By Ben Welsh and Robert J. Lopez
6:03 PM PST, December 21, 2012
A three-year effort by California to improve 911 emergency service has been stymied by flawed data and aging computers at local fire departments and rescue agencies across the state, a Times investigation has found.
Since 2009, the state Emergency Medical Services Authority has been seeking to centralize reports on millions of emergency medical responses, a project that officials see as critical to improving life-saving practices.
State officials hoped to capture information from the moment dispatchers answer a call until the victim is transferred to a hospital. The program would for the first time give public officials, medical researchers and regulators the ability to compare response times and patient treatment across local jurisdictions.
But the project has floundered because many fire departments and ambulance operations have been unable to provide usable information.
One problem is that fire departments report basic information inconsistently, including how long it takes them to reach victims. Some begin counting the second a 911 call is answered. Others, including the Los Angeles Fire Department, have started the clock when rescue crews are alerted at fire stations.
Moreover, nearly half of the state's 32 regional emergency medical agencies have failed to contribute reports to the system, officials said. And many of those who do file reports use paper records.
The shortcomings, officials and experts said, underscore how fire agencies lag behind police departments and the private sector in using technology to better manage and evaluate their performance.
"There's been a lot of benign neglect in the fire service as far as collecting data," said Robert Upson, a Connecticut fire marshal who has analyzed data for a nationwide group that sets performance standards for fire departments.
"There's so much sloppiness in recording data. It's just built into the system."
Similar troubles have fueled a months-long controversy over faulty response time data at the Los Angeles Fire Department. In March, top commanders admitted that the department had repeatedly published reports overstating how fast rescuers reached victims in need of help. The flawed reports have been blamed on the use of unqualified firefighters to analyze data and outdated computer systems.
In an effort to improve such data, California officials launched their program to collect rich, comparable details on medical emergencies statewide. Incident reports were to be gathered by regional regulatory agencies and forwarded to the state.
But three years and about $1.6 million later, the voluntary project is plagued by lack of participation, money problems and inconsistent information. The root of the problem is that some agencies rely on outmoded, "home-brewed" computer systems, said Tom McGinnis, the state official overseeing the project.
"We can't compare apples to apples. We compare apples to oranges and peaches," McGinnis said.
The state isn't forcing cash-strapped local agencies to participate because doing so would require many to replace computer systems, McGinnis said. "Really what it comes down to is money," he said.
Some experts say the state program won't be able to deliver on its promise until reporting standards are clarified and participation is mandatory.
"It should become a requirement tomorrow," said Bruce Wagner, the top administrator for the emergency medical services agency in Sacramento County.
His agency is among those that have not provided data to the state. That's because fire departments and ambulance firms under his jurisdiction are hesitant to spend time and money gathering records if they are not required to do so, Wagner said.
"It's hard for us to tell them they are going to incur additional costs if it's not mandated," he told The Times.
Los Angeles County, where a third of the state's 911 medical rescues take place, is a year behind in processing performance information because 28 of the county's 31 fire departments submit paper reports, said Cathy Chidester, the local oversight agency's top executive. Voluminous pages of information must be individually scanned into electronic files or manually typed into a county computer system.
"It's like sweeping sand off the beach," Chidester said.
Of the county's three largest fire departments — Los Angeles city, Los Angeles County and Long Beach — only the LAFD collects medical records electronically.
The county Fire Department has not filed reports on more than 300,000 incidents over the last two years because budget cuts eliminated employees working on the records, officials said. Next year, the agency is launching a test program in which paramedics will use iPads to create electronic reports, Chief Deputy Mike Metro said.
The state data project, known as CEMSIS, short for California Emergency Medical Services Information System, has also struggled for funding. It began as a $240,000-a-year demonstration project using federal grants and philanthropic donations. But no permanent funding has been secured.
Where possible, officials are attempting to use the partial records they have compiled for research. But thus far, they haven't been able to answer fundamental questions, including how different agencies' 911 response times compare, McGinnis said.
Ideally, McGinnis said, regulators could use the database to compare "the entire spectrum" of emergency medical care in California. "I want everybody to participate and see what we're doing statewide," he said.
Detailed data could improve understanding of what works best in the field. For example, researchers could examine how often rescuers are able to restore heartbeats after arriving on the scene, a key step in increasing cardiac-arrest survival rates, said Dr. Marc Eckstein, the medical director for the Los Angeles Fire Department.
"You have to really drill down to make sure we are talking about the right things," he said.
Slipping response times at the LAFD were only documented when outside experts, the city controller and The Times dug into the department's data. A series of Times reports found breakdowns and delays in processing 911 calls, dispatching units and summoning the nearest medical rescuers from neighboring jurisdictions.
Los Angeles Fire Commissioner Alan Skobin, who is overseeing a task force charged with overhauling the LAFD's data management, said programs such as California's fledgling 911 records system could help his agency compare its performance to other departments and improve service.
"There's a benefit to looking outside," Skobin said. "That's something the LAFD has to do."
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