At 3:28 on a Saturday morning, a buzzing, electronic horn echoed throughout the darkened, windowless communications center of the Richmond Ambulance Authority.
A woman seated at a desk answered immediately.
Communicating through a headset, she quietly read from a script located on one of the half-dozen screens in front of her.
“Is he breathing?” she asks.
With each response, she clicks a button, which leads to a new set of questions. Like a life-and-death version of “Guess Who?,” the diagnosis arrives. It’s stomach pain – likely a flare-up of Crohn’s Disease.
“Okay, ma’am, I need you to make sure she doesn’t eat or drink anything until we arrive. It could make our job harder – an ambulance is on the way.”
The blaring horn indicates an incoming emergency call that was just routed from the city’s 911 center. When a person dials 911, an operator at the city’s call center on Hopkins Road inquires about the situation. The call is then routed to the police, fire department or the RAA.
Under 7 minutes later, the ambulance arrived in Gilpin Court.
Advanced technology, intuitive staff and speedy response times – these are among the things that make the RAA stand out.
Although the fact seems to elude many Richmonders, the RAA’s systems and protocols are the envy of ambulance services across the globe. According to the Coalition of Advanced Emergency Medical Services, Richmond’s is proportionally the busiest EMS system in the nation. Over 1,500 ambulance calls are placed for every 10,000 people in the city.
There are a variety of reasons for Richmond have such a busy EMS system. According to the Census, Richmond’s population is disproportionately poor – over 40% of children age 0 to 17 live in poverty. Richmond is also a violent city – Church Hill has often been placed on the list of America’s 10 most-dangerous cities, according to Morgan Quitno, a firm that specializes in ranking city statistics.
RAA provides all ambulance services within Richmond’s borders. It is a governmental entity created by the Commonwealth and overseen by members of City Hall.
The RAA receives an annual subsidy from the city, around $4 million yearly, which covers some of its $16 million operating budget. The remaining money comes primarily from insurance billings.
Despite the seven-figure budget, money is always tight. “We run about 50,00 calls per year, conduct about 40,000 transports but only 20,00 of them pay for the service,” Decker said.
According to RAA CEO Chip Decker, timeliness is the highest of priorities.
The goal for any EMS agency is the arrive on the scene in under nine minutes 90 percent of the time. In October, the RAA’s average was six minutes, seven seconds. In fact, 71 patients were reached in less than a minute.
It all starts in the call center. From the moment a call comes in, each keystroke becomes data to be scrutinized and evaluated. Wes Wampler, operations supervisor, said “(Data) lets us mine into what’s going on. It’s an intelligence gathering game.”
Eschewing speed, the RAA analyzes data to best position its two-person EMS teams. Depending on the time of day, between 7 and 22 ambulances are dispatched throughout the city.
In the communication center, a computer system displays a city map with the areas of historically highest call volumes shaded in violet. It looks just like an infrared map, with the “heat” being the number of EMS calls. Analyzing hundreds of thousands of calls – locations, times of year and day, weather, etc. – the system can accurately predict what segments of the city will be most active.
In tandem with this analysis, ambulances are tracked via GPS so availability is always known. The communication center’s system learns call trends and traffic data, further helping the RAA strategically place ambulances at posts throughout the city.
According to Rob Lawrence, the RAA’s chief operating officer, gadgets and fast ambulances won’t suffice.
“That’s only half the battle,” he said. “What you need to do when you get there is do something really smart.”
In addition to rigorous analysis and planning, the RAA is involved in groundbreaking medical services.
The RAA has partnered with The Medical College of Virginia to create a system of treatment for cardiac arrest patients known as Advanced Resuscitation Cooling Therapeutics and Intensive Care Center, or ARCTIC, which has shown unprecedented success rates.
When a patient enters cardiac arrest, the heart stops beating, depriving the body’s organs of oxygen. According to Lawrence, chances of surviving a cardiac arrest decrease about 10 percent each minute after the heart stops. The chance of surviving with no neurological damage is even slimmer.
With the ARCTIC system, however, paramedics drill under the patient’s kneecap and inject chilled liquid into the bone marrow, quickly dropping the body’s core temperature. This means less oxygen deficiency. Upon arrival at MCV, the body is monitored and, using a computer-controlled sequence, its temperature is raised back to normal levels.
Let’s say your heart stopped while reading this very sentence. If a team of RAA paramedics responded to your 911 call, the chances of your heart and circulation restarting stands around 46 percent. The national average is less than 7 percent.
“This place is EMS top gun,” Lawrence said in his stern British accent. “This is where everything is done efficiently.”