Failure to Follow Ambulance Regulations Creates Delay

North Dakota is a big, beautiful state with plenty of space to enjoy. But when illness or sudden injury require hospitalization, covering the distance between the patient and a medical facility as quickly as possible becomes the primary objective. When residents need ambulance transportation to a hospital or to transfer between hospitals, they need to know that an ambulance will reach and deliver them to the proper medical facility with due speed.

A recent story by The Minot Daily News highlights how patients may be put at risk when regulations for ambulance transportation are not followed, causing long and expensive delays before patients reach care.

What regulations address ambulance delay in North Dakota?

Ambulance providers and hospitals using ambulances for patient transfers to other facilities owe patients a duty of care. They are also subject to state and federal regulations. North Dakota Administrative Code – Title 33, Article 11, Chapter 1.2 sets out requirements for ambulance “Response Times,” mandating ground ambulances “must meet” certain time “standards ninety percent of the time.” The ND Code states:

1. The time of dispatch to the time that the ambulance is enroute must not exceed ten minutes.
2. Within the city limits of Bismarck, Fargo, Grand Forks, Mandan, Minot, and West Fargo the time from dispatch to the arrival on scene must not exceed nine minutes.
3. In rural areas as defined by the United States census and frontier area ambulance services that respond to interstate 94, interstate 29, United States highway 2, or United States highway 83 between Bismarck and Minot, the time from dispatch to the arrival on scene must not exceed twenty minutes.
4. In frontier areas as defined by the United States census, the time from dispatch to the arrival on scene must not exceed thirty minutes.

According to The Minot Daily News, in 2017 the North Dakota Attorney General also issued a memorandum establishing that hospitals should prefer local ambulance services for inter-facility transfers.

Despite the ND Code and Attorney General Memorandum, The Minot Daily News reported that from June 2020 until August 2021, Mountrail County Medical Center (MCMC) located in Stanley, ND “passed over” the local Stanley Ambulance Service (SAS) for about 150 patient transfers. Instead, MCMC exclusively used Community Ambulance Service and NorthStar Criticair located in Minot, over 50 miles away.  The article explained the “effects on the hospital’s patients, and on the Stanley Ambulance Service, were immediate:”

If a patient was in desperate need of a transfer from MCMC to anywhere in the state, they would have to wait for Community Ambulance to be contacted, assemble a crew, drive nearly an hour to Stanley from Minot, and then transport them to their destination, while SAS and its two full crews sat unused minutes away, deliberately left on the shelf.

MCMC continued to bypass SAS even though “the director of the Division of Emergency Medical Systems, sen[t] an email to MCMC CEO Stephanie Everett on June 24, 2020, bringing the 2017 memo to her attention and directing the hospital to utilize the local ambulance.”

The newspaper also reported that although Federal regulations require hospitals to limit air transportation based on severity of a patient’s condition and unavailability of ground ambulances, MCMC used air ambulances for about half of the transfers, at a cost of $25,000 to $45,000, compared to $3,000 roundtrip by SAS ambulance. Forty of the air transfers took patients from MCMC to Trinity Hospital in Minot. In the two preceding years, MCMC had used air ambulances only once.

Although the story did not provide facts about each derailed ambulance run, Dr. Paul Olson, Medical Director for SAS, commented that in one instance “Community Ambulance was unable to get a crew together to transfer a stroke patient in Stanley, leading to a helicopter being flown in by NorthStar, all in order to not utilize SAS in any way.”

The Minot Daily Times noted the reason MCMC refused to use SAS “remains murky.” At present, it is unclear whether the “relationship between the community’s hospital and ambulance service will become amicable and cooperative.”

How can failure to follow ambulance regulations harm patients?

Considering North Dakotans may live in rural areas far from hospitals, and there are significant distances between local hospitals and North Dakota Critical Access Hospitals and Referral Centers, access to swift, sure, ambulance service with trained EMTs according to regulations is extremely important.

The MCMC-SAS story demonstrates failure to follow ambulance regulations might cause harm to patients by:

• Delaying treatment, potentially causing death or worsening outcomes.
  • For example, UCI Health says that “delaying stroke treatment may be deadly,” but timely treatment can prevent permanent damage. Similarly, treatment in the “golden hour” after heart attack can reduce death rates by 50% since “time is muscle.” Time is of the essence in any number of emergency situations, illnesses, and injuries.
• Increasing patient medical costs for treatment.
• Increasing patient pain and suffering.
• Increasing transportation costs. Ambulance costs vary greatly. Unnecessarily using out of area ambulances or air ambulances can increase patient bills.

If you or a family member has suffered harm due to an intentional or negligent delay in receiving medical treatment, you will need an attorney to represent your interests. Larson Law Firm P.C. has experienced personal injury and medical malpractice lawyers who can examine liability in the situation. We have offices in Minot, Bismarck, and Fargo. Contact us to schedule a free consultation with a North Dakota lawyer or call us toll free today at 701-484-HURT.