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Boy's Death Leads Atlanta To Review EMS Response

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The city of Atlanta is trying to learn from Emil Gadjev's death.

The 13-year-old boy collapsed from sudden cardiac arrest Sept. 11 on his middle-school soccer field.

Research shows that six minutes makes the difference between life and death in such cases. Many victims can be saved if they get a shock from a common device known as a defibrillator within that time. But more than 12 minutes passed before help arrived for Emil.

Because of the boy's death, Atlanta school system officials are considering putting portable defibrillators in the city's schools. The devices are easy to use, even by someone who isn't trained, to shock a quivering heart back to a normal rhythm. Across the nation, schools increasingly have been installing the devices to protect students and staff.

At the same time, Atlanta is scrutinizing its emergency medical service, or EMS. A computer error delayed the response to Emil, and that problem has since been solved. But city officials acknowledge that the incident is a symptom of larger issues in a splintered system that they are struggling to fix. ''We recognize there is a problem, but it is going to take both the city of Atlanta and the county working together to produce a better system,'' says Kenneth Allen, Atlanta's interim fire chief.

Atlanta's emergency medical system is set up like many across the nation: Trained firefighters carrying defibrillators are the first responders. The system is supposed to get the closest fire engine to a medical crisis fast. That system failed Emil.

A USA TODAY investigation raised questions in July about the performance in Atlanta and other major U.S. cities. It found that emergency medical services in most of the 50 largest cities are fragmented, inconsistent and slow. As a result, more than 1,000 lives are lost needlessly each year.

USA TODAY estimates that 83 people collapse in Atlanta each year with the best chance of being saved: They are seen going into cardiac arrest and are found in need of a shock from a defibrillator. How many of these people are actually saved is considered the truest measure of an emergency medical system's lifesaving performance.

Atlanta refuses to say how many such people it saves, if it knows. If Atlanta is in line with the national average, about 6%, it would save five of these victims. If its save rate matches some higher-performing cities, 20%, 17 lives could be saved.

The USA TODAY investigation found that the cities that save the most lives measure their EMS performance closely, and one key measure is response time. Like many other major cities, Atlanta has for years relied on response-time measures that do not tell the true story. The city measures response time from the moment the crew is notified of the emergency until it arrives at the scene. In Emil's case, the official response time was 8 minutes, 21 seconds.

In fact, 12 minutes and 12 seconds elapsed before the first crew arrived. The official measure did not count the minutes that were lost as the call was transferred from one dispatch center to the next, sending an ambulance from one communications center and the fire units from another. The clock began when the fire crews were notified of the emergency.

A parent at the soccer field saw the boy collapse and called 911 immediately. But when the address to Sutton Middle School appeared on the dispatcher's screen, the computer did not recognize that Engine 27 was just a few blocks away. It recommended sending units that were farther from the school. As those crews raced to the scene, Engine 27's crew sat in the station and adults did CPR on Emil.

One mother got in her car and drove to Station 27. After she told the crew of the emergency, it took only 99 seconds for Engine 27 to reach the school. By then, the other crew had arrived and almost 14 minutes had passed.

Firefighters shocked the boy with their defibrillator, but because those shocks came more than 12 minutes after collapse, he had little chance of survival.

Allen says the USA TODAY probe sparked new efforts to improve EMS. ''People are asking what is wrong with our system, and what will it take to improve?''

The city is upgrading dispatch computers and shifting its response-time goal from the current five minutes to four.

''We should be providing the best system we can,'' Allen says. ''If my family was injured, I would want (emergency crews) to get there as fast as they could.''

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© Copyright 2003 USA TODAY, a division of Gannett Co. Inc.

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