Stroke victim waited 11 minutes before being told no ambulance available
COLUMBIA, S.C. (WIS) - The stated mission of the Richland County Emergency Services is to provide “prompt” service for residents in need.
A WIS Investigation into two 911 calls the morning of Friday, Sept. 24 show ambulance service was not available despite repeated calls for help for stroke victim Tommy Betenbaugh.
Betenbaugh is a Columbia retiree and works part-time for the Richland Library system. He told WIS the work gives him a reason “to get up in the morning” and customer service is important to him.
“I want [visitors] to be happy and feel good about their experience at the library,” he said.
Betenbaugh said he is a “floater associate” for the system, meaning he fills in for employees at multiple branches.
On the morning of Sept. 24, he was at the Cooper branch on Trenholm Road.
“I stood up, my right leg was very, very weak. I mean I could walk, but I had to hold onto things and I said what’s going on here? I said maybe it’s just a pinched nerve, I’ll walk it off. There was no walking this off,” he said.
He said he spoke to a co-worker about his condition, and they went to the back of the library. He said he called his wife Mary Ann, a physical therapist.
“I told her what was happening, she says it sounds like you might be having a TIA or a stroke,” he said.
The CDC describes a TIA as a “mini-stroke” and that “it is different from the major types of stroke because blood flow to the brain is blocked for only a short time—usually no more than 5 minutes.”
With a patients’ blessing, Mary Ann said she left her work and made her way to the library.
“Tommy doesn’t call me unless it’s something important, so I knew I better take it,” Mary Ann said.
Upon arrival, she said she began assessing him.
“I tested his leg sensation, you know, less on the right, more on the left, do this, do that, and I’m like immediately I’m like okay to the librarian we need to call 911,” she said.
WIS obtained the call through a Freedom of Information Request from the City of Columbia. Its timestamp is 11:09:37 a.m.
The city sent a redacted version of the call to protect the caller’s personal information. The redacted version lasted one minute and 17 seconds.
At the beginning of the call, the librarian conveys the address, symptoms, and concerns about a stroke.
911: 911 what is your emergency?
Librarian: Hi, um, my name is Charlotte. I’m calling from Richland Library Cooper on North Trenholm road. Um, we’ve got a, an employee who is having a medical emergency.
911: Okay, what’s the uh complaint right now? Symptoms chest pain, trouble breathing, or weak and dizzy, what do you got?
Librarian: We’ve got weak and dizzy (inaudible) no chest pain but very weak, very dizzy, um might be having a stroke.
911: Weak and dizzy possibly having a stroke, alright
The call ends with the 911 operator promising help.
911: If anything gets worse with the condition just say call us back and say hey this is happening, but help is on the way.
Librarian: Okay, okay, sounds [call ends]
“I’m just trying to be calm, keep him calm. She, you know, made the phone call, and then we’re waiting, and then nothing,” Mary Ann said.
After waiting 11 and a half minutes, the librarian calls back at 11:21:00 a.m.
WIS also obtained the second call through the Freedom of Information Act and the length of the call was one minute and 38 seconds.
911: 911 what is your emergency?
Librarian: Hi, um, I called a few minutes ago from Richland Library Cooper at 5317 North Trenholm Road we have an uh employee with a medical emergency, would it possible, has somebody already been dispatched to come over here?
911: Uh, unfortunately, we have no ambulances that’s, uh, that are clear right now. So, the call is still pending unfortunately um but as soon as they get somebody uh from the hospital they’ll have somebody in route momentarily.
Librarian: Okay let me let you talk to his wife real quick.
911: Oh, ok
In her interview with WIS, Mary Ann said “I thought okay, if I tell them I’m a trained medical professional and I can tell what’s going on, maybe it would be different.”
The call continues:
Mary Ann: Ma’am I, I am a physical, I, my husband, my husband is an employee here, he called me, and I’m a physical therapist (inaudible)
911: Ok what are the symptoms beside being weak and dizzy that we’ve got?
Mary Ann: Okay, he’s having he’s had weakness in his right leg, in his right arm, his, he’s not, the sensation has decreased on the right side versus the left side and his speech is just a little slurred.
Mary Ann: Huh?
911: I said okay, I’m putting everything you just told me in the notes now.
Mary Ann: Okay any other symptoms, what else Tom? Right leg worse than your left arm? Right leg is much worse than the left arm.
911: Alright, um just like I told the last person on the phone, that uh, unfortunately, we have any no ambulance that’s available right now, and as soon as they come available they’ll have a unit in route.
Mary Ann: Okay, alright, okay, let’s, okay, thank you, bye-bye [call ends]
Tommy said he was looking on.
“I’m like what the heck? Because when you mention the word stroke or heart attack or something like that, that’s one of those things that you have to go just as soon as you can, at least that’s my understanding,” he said.
With no luck on the second call, Mary Ann said she drove Tommy to the hospital.
“Almost immediately it was like okay, go-mode, you know, and I was like to the staff we’ve got to get him to my car,” she said.
The hospital treated Tommy for a stroke and he spoke with WIS on Friday, Oct. 8. He said he was grateful to be alive.
“I am one of the luckiest guys on the face of the Earth. I’m very blessed to be here. Somebody’s not done with me yet and I don’t know why,” he said.
For Mary Ann, the episode took a while to digest. She got visibly emotional while speaking with WIS.
“For us to be the ones that they don’t have the ambulance for, it could have been so much worse, so much worse,” she said.
Tommy’s loved ones contacted WIS after a Sept. 28 report on Lexington County residents misusing the EMS system, with 25 percent of the calls being non-emergencies.
Department leadership exposed blatant misuses of the system, such as one resident calling 153 times so far this year and another calling about honey in her eye.
The misuse comes amid a nationwide shortage of EMS workers, and the Betenbaughs are hopeful their story will convince some to think twice before calling 911 for minor issues.
“My request is for people to be respectful and knowledgeable when EMS needs to be called and when they don’t. Not to abuse the system I guess that’s where my frustration is, people that abuse the system,” Mary Ann said.
“People, don’t do that, because there are more important things than a hangnail,” Tommy said.
Richland County Emergency Services Director Michael Byrd would not comment on why no ambulances were available for Betenbaugh.
In his interview, he listed manpower shortages, delays in Emergency Rooms accepting patients (also due to short-staffing and high demand), and sudden influxes of calls as drains on EMS resources.
“One wreck could cause three or four wrecks and then we of course have to deal with all of those,” he said.
He said the employee shortage began before the pandemic, but the pandemic exacerbated the situation.
“We have employees that may be exposed to COVID that we have to isolate or quarantine, and of course we have injuries and sicknesses of our employees, so some of those things actually contribute to some of the shortages that we’re seeing while we’re staffing ambulances,” he said.
A WIS Freedom of Information request showed the county EMS system is budgeted for 239 employees.
There were 38 vacancies as of Sept. 24, 2021 and 39 vacancies as of Oct. 21, 2021.
Through Oct. 21, EMS had responded to 69,503 calls.
“I think that as we move forward and we’re talking about next year or in five years or in 10 years, that staffing has got to increase pretty good. Because our call volume, the demand on EMS is increasing and the issues that the industry is seeing right now, it’s just harder to get people to want to come into the industry and get them through the certification process,” he said.
He said he did feel the department could adequately keep Richland County safe and provide an ambulance when needed.
“I think generally speaking that we will respond to every call, there may be a delay for all the reasons I talked about, but we will respond to calls,” he said.
Byrd said those delays could last for 30 seconds or “several minutes.”
He said the department does not keep data on response times and the WIS FOIA on department data bore that out.
“[The public has] to understand that the overall situation we’re in now with the pandemic and all those other things I’ve talked about, there’s a potential for a delayed response. That’s a real thing,” he said.
“We’ve taken several strategies. We’ll be taking more different strategies to mitigate those delays but the public needs to be aware that this is an extremely busy time for EMS and healthcare.”
Those strategies include:
- Utilizing firefighters to respond to scenes (they’re trained in emergency medical response)
- Allowing paramedics move call to call without transporting a patient
- Using “basic EMT staffed ambulances” to put more transport vehicles on the road
- Putting more ambulances on the road during peak times
- Adjusting responses based on the risk level to the patient
Byrd’s phone interview with WIS began at 11:22 a.m. on Friday, Oct. 22. It was exactly four weeks since the Betenbaugh incident.
He told WIS there were 14 ambulances and 5 quick response vehicles on the road at the time of the interview, with five ongoing calls.
Byrd said the number of ambulances on the road can range from 10 to 22, depending on the day and time.
He said that Friday’s allotment was “a normal amount.”
WIS asked Byrd how often that number of vehicles is " not enough?”
“That’s hard to answer. I can tell you the more ambulances we have in service the better and we certainly want to get to having all our positions filled where we can staff as many as we possibly can,” he said.
He said call volume can vary rapidly, but peak times are between noon and midnight.
“We can see a delayed response at any time. Regardless of the day or time, as I indicated, sometimes we get these groups of calls that come in and it creates a very busy time for 30 minutes or 45 minutes, and then it calms back down,” he said.
Byrd again declined to comment on the communication from the 9-1-1 dispatch to EMS in relation to Betenbaugh’s situation but did speak to the flow of communication.
He said there is a call-taker (the dispatcher on the phone) and a telecommunicator (the individual who sends out first-responders).
“The call-taker probably would not [have updated information on how many ambulances are available] but the telecommunicator would,” he said.
WIS asked if it’s possible the call-taker could promise help without knowing if it’s available and Byrd said he could not speak for the 9-1-1 dispatch office.
On Oct. 20, WIS reached out to the Columbia 911 Communications office for comment from Interim Director Jacquelyn Richburg about why the first dispatcher promised help, but the second said there were no ambulances.
On Oct. 22, the spokesperson for the City of Columbia sent WIS the following email verbatim:
911 staff did not have any other findings other than what was already provided to you on the two audio recordings.
September 24, 2021
5317 N Trenholm Rd
11:09 1st Call received
11:10 Call entered in CAD
11:11 CRC Advised EMS Supervisor this call was pending
11:21 2nd Call received (Confirmed Stroke) - CRC employee informed the caller there were no ambulances available as this employee could see this call in the pending queue
911 CRC management, nor staff, can address your questions regarding the response time or the availability of an ambulance. You will need to contact/interview officials with the responding agency.
CAD represents the communications system and CRC stands for Columbia Richland Communications.
Richland County’s EMS system is not new to controversy.
A WIS investigation into the EMS department in 2017 found paramedics stretched thin to cover the county.
The county council responded by pushing more funding toward the department that October.
A WIS report from that time listed the following:
- EMS will receive $2.5 million to spend on equipment. This was approved in the last budget cycle but will be dispersed by January 1.
- The starting pay for advertised EMS positions will be increased to 10 percent in the hopes that they can hire experienced and valuable employees.
- All existing employees will receive a 5 percent increase in pay by December 2017.
- Eight new positions have been approved in addition to the 11 which are currently unfilled. That means 19 positions are open.
- 24-48 new EMS positions will likely be voted on by the county council and approved by the next budget cycle.
- Richland Co. Council passes motion that could help the county’s EMS issues
- WIS investigation leads to big changes ahead for Richland County EMS
Challenges facing the system
Staffing is not just a local issue.
Lewis said vacancies are just part of the issue and he reports the association’s member agencies have seen a 30 percent climb in call demand in the last three months.
He said it’s hard to quantify a cause, but he cited COVID-19 and increased public mobility.
“One of the other things that is very difficult for us is the hospital staffing crisis is now begun to impact EMS in a way we didn’t anticipate. Due to the shortfall in the folks in hospitals, we’re seeing delay times with overcrowding and that makes it difficult for EMS crews to drop patients off and return to service,” he said.
- SC hospitals battle with ‘highly concerning’ nursing shortage and lack of educators
- South Carolina needs nurses, statistics estimate a 24% drop in staff over the coming years
In July, the General Assembly approved $350,000 to help with the effort. Lewis said he expects the money to be available in the coming weeks and it will be used to hire a marketing firm to promote EMS jobs and education.
“We’re spooled up and ready to go with that as soon as the funds are made available, we’ve started front-loading as much of that process as we can,” he said.
Additionally, he said he’s working with certification providers to prepare for more students, a consultant to help promote the profession in K-12 schools, and with local agencies about establishing apprenticeship opportunities.
“I think we’re doing everything we can at the current moment with the support of the General Assembly and our stakeholders across the state to do what we can to mitigate this workforce shortage,” he said.
If you’re interested in an EMS career, you can contact the association through this link.
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