Orange County Health Care Agency officials are investigating two cases in which officials say Angel Stadium’s private ambulance service improperly transported fans with serious injuries.
The focus is on two Angels games last spring when AmeriCare Ambulance teams of emergency medical technicians or EMTs transported one patient needing trauma services and another needing stroke care to a hospital rather than call 911 for better-trained paramedics, which Anaheim Fire Department officials said are the proper staff to evacuate such patients.
Furthermore, AmeriCare’s ambulances also used flashing lights and sirens to go to UC Irvine Medical Center in Orange, which Anaheim Fire Chief Randy Bruegman said shouldn’t have occurred.
Dr. Samuel J. Stratton, medical director of the Health Care Agency’s emergency-disaster division, said he has launched a “formal investigation” of the March 30 and May 4 incidents.
Depending on the outcome of the investigation, AmeriCare could be placed on probation or have its county permits suspended, Stratton said.
Michael S. Summers, AmeriCare’s founder, said, “I can’t comment on individual patient runs.”
Summers also said he wasn’t aware such a county probe was under way, noting county officials had told him his firm was providing excellent service.
Anaheim’s Fire Department officials believed that AmeriCare was transporting “a whole lot” of patients from the stadium without paramedic assessments, Summers said, but only about “one or two patients per baseball home stand” were evacuated by his ambulances. AmeriCare bills for such trips, he added.
Transporting trauma or stroke patients to hospitals typically involves radio communication between paramedics and nurse-physician teams, who then prepare staff and equipment for patient arrival. An unannounced arrival of such patients can compromise care.
But the extent of communications between the EMTs and the hospital couldn’t be determined; neither Summers nor UC Irvine officials would say. Bruegman said he heard the EMTs may have called the hospital on a cell phone.
EMT ambulances like AmeriCare’s don’t have the radios that paramedics use for such communication. They do have access to a computer that can show UC Irvine was fully functioning and able to accept such patients.
This summer, Stratton held meetings with the ambulance provider, stadium officials and Anaheim Fire Department leaders to examine issues and work out optimal responses.
“Everyone was extremely cooperative,” said Stratton, who has broadened the probe to examine overall impact of stadium events on the emergency system.
Interviews and records found by Voice of OC also show AmeriCare ambulances also were involved in two other problematic incidents this spring.
The more serious occurred around 7 a.m. June 1, when an AmeriCare ambulance driven by an EMT, who had worked at an Angels game late the night before, crashed into cars slowed to exit Interstate 5 at Camp Pendleton in Oceanside. The accident sent five people to hospitals, including two evacuated by helicopter because of major bone fractures, reports state.
The California Highway Patrol determined the driver was in violation of the state’s vehicle code for traveling at an unsafe speed and not paying attention to traffic. No citation was issued, however, because CHP officers issue sanctions only in cases where they observe the offenses, CHP officials said.
In a May 9 incident in Santiago Canyon, the driver of an AmeriCare ambulance responding to a call from Orange County Fire Authority paramedics for transportation of a critically injured trauma patient didn’t know which emergency lights to activate for a life-saving run and required a map to plot a route to the designated hospital.
Fire Authority officials said they worked out a corrective plan with AmeriCare to try to ensure that its EMTs are properly versed in equipment operations and familiar with hospital locations.
The run was the first in which the driver was asked to deploy full lights and sirens, said Summers, prompting “a misunderstanding.” The driver was using the map to check the route, he added.
The Carson-based AmeriCare’s most substantial contract is in Santa Monica, where two years ago it won the exclusive right to provide ambulances and EMT staff to assist the city’s Fire Department paramedics.
“They have provided great service,” said Tom Clemo, a deputy chief of operations for the Santa Monica Fire Department. “They are meeting or exceeding contract requirements.”
In Orange County, AmeriCare provides EMT-staffed ambulances to transport patients with OCFA paramedics/firefighters in two regions: Villa Park and some canyons and hills in the east, where runs are fewer but can be complex due to terrain and communication challenges.
Part of a Larger Debate
Beyond the immediate safety concerns, the incidents involving AmeriCare are drawing attention, because they come as the county is considering privatizing paramedic services on several levels.
The county Health Care Agency has in recent months launched a pilot program to determine whether private paramedics can be used for interfacility transports for critical patients. Also, top county officials are considering replacing Fire Authority firefighter-paramedics with a private firm at John Wayne Airport for runway accidents.
Both initiatives have drawn sharp criticism from union firefighters and some fire chiefs, who say such a slide toward privatization will ultimately reduce the overall quality of emergency medical response.
The main fear, said those fighting privatization, is that emergency care could be provided primarily by young, less-experienced personnel who will work for less but not provide the same quality of care.
Meanwhile, operators and advocates for increased use of private paramedic service — which include members of the Orange County Board of Supervisors and others in the Republican establishment — argue that such concerns are irrelevant.
Privatization advocates have argued that private paramedics may have the same level of training and certification as public paramedics but do not cost taxpayers as much in wages, benefits and pensions.
Angels officials said that in August 2012 they contracted with AmeriCare to replace a long-time provider after a competition, which included price.
There were “some glaring weaknesses” in medical services they wanted to correct, said Brian Sanders, the Angels’ senior director for ballpark operations. The prior firm was MSMI Medical & Safety Management in Fountain Valley, which retains its contract for the nearby Honda Center.
Summers said his firm won the contract because it offered flexibility to add staff when needs arose among stadium crowds.
Under the overall plan for Angels Stadium, the Anaheim Fire Department always has a paramedic-staffed vehicle on site to assist ballplayers during games, per Major League Baseball requirements. AmeriCare EMTs are there to assist the crowd. But Bruegman said all transports from the stadium are to be conducted after calling 911 for paramedics.
Since a 2011 incident at Dodger Stadium in Los Angeles when a San Francisco Giants fan was savagely beaten in the parking lot, event emergency services have taken on a higher profile.
Sanders said the Angels contract with AmeriCare is silent on handing transports, with the medical decision left to emergency staff.
In the first AmeriCare run about 9:30 pm on March 30 during a game with the Dodgers, Fire Department officials said the paramedics at the scene saw the EMTs leave with the patient with flashing lights and sirens operating.
Stratton said the injured patient had fallen at least 15 feet, which by “mechanism of injury” qualified the person as needing assessment at a trauma center.
Trauma centers such as UC Irvine’s have specialized surgeons, nurses and equipment always available to provide rapid assessment and care because such patients are at greatest risk of dying if not treated quickly.
Stratton said no one contacted the Health Care Agency’s emergency-disaster office until Anaheim and UC Irvine officials did after the second AmeriCare transport from the stadium to the hospital on May 4.
“Those two cases got our attention,” said Bruegman. “I personally sat with the Angels and AmeriCare to share concerns. I don’t believe there has been an issue since.”
It was made clear, Stratton said, that effective immediately, Anaheim paramedics and their contract ambulance service, Care Ambulance, would do all stadium transports to hospitals.
“With any new process, there are kinks that need to be worked out in both cases,” said Sanders. “We needed an open dialogue. Stratton is the boss.”
After the May 9 AmeriCare response to help OCFA paramedics, an “incident resolution” report was filed about the confusion in evacuating a person injured at a meat market.
When the AmeriCare ambulance driver asked his colleague “which lights to use,” the report states, an Fire Authority paramedic told them to drive Code 2 [slower] to the trauma center, rather than Code 3 [for a life-threatening case] as initially requested.
The report states that when the paramedic saw the driver was seeking a route with a map book, the paramedic said he would provide directions to the driver.
Later, Fire Authority staff determined the AmeriCare team typically worked in San Diego County and had responded from Laguna Hills.
Knowing regions, roadways and the quickest routes to hospitals is standard operating procedure for well-trained rescue crews.
Fire Authority reports state that AmeriCare agreed to increase training, quiz EMTs on routes and facilities and seek to regularly deploy staff who were familiar with Orange County regions.
In the I-5 accident involving AmeriCare, CHP officers were told the 23-year-old driver from Anaheim went to bed about 11:30 p.m. May 31 after working an Angels game, then rose at 3:40 a.m. the next day and left in the ambulance for Camp Pendleton at 6 a.m. to offer aid at a mud run.
Summers said his crews are supposed to have at least five hours of rest between shifts.
The driver told CHP officers he was either talking to his companion or looking at the floor when he crashed at an estimated 60 mph into the creeping line of cars exiting at Harbor Drive.
Summers described the driver as “a fairly new” EMT who realized he was “passing the exit” and “moved over real quickly” rather going to the next exit and coming back as a more experienced driver might have done.
Three struck vehicles were scattered in traffic lanes, prompting a freeway closure during which a helicopter landed in the roadway to evacuate the two most seriously injured.
Because they are expecting a lawsuit, Summers wouldn’t discuss many specifics of the accident.
The EMT is “a really great guy who feels horrible,” Summers said.
Rex Dalton is a San Diego-based journalist who has worked for the San Diego Union-Tribune and the journal Nature. You can reach him directly at firstname.lastname@example.org.