be worked out promptly.

"We're not mad," said Russell, "just frustrated."