Twin City Ambulance

On Saturday my wife fell in our yard and dislocated her hip, so I called 911. Unfortunately, Twin City Ambulance came. The ambulance that showed up had no pain medicine on it and we were told that they were only EMT's and weren't able to administer meds. If you've ever had a dislocated joint, you know the pain she was in. After her screaming in pain with them just sliding a sheet under her butt so they could try to pick her up I stopped them and asked again if they could get her meds so they could get her on a stretcher. They were telling us that the people that could administer meds were either not working or too far away so she would have to basically bite the bullet and let them put her on the stretcher. That's when I thought I was going to be taken away by the officer that was there, because I lost it. Thank God that our local fire department showed up. The captain took over, told them to either get on the phone and get her meds or he was calling the competition. Go figure, that's when all the sudden Twin City had someone close enough to come. The captain told them to tell the ambulance to come HOT. When the second one came, the guy looked at my wife laying on the ground (by the way, at this point, she had been laying on the wet ground for over an hour while twin city was trying to figure out what to do and trying to talk her into just not taking any meds and just suffer) the guy pointed at my wife and started to yell at the captain about having them come hot in front of my wife, my daughter, the officer, the other fireman that had come and all his co-workers. I found this to be the most unprofessional ambulance crew I have ever dealt with. From this point forward, if I ever have to call an ambulance, I will demand they send someone other than Twin City Ambulance. We had 4 people from this company and in my opinion, 3 of the 4 people weren't close to being qualified to be doing the job. The only reason I say 3 out of 4 is because the 4th person really just stood there, didn't do anything, didn't say anything so I have no opinion about her. Then they finally got her some meds that (she said) barely worked. Then instead of rolling her a little and sliding a backboard or something stiff so they didn't have to flex her already extremely painful hip, they picked her up by her other 3 extremities. They couldn't get her up high enough to place her on the stretcher, so they put he back on the ground. Then I watched them lower the stretcher a good 4 inches. The saddest part of this all is that I had to watch the incompetency of these people as my wife is in pain and they didn't seem to give a crap. Again, if I need an ambulance in the future, I'll demand a different company.

You've raised several new issues that were not included in your first letter of complaintI am somewhat limited in my ability to investigate these additional issues, as the paramedic in question is no longer in the employ of Twin City AmbulanceAs such, I will not have the opportunity to interview him further.Ultimately, we do not want you or your family to hesitate to call in the future, if necessary, because of this experienceTo that end, we are waiving all charges associated with your son's call on November 23, Changes were made to the charges earlier today and there is a zero balance on the accountPlease return the check that you have in your possession to your insurance company.Although I cannot address all of your concerns, I did want to provide you with some supplemental information.We have the ability on all of our vehicles to properly secure any patient from infant to adultJust last year we introduced the Quantum ACR restraint system for pediatricsAll of our personnel were thoroughly trained in thei ruse prior to deployment, including the crew on this callIn cases where a child is not secured with a parent on the stretcher we can use the ACR deviceI have no idea why anyone would have mentioned a car seat during this callI am sorry about the confusion that this may have caused.You expressed concerns about the speed in which the paramedic checked your son's oxygen saturationThe pulse oximetry units that were in service at the time took samples at a rate of two samples per secondThe analysis is done almost instantaneously and is then presented on the screen in real timeThe accuracy of the system is +/- 2% when the patient is still, and +/- 3% when the patient is movingWe have since upgraded our equipment further, and now have the ability to monitor different blood chemistry saturation's in real-time.The last item I would like to touch on is the concept of" high flow oxygen." The phrase "high flow oxygen" is commonly used interchangeably with "high concentration oxygen." For many oxygen delivery devices this is true,but not alwaysTo further add to the confusion, the concentration of oxygen from the delivery device usually differs from the effective concentration of oxygen that enters the patient's lungs.For example, medical grade oxygen is at least 99% pure One of the oxygen delivery devices that we carry is anon-rebreather maskThese devices will output medical grade oxygen at full concentrationHowever, most medical publications will list the oxygen concentration from a non-rebreather mask at 90% +, not 99% to I 00%This is because the patient, with each breath, will inhale some amount of his own exhaled air along with a small amount of room air.Other devices, such as a Venturi mask, do not deliver full concentration oxygenNonnal room air has an oxygen concentration of about 1%A Venturi mask is designed to supply "enriched air." That is, air that has a higher concentration of oxygen than room air, but not pure oxygenVenturi masks are designed to provide air that contains between 24% oxygen up to a maximum of 60% oxygen at mostInterestingly, because this device allows unrestricted airflow to the patient, it could be considered a high flow device based on air flow aloneHowever, it is not a high concentration (02) device.One of the notations made by the paramedic indicates that your son was receiving oxygen from a Venturi mask at a low flow rate when he arrivedas I stated in the previous paragraph, this could be considered high flow (air), butlow concentration (02).Based upon the information that you have provided, I have no doubt that your son received oxygen throughout his hospital stayHowever, I would be very surprised if he received high concentration oxygen for the entirety of hisstayWithout reviewing his medical records I could not comment further.It seems clear that your pediatrician took a measured approach to oxygen administrationThis was what I was getting at in my previous letterI suspect that the hospital staff took the same measured approach when treating your son.I hope that I have addressed most of your concernsIf you have any additional concerns please write me at the address above or through the Revdex.com.~~~Terence ** *** President Twin City Ambulance

Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me. Regards, *** ***

Dear Sir,You are correct, the primary contact for getting this resolved is Jill *** Mrs*** and several key members of management were out of town this weekMrs*** is due back tomorrow It is highly unlikely that she has heard the voicemail messages that you
have left for her as they appear to have all come in, in the last business daysI will forward this communication to her for review. We will verify that the check was mailed to the correct address and will also check with our financial institution to ensure that it was not cashed by someone elseWe should be able to re-issue a check to you by this time next week Please advise us through the Revdex.com when you receive your checkWe apologize for the delay in getting this matter resolved.Terence * ***PresidentTwin City Ambulance

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.  Thank you. We will return the check to our insurance company.  I just wanted to clarify that my son was put on hi flow nasal cannula once he arrived in the ER on Monday until Friday, the day before he was discharged.Regards, [redacted]

I received your recent complaint filed with the Revdex.com office in Amherst, New York.First, I must apologize that no one contacted you sooner. When I reviewed the billing notations on your account I discovered the reason why. The only work that Twin City ambulance does not do in-house...

is medical billing. It appears that the number that you contacted us on was our billing number which forwards to our billing company in Pittsburgh Pennsylvania. At the time that you first called, the billing company had not received the electronic tile on your son's call. On subsequent calls, my understanding is that the billing supervisor was unavailable. Apparently, the billing personnel that you spoke with were under the impression that your call was in regards to a billing dispute, not a concern about patient care. As a result, they did not forward your complaint back to us for review. I am working with my staff to determine why you were not contacted earlier by the billing supervisor. Until I received your complaint through the Revdex.com I was unaware that you attempted to contact us.However, one of our supervisors did receive a call from a physician at [redacted] on November 24, 2015 regarding your son's care. At that time, our shift supervisor forwarded the concerns on to our Quality Improvement manager. Our Ql manager reviewed your son's file, interviewed the EMT and Paramedic that were on the call,requested supplemental reports, and submitted his findings on December 8, 20 15. Our Ql manager determined that there was no indication of"bad patient care.'·Upon receipt of your complaint through the Revdex.com I again reviewed the documentation with several members of my senior staff. We determined that the paramedic did not violate any state or regional protocols, and that his actions were both prudent and appropriate based upon the condition of your son during transport.Due to federal privacy laws, (HIPAA) I am somewhat limited in discussing your sons specific medical issues and treatment with a third-party; in this case, the Revdex.com. I can, at your request, send you an information release if you would like additional information, that I cannot provide here, to be sent through the Revdex.com. This form would need to be signed and notarized prior to our release of the information.I will attempt to address your concerns based only on the medical information that you have released to the Bureau.I hope that when you review the information that I have enclosed, your concerns about your son's care will be addressed.You stated in your letter that your sons oxygen levels were in the high 80s at the pediatrician's office, increased to the mid-90s during transport, and then dropped back down to the high 80s at the hospital. As you know, your son received treatment at the pediatrician's office prior to an ambulance being called. The effects of the type of treatment that your son received tend to peak in the first few minutes after administration. After about an hour, the effects of that treatment begin to taper off. The temporary increase in oxygen saturation was not as surprising or miraculous as your letter indicates. Rather, those numbers are generally what would be expected as the treatment worked as it was intended and your son got some measure of relief, even if only temporary relief.As for oxygen administration, oxygen is considered a drug in the medical profession. Drugs should never be given indiscriminately. Rather, drugs are given only where indicated to treat a specific condition, and then only in the proper therapeutic dosage required for the desired effect. In th is case, the paramedic evaluated your son and based upon his physical assessment and his oxygen saturation levels at the time of transport, he determined that supplemental oxygen was not indicated during transport. This is consistent with current research and accepted practice.I have enclosed copies of three articles that explain the pitfalls of over oxygenating patients (hyperoxia) in an acute care setting. The first document is a scholarly article that was published in the Journal of Transitional Respiratory Medicine. The other two documents are taken from the Emergency Medical Services (EMS) trade journals, EMS World and EMS I. Fortunately, the latter two are considerably less dry than the first. I have highlighted the sections that I feel are most relevant. Please take note of the target numbers stated at the top of page 3 of the EMS I article. As EMS protocols were being developed in the 70s and early 80s, the ability to measure oxygenated hemoglobin in the field was nonexistent. At the time it was also believed that problems associated with over oxygenating a patient(hyperoxia) on ly developed over long periods of oxygen administration, and then only in patients that had certain chronic pulmonary diseases. Today, field measurement of oxygenated hemoglobin (Sp02) is available on almost every ambulance. Additionally, much of the research published in the last 15 years indicates that high flow oxygen used in situations where it is not warranted offers little to no bene fit to the patient, but may actually be harmful even in relatively short duration. I encourage you to review the information that I have provided.At a couple of points in your letter to the Revdex.com you express concerns over "waiting around for an ambulance." Our records indicate that we received the call at our communication center at 09:33, and our ambulance arrived on scene at 09:37, for a total response time of four m inures. This call was dispatched as a "cold" response,which means a response without the use of lights and siren. A response time of four minutes is generally considered excellent by any measure, even for a "hot" response. There doesn't appear to be any delay in getting an ambulance to your son.The invoiced charges on your bill are not predicated on the administration of oxygen, or any other treatment. There are no a Ia carte services in ambulance transportation. Our rate structure is based upon reimbursement schedules established by government programs such as Medicare and Medicaid, as well as schedules established by private insurers. All of these programs are similar in the way they reimburse for ambulance service. Ambulance transportation is classified as either Basic Life Support or Advanced Life Support based upon the needs of the patient. The only itemized charge is mileage. Charges and reimbursement are based upon the response of a properly equipped and certified ambulance, staffed by certified medical personnel, and providing assessment, evaluation,necessary treatment, and transportation to a properly licensed medical facility. The charges and reimbursement schedule does not change based upon the specific medical problem of the patient or the type of treatment required.I believe the decision to transport by ambulance was prudent. Your pediatrician clearly recognized that there was a risk that your son's condition could deteriorate. It was important to have trained medical personnel on hand during transport in case that happened en route. I believe that the temporary improvement that our medic saw during transport was a direct result of the treatment he received at [redacted]. I am sorry to hear that your son's condition worsened later on. I hope that I have been able to put your mind at ease with respect to the decisions made by our paramedic.Terence [redacted]President Twin City Ambulance Twin City Ambulance Corp.[redacted]