This story was updated Nov. 2, 2015, to correct the location of Mayor David Bennett's previous home.
Six minutes is the narrow margin between life or death in the immediate aftermath of a heart attack.
But on Hilton Head Island, six minutes is usually all emergency responders need.
In four out of every five medical emergencies last year, paramedics from Hilton Head Island Fire Rescue reached their patients in five minutes or less, according to department statistics.
In about 68 percent of those almost 5,600 calls, crews made it to the scene in under four minutes -- less than the time the Mayo Clinic has found it takes for permanent brain damage to begin after cardiac arrest.
The short response times make Hilton Head Island the gold standard in Beaufort County.
Elsewhere in the county, ambulances take three minutes longer on average to reach a patient after receiving a call.
While Beaufort County EMS has made many upgrades in recent years and improved its response times, they still fall short of Hilton Head's.
The difference is in some ways is geographical -- Hilton Head island is obviously only a fraction of the size of the entire county.
But it is also the consequence of detailed, data-based master planning by the town's combined fire and emergency medical service over the past 20 years, said Fire Chief Brad Tadlock.
Until 1993, only one Beaufort County ambulance served Hilton Head Island and two separate fire districts served Sea Pines Resort and the rest of the island.
But as development after development sprouted up along William Hilton Parkway, it was clear that more needed to be done, said town manager Steve Riley, then the town's community development director. Instead the town struck out on its own, just as it has done with state road maintenance and its unique beach renourishment and land preservation programs, he added.
"You already had a community that felt it needed to be more than just that one (ambulance); We were just too big for just that," Riley said. "So we consolidated fire districts and absorbed the rescue squad, and Hilton Head Fire Rescue was born. It's been a long-time community commitment to having a somewhat higher level of service."
In 1998, town and fire leaders crafted the district's first master plan -- laying out all the data it had available to map the trouble spots and chart out 20 years of improvements for the island.
Hilton Head now has seven ambulances, stationed 24/7 at each of its fire stations across the island. An eighth ambulance is staffed for 10 daytime hours, four days each week to supplement the stationed crews because 80 percent of emergency medical calls happen during the workday, Tadlock said.
Over the past 15 years, the department has built a new station on Marshland Road, near the Cross Island toll booth; relocated its stations near Matthews Drive and renovated many of its other facilities, Tadlock said. One of the island's original fire stations, Station 2 on Lighthouse Road in Sea Pines, is due for a $2.5 million renovation during the next two years, he added.
The department also has upgraded its dispatching software, the computers in its response vehicles and long ago installed the devices that turn stoplights green for approaching responders, Riley and Tadlock said.
The biggest improvement for response times, however, has been a common sense one: Gates.
"The way Hilton Head was designed and built, we have these gated communities with limited access for a reason, but that limits our access, too," Tadlock said. "That left us to devise ways to improve our emergency response while still maintaining that level of privacy and comfort that the communities wanted."
Neighborhoods that once had only one way in -- Long Cove Club, Wexford and Indigo Run, for example -- now have emergency access gates to give crews shortcuts to the backsides or inner-roads of the island's most exclusive neighborhoods, Tadlock said. The simple addition of a U.S. 278 gate into Palmetto Dunes across from the Whole Foods grocery store cut up to 10 minutes off the response time to the homes on the northern end of the gate neighborhood, he added.
The island now has more than 175 access and "Click2Enter" gates, which read the radio frequencies used in emergency vehicles to automatically open the gate.
"That's addressed a lot of our trouble spots, though we'll still always have some longer response times around the periphery of the island," Tadlock said.
Mayor David Bennett and his wife, Terri, can attest to how effective the changes have been. Last year their daughter, Audrey, had a seizure at their Palmetto Dunes home.
"We called and they were there like that," Bennett said, snapping his fingers. "It happened so fast, and I actually rode with (Audrey) in the ambulance out through one of those gates to the hospital."
The quick response made all the difference, and doctors at the hospital were able to treat Audrey for a dangerous virus, Terri Bennett said. One of the paramedics who initially responded even called the Bennetts later that night to personally check on Audrey's condition, David Bennett added.
"It was incredible to pick up the phone and see them so soon," Terri Bennett said.
Those improvements have earned Tadlock's department three accreditations from the Commission on Fire Accreditation International, and the department will begin working toward its fourth next year, he said.
A new accreditation will bring with it a review of the department's master plan and likely recommendations for some incremental improvements to response times or procedures.
"For us, we continually analyze our data and try to find some more improvements," Tadlock said. "For us here, it's not such that we're growing as it is the redevelopment of the island that will be changing how we look at things ... but it doesn't happen overnight."
Reaching patients within five minutes on 83 percent of ambulance calls is good, but it doesn't yet meet the department's ambitious internal goal to be on the scene within 5 minutes 90 percent of the time, Tadlock pointed out.
"We've built the stations we think we need for the long term, but I think there's going to continue to be innovation and new ideas about how to deliver service," Riley said. "There will be better ways of doing business and providing service, and we'll find them."
- County Council approves new ambulances, updates to software, November 19, 2013
- Lawsuit alleges county concealed paramedics' misconduct, May 21 2011
- Beaufort County tweaks emergency procedures after EMS study, January 6, 2012