Sanford Edlein sat on a green velvet couch across from his wife, Rita, and declared himself a lucky man. It had been weeks since he nearly died.
The room is decorated with photos and memorabilia from the Edleins' travels and pictures of their family. What's out of place in the Sequoyah Hills home is the blood pressure monitor on the counter. It's a bit of an eyesore, but Rita said she follows Sandy around with it, all day, every day.
Her paranoia is new. She's been on edge since December when Sandy laid on the couch suffering from a "widowmaker" heart attack as he waited nearly an hour for an ambulance to arrive.
A delay in ambulance access is a problem across America, and it's a multifaceted issue with no simple solution. Patients are relying on emergency rooms for routine care, which creates delays for people experiencing true emergencies.
American Medical Response, the company Knox County uses, has a history of delayed responses. The company was rehired by the Knox County Commission in November over four other providers, in part because of improvements company leaders promised to make.
Commissioners admit the new contract isn't perfect, but say they were backed into a corner because letting the contract expire with no ambulances ready to serve county residents was too much to bear.
The Edleins are skeptical, and making their own plan to get Sandy to an ER when the next crisis hits.
What happened Dec. 19
On that life-changing December night, Rita called 911 at 10:43 p.m. suspecting Sandy was having a heart attack, she told Knox News. It wasn't long before Knoxville Fire Department responders arrived. By 10:50, Sandy was hooked up to an IV line and firefighters were able to confirm Rita's assumption through a portable EKG test.
By 10:55 p.m., a second fire engine arrived. All Rita and the firefighters could do at that point was keep Sandy calm and prepare for an ambulance they hoped would arrive. He was already maxed out on aspirin and nitroglycerin.
"There were like, seven firemen standing in here," Rita said. "You could see, they were visibly upset that it was taking so long."
Even as a new contract requires stricter enforcement of quicker response times, the Edleins don't trust AMR. They're making alternative plans for the future.
'His heart will probably stop'
Gone are the days of planning luxurious vacations. Instead, Rita dreams up faster ways to get Sandy to the hospital.
A test image of Sandy's heart attack showed complete blockage of the left frontal artery. After someone suffers an initial attack, the chances of it happening again are heightened: One in five people who suffer a heart attack have a second one within five years, according to the American Heart Association.
"You have to make a plan for the future," Rita said. "It's kind of morbid, but a conversation I've had to have with him is 'OK, they've already told us, should he have another heart attack ... his heart will probably stop.'"
She learned how to do chest compressions until an ambulance shows up. She's figuring how safely to drive him to the hospital herself. Based on their experience, she's likely to get Sandy there herself.
During Sandy's initial heart attack, she considered driving him to the hospital, but he was already hooked up to machines and paramedics advised her against it.
"I just tried to sit back and be quiet and just (stood) at the front door hoping they would pull up."
An ambulance didn't arrive until 11:35 p.m., almost an hour after her call. Catheter laboratory staff had been waiting upon his arrival at the University of Tennessee Medical Center, just three miles from their home.
"Any medical professional you've ever talked or we've spoken to can't believe he survived it," Rita said. "That's why they call it the widowmaker."
Where were the ambulances?
Joshua Spencer, AMR's south regional director, told Knox News in an email there was unusually high call volume on the night of Sandy's heart attack, and 11 ambulances in service. A report by a third-party firm hired by the county to review AMR's contract recommended 14 should be circulating at that hour.
All 11 ambulances were assigned when Rita called for help, Spencer said. AMR requested assistance from neighboring EMS agencies but none were available.
Finally, at 11:10 p.m., an ambulance was dispatched to the Edleins' house from Parkwest Medical Center 9.2 miles away. Spencer said three other units closer to their house were unable to offload their patients in time.
AMR policy says EMTs must wait with patients until they're seen by a physician before they can leave the emergency room. Industry standard for offload times in emergency rooms is around 30 minutes, Spencer said, but the average offload time for the 24-hour period during Sandy's heart attack was an hour and 10 minutes. That's due to staffing problems in hospitals and emergency rooms, another reflection of America's systemic health care deficiencies.
"If the offload time on this day averaged 30 minutes instead of 70 minutes, there would have been82more hours of ambulance availability in Knox County (equivalent to almost 7 additional ambulances in service)," Spencer said in an email to Knox News.
Officials tout new contract with more accountability, but they're taking a passive approach
One month into the new contract, Knox News asked every Knox County commissioner, Knoxville City Council member and the mayors of Knox County and Knoxville how they are holding AMR accountable.
The short version: They're waiting.
The contract allows AMR a grace period of a month to implement software needed for submitting reports to county officials, and most elected officials said they were waiting for that period to end before they look further into AMR's performance.
New response time standards and increasing hires at AMR are expected to improve performance.
Targeted wait times are 10 minutes for inside Knoxville city limits and 20 minutes for Farragut and the Corryton, Mascot, Powell and Strawberry Plains communities, according to the contract. AMR is required to meet those response times or it will face a penalty.
Spencer told Knox News AMR has hired 28 new employees since the new contract started.
The Knox County Health Department will receive monthly reports on response times, systemic errors impacting service, customer hotline reports and "other reports requested by Knox County." Other reports will be available less frequently: financial reports come in semiannually, patient satisfaction reports will be available quarterly and a list of EMTs will be available annually.
Kevin Parton, senior director of the Knox County Health Department, said AMR representatives, the dispatch manager and Knox County Health Department Emergency Response Coordinator Steve Hamby will attend monthly meetings at which reports are given.
Knox County commissioners can't attend those meetings because of patient privacy laws, Parton said, but commissioners will receive quarterly briefings from AMR.
Sandy's supposed to be recovering from his heart attack and the subsequent complications that caused him to return to the emergency room (that time, Rita drove him there in four minutes). Instead, he's sharing his story.
On Jan. 12, the Edleins sent a letter to Knoxville Mayor Indya Kincannon and Jacobs' offices describing his experience with AMR and expressing his frustration. He received confirmation that both offices received his letters by Jan. 27, but as of March 11, he has not received a response.
In an email to Knox News, David Brace, Kincannon's chief of staff, said he wasn't aware of constituents reaching out.
Sandy thinks the solution is holding the government and AMR accountable.
"This is not a Republican issue, it's not a Democratic issue, it's not a liberal issue, it's not a conservative issue," he said. "It's an issue of competence of government."
Allie Feinberg reports on politics for Knox News. Email her: allie.feinberg@knoxnews.com and follow her on X, formerly known as Twitter, @alliefeinberg.
Support strong local journalism by subscribing atknoxnews.com/subscribe
This article originally appeared on Knoxville News Sentinel: Ambulance delay causes mistrust for Knoxvillian who suffered heart attack
