Every second counted for James Smith, a 65-year-old Bluffton man who suffered a massive heart attack in April 2009 in his Baynard Park home.
While his wife Sarah Smith immediately called 911, she waited nine agonizing minutes before an ambulance arrived. As her husband lay in pain, the ambulance's EMTs were a few blocks away, struggling to gain access to the neighborhood's unmanned gate. James Smith sustained severe brain damage that led to his death 11 days later.
A high-profile lawsuit by Sarah Smith and suits by two other families in 2008 and 2009 led to an overhaul of how Beaufort County EMS -- which provides emergency care for all of the county except Hilton Head Island -- handles emergency calls.
Today, those changes are paying dividends with drastically reduced response times. On average, county ambulances now arrive in 8 minutes and 34 seconds, down from 12 minutes and 50 seconds in 2009, according to county EMS data.
Those minutes can mean the difference between life and death. In emergencies such as cardiac arrest, patients' chances of survival decrease by 7 to 10 percent with each minute they wait for help to arrive, according to the American Heart Association.
But more must be done to improve county response times. National standards dictate ambulances should arrive within 8 minutes to 90 percent of calls. Last year Beaufort County EMS fell short of that standard, arriving within 8 minutes to 68 percent of calls.
The county has yet to make the most expensive and most debated changes that would improve response times:
- Both Bluffton and Burton -- two communities that are comparatively underserved by EMS -- need new EMS posts where ambulances would be housed and first responders would be on standby around the clock. But no funding source has been identified and no timeline has been set to get the projects done. The area with the longest wait time for emergency response, St. Helena Island, is not slated for improvements even though the average response time in recent years has been 11 to 12 minutes.
- Concerns persist that firefighters often arrive on the scene of medical emergencies before ambulances do. That's because Beaufort County has double the number of fire stations than EMS posts. But fire trucks are not equipped with the same level of advanced life support and cannot transport patients like ambulances can.
Some local fire chiefs have long advocated that the municipalities, such as Beaufort and Bluffton, that already oversee their own fire operations, take over EMS operations for their areas as well. The results, proponents say, would be a faster, more efficient level of service because fire and EMS resources would be pooled and controlled locally.
"To me, EMS getting there in eight minutes is not good enough here," said Beaufort fire chief Sammy Negron, a longtime proponent of consolidation. "Fire departments are getting there first all the time because eight minutes is way too slow when a life is on the line."
Negron points to three instances in just the past few months where Beaufort firefighters arrived before EMS and likely saved lives, including an elderly woman who suffered a cardiac arrest earlier this month as she was having dinner. Firefighters were able to perform four full cycles of CPR before Beaufort County EMS arrived on scene, according to fire district officials.
"I wish more people would speak out about this (need for consolidation) because a lot believe it," Negron said.
But the idea was rejected in a 2011 county-ordered review of EMS because no countywide fire authority exists."A fire-based EMS system is not feasible in Beaufort County because there are eight fire jurisdictions with separate capabilities, funding, management skills and medical protocols," the 2011 review stated.
Today, consolidation is still not a viable option, say county leaders."It is easier said than done," said deputy county administrator Josh Gruber. "We're always open to examining the idea, but you can't get traction when you're dealing with seven chiefs and very diverse geographic areas."
Scroll down for a map of Beaufort County EMS response times.
NO ADDITIONAL TRAINING FOR COUNTY PARAMEDICS
A second lawsuit in 2009 raised questions of whether the county's paramedics were adequately trained.
On Oct. 30 of that year, Brian Lanese of Bluffton was attacked in his backyard by three masked men and suffered severe head trauma. Lanese and his wife sued the county, claiming that he received grossly inadequate care.
EMS failed to call a medical helicopter to transport Brian Lanese quickly to a trauma center in Savannah, according to the lawsuit, and two paramedics refused to believe he was not intoxicated and were slow to assess his injuries.
An off-duty Hilton Head Island paramedic, who was a neighbor of the Laneses, repeatedly asked the paramedics to transport Brian Lanese to Savannah's Memorial University Medical Center, a top-rated trauma center, instead of Hilton Head Hospital, which was not staffed or equipped to treat trauma cases, according to the suit. The paramedics initially refused and headed for Hilton Head before eventually rerouting to Savannah.
The attorney for the Laneses later discovered that the two paramedics, both of whom still work for the county, had histories of behavior on the job that resulted in disciplinary actions.
The lawsuit ended in a $150,000 settlement and was the driving force behind a county-sponsored review of EMS and the eventual overhaul.
But the overhaul has not included additional training for paramedics. The county did add 20 new part-time paramedics to bolster service.
"There were no policy changes that came after that (lawsuit) because that incident didn't relate to policy issues," Gruber said. "And the county absolutely disagrees with those complaints."
Efforts to reach the Laneses last week were unsuccessful.
But their case led to other important conversations -- and ultimately to improvements -- to EMS service for Bluffton residents.
In 2009, for example, Bluffton Township fire chief Barry Turner sent county administrator Gary Kubic a letter complaining that too few ambulances served the town.
"We want to make sure our citizens get the protection they need," Turner wrote. "With three, they're not."
A new ambulance was added and today, Bluffton and Sun City are served by four ambulances.
Current Bluffton Township fire chief John Thompson said last week that he didn't want to comment on current EMS service as it is run by the county rather than the town's fire district.
"It's not my place to say," Thompson said. "But I think the county has already made some improvements."
Sarah Smith's lawsuit has also benefited residents.
Beaufort County Council passed a measure after her suit, requiring all new gated communities to have codeless and keyless systems on each gate to prevent similar EMS delays. Existing communities were required to retrofit their systems with radio-controlled gate openers that allow first responders to control the gate and avoid delays.
Sarah Smith said last week that she was proud that her tragedy may mean others might not face the same long and damaging wait for ambulances to bypass gates.
"It's a feeling where you've called 911, you have no idea how long it's taking and every second seems like hours," Smith said. "It was an experience that I would never want anyone to go through. Period. And now I hope all those people in gated communities won't have the same thing happen to them."
NO MONEY YET FOR BLUFFTON EMS POST
Bluffton EMS is still grappling with a long-standing problem: Trying to keep pace with rapid growth.
The concerns have been raised repeatedly over the past decade as the town's population has increased from about 4,885 in 2005 to 15,200 last year.
Within the next 12 months, the county hopes to build a new EMS station.
But County Council has not agreed on how to pay for the project, council chairman Paul Sommerville said."We have a whole list of projects we'd like to do," Sommerville said. "But there is limited dollars to do everything so that will be a factor."
Potential sources of funding include a 1 percent hike in the local sales tax that county officials have proposed for three years to pay for local projects. Other options include adjusting the county budget or borrowing money.
The county has identified potential locations for the station along the Bluffton Parkway and in the Pritchardville area.
Less expensive changes have already been made that have improved response times, including the one new ambulance serving Bluffton and Sun City, bringing the total number now serving the town to four.
Response times have improved in the past five years with all of the area's ambulances cutting response times by one to five minutes.
That improvement came in part from encouraging a more regimented process for responding to calls in Bluffton and across the entire county.
"We made people more aware that they need to be up and heading to calls much faster," said county EMS director Donna Ownby. "There are little things that can shave off time like putting your boots right where you'll need them so you're ready to go. We said, 'People are looking at your response times and we need to make some changes.'"
The county has also discontinued a program where ambulances were rerouted when another nearby ambulance was on a call.
The review found that rerouting meant that ambulances in Bluffton would often move farther away from their next call. For one Bluffton ambulance in 2009, 72 percent of its calls were reroutes to fill in for other units.
"It was like a crystal ball. You don't know where the next crime or accident is going to happen," Beaufort County public safety director Phil Foot said. "So rerouting vehicles meant that you might be moving in the opposite direction of where you'd need to go next."
But improved management can only help to a point in Bluffton.
Times can only be cut so much when starting from stations far away from high-call density areas like Bluffton Parkway, where a new station is proposed.
The county needs to find $2 million to $5 million to build both of its planned stations in Bluffton and Burton, Gruber said.
"I feel like we have done all the improvements we can up until this point, short of building new stations" Gruber said.
NO HOME FOR BURTON'S AMBULANCE
A 2011 review of county EMS raised a red flag for the fast-growing community of Burton. The northern section of the Burton Fire District near Laurel Bay and the Marine Corps Air Station Beaufort was not within reasonable travel distances for ambulances to arrive within 8 minutes, the review found.
In response, the county purchased and staffed a new ambulance to serve the quickly growing area.
But there was no facility in Burton to house the new ambulance and staff.
So instead, the ambulance is housed in EMS headquarters in Beaufort.
Meanwhile, Burton continues to rely on just one ambulance. Last year, it responded to more calls than any other ambulance in the county -- 2,303 calls. Sometimes, ambulances from other areas are dispatched to help.
County officials say they hope to eventually house the ambulance and its EMTs in a yet-to-be-built Burton EMS station on county-owned property on Shanklin Road.
But it's just a goal with no timetable or funding source.
"The major thing was getting the equipment and getting the people and we've already done that," Gruber said. "But we haven't been able to put them in their ideal areas yet without new stations."The county purchased its two new ambulances in 2013 for $150,000 each, bringing the county fleet up to 11 front-line ambulances.
While the Burton fire stations are able to easily cover the area with response times within 4 minutes and can respond with basic life support, average EMS response times in the area remain about a minute and a half longer than the county average at 9 minutes and 54 seconds last year, according to county data. First responders say more ambulances in the area will be a welcome change.
"I would love to see another ambulance in Burton," said Burton Fire District Assistant Chief and Medical Officer Randy Wells. "Honestly, the citizens deserve it."
Map: Click or touch pins to see local EMS response times
Follow reporter Erin Heffernan at twitter.com/IPBG_erinh.
- 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