Whether it’s a loved one not breathing, a heart attack or a car crash, you pick up the phone and dial 911.  You expect the first medical responders to arrive within minutes and that includes an ambulance.


But some residents in Sioux Falls who’ve experienced an emergency say they were told it was a “Level Zero,” and they either had to wait longer than expected for an ambulance, or one never arrived at all.

“Level Zero” is a new term used when all ambulances are busy. It’s part of the new ambulance service in Sioux Falls. 

Paramedics Plus, based out of Texas, won the City contract last year.  

The city says Paramedics Plus has been in compliance with response times for calls 95 percent of the time, well above contract requirements. 

But Angela Kennecke has been going through the raw data on thousands of emergency calls and has uncovered some inconsistencies for our Eye on KELOLAND Investigation.

 “9-1-1, where is your emergency?” The Metro Communications Dispatcher said. 

Like most emergencies, the one that took place at this east side Sioux Falls home on May 14th was unexpected.  Megan Sage and her husband had returned home from a night out and she went in to check on four-year-old Emmy. 

“She was just kind of gasping for air and saying, ‘Mommy, I can’t breathe, I can’t breathe, I can’t breathe,'” Sage said.

Emmy doesn’t have any allergies and hadn’t eaten anything unusual.  As a nurse, Sage knew her daughter needed immediate medical attention.

“And then I noticed her lips were turning blue, kind of that blue tinge around her lips and I thought, ‘we need to call an ambulance right now.'” Sage said.

Five minutes later, the fire trucks arrived and EMTs put Emmy on oxygen. 

“And what about the ambulance?,” Kennecke asked.
“The ambulance never came,” Sage said. “When they finally got her stabilized, they said, ‘you’re going to have to drive her to the ER,’ which was a little surprising to me. They did get on their radios and say, ‘Are there any ambulances?’  And I heard them say they were at a Level Zero and they just told us that we’d have to drive her in ourselves.”

20 minutes later, that very same night, Hamida Hussein was in labor with her 8th child. 

A lot of pain, yeah,” Hussein said.

After she called 9-1-1, the fire department arrived, but not the ambulance. 

“Sorry, have to wait, everything is busy, hospital is busy; ambulance maybe come, a little bit waiting,” Hussein said.

“So you were told it was really busy, all the ambulances were busy?” asked Kennecke.
“Yeah,” Hussein said.

An ambulance eventually transported Hussein to the hospital and Yusuf was born the following day. 

Though you could chalk both Sage’s and Hussein’s cases up to just one busy night,

Paramedics Plus has paid nearly $25,000 in fines for 27 late calls, known as “outliers,” in 7 months. Yet it paid no late fees for the most life threatening, or Priority 1 emergency calls. 

Generally we’re within compliance. We have some outliers that do happen, but you can count on it within 15 minutes and 15 seconds, Michael Bureau of Paramedics Plus said.

But KELOLAND News wondered how cases like the ones on May 14th could happen, and compliance rates could remain higher than 95 percent for Paramedics Plus.  So KELOLAND News asked the City for the raw data on emergency calls.  KELO was not given any medical or identifying information on those calls.

Here’s what we found:  Out of 5,019 emergency calls from September of 2015 through April of 2016, the fire department arrived before the ambulance 25 percent of the time or 1,269 times. On average, the fire department arrived 3.53 minutes before the ambulance. 

“Sometimes they (the ambulance) are there before fire.  You probably saw that. You had to have seen that. But most of the time they are going to get there a little bit past, but fire has done some things to help get that patient ready,” City Health Department Director Jill Franken said.

Sioux Falls Health Department Director Jill Franken oversees ambulance service in the City.  We also asked her about the 70 times the ambulance never arrived out of those 5,000 calls.

“That would be one very simple reason; they cancelled the call,” Franken said.

“All 70 times would have been cancellations?,” asked Kennecke. 

“Sure absolutely.  When you look at the number of calls, I’m actually surprised it’s not more than that to be honest with you,” Franken said.

But you’ll remember that in the Sage’s case, with little Emmy, who wasn’t breathing, the ambulance never came and her parents were told to drive her to the hospital.

“I don’t know who told them that. I don’t know how it was communicated. But that would be unfortunate, Franken said.

We also asked the City for the time it was determined an ambulance was needed and the actual time the clock was started on that ambulance.  We found, on average, there was a 2 minute 2 second delay.

But sometimes it could be much higher, from 6 to 12 even 15 minutes or more.

“I think that’s a really good question for Metro,” Franken said.

So KELOLAND News Investigates went to Metro Communications Deputy Director Jesseca Mundahl to ask her why there would be more than a 2 minute delay on average from the time the clock started for the ambulance after it was determined one was needed.

“The data, looking at these numbers, doesn’t paint the picture at all. It’s just time stamps in a computer and who knows what was going on at each moment,” Mundahl said.

Metro says each call must be looked at individually and it could be as simple as the wrong time was entered in the computer.  We also wanted to know how “Level Zero”, when no ambulances are available, is handled when emergency calls come in. 

Level Zero happened like 439 times in the 8 months we looked at. 

Angela asked if that was a lot:

“As long as there is not a call holding, it really doesn’t matter–they’re all being used appropriately as long as they become available, that’s how it’s supposed to work. Even though your data might say it was marked Level Zero all these times, how many actually had a call holding as a result of it?” Mundahl said.

“But it does happen. Sometimes there are calls holding?,” Kennecke asked. 

“It does happen, but Fire Rescue goes for those, it’s not that we do not send anybody for those calls,’ Mundahl said.

While there are no minimum requirements, Metro Communications tells us that Paramedics Plus has an average of five trucks stationed around Sioux Falls during busy times.  According to its contract with the City, Paramedics Plus must staff according to historical data and peak times for service. 

Michael Bureau of Paramedic Plus: “We have to have reserve ambulances for 130 percent of the fleet.”
Kennecke: “And does that always happen.”

Bureau: “Uh huh.”

Kennecke: “They’re supposed to have staffing or ambulances ready to go for 130 percent of the surge or peak times, so if that would be the case, should we ever have a level zero?”

“We have seen an increase in ambulance requests since paramedics plus started,” Franken said.

Franken says those numbers have actually gone as high as a 200 percent increase in capacity.  But that’s where mutual aid with ambulance services from surrounding communities should come in. According to the City’s Level Zero policy, MED-Star out of Brandon is the primary mutual aid provider for Sioux Falls.

Bureau:  “And we’ve also reached out to outlying communities in both Lincoln and Minnehaha County.”
Kennecke: “So you have a mutual aid contract with MED-Star in place.” 
Bureau:  “Uh huh.”
Kennecke: “Right now?” 
Bureau: “Uh huh.”

“Angela, we do not have a contract in the City of Sioux Falls, but interestingly enough, we’ve been called twice in the last couple of weeks to come into town to be mutual aid. But we haven’t transported anybody as of this date,” Jay Masur of MED-Star said.

The City says MED-Star has been “sent” the contract for mutual aid and Masur tells us he’s been trying to meet with Michael Bureau of Paramedics Plus to finalize the agreement.

Because the Sages live on the eastern edge of Sioux Falls, Brandon-based MED-Star would have been a logical choice to respond in their emergency.  Even though no ambulance came to the Sages, Emmy has recovered and proudly shows us a bear given to her by the firemen who gave her oxygen.

“What did you name her?” Megan Sage asked.

“Princess of the World,” Four-year-old Emmy said.

While Emmy’s outcome is a positive one, Sage worries about the next potential emergency.

“When you want an ambulance to come, you just call one, and that’s not the way it is, I guess,” Sage said.

“Every single call like that, even if I don’t know about it myself, I can tell you there’s people in the EMS system that know about it and they’re evaluating that and using that as an opportunity to improve.  That’s what I can tell that mother,” Franken said.

Kennecke: “If I pick up the phone and I call an ambulance, I’ve got a family member who I think may be dying. I want to know an ambulance is going to be there.”
Bureau: “Uh huh.”
Kennecke: “Can you guarantee to me an ambulance will be there?” 
Bureau: “An ambulance will get there.”
We want to let you know that Sage is related to a KELOLAND employee.  We also spoke with newly-elected councilman Pat Starr, who witnessed his own emergency when a child blacked out during a basketball game last winter while he was officiating a tournament. He told us it took 17 minutes for the ambulance to arrive. 

“Even if you’re at 95 percent service level that means that 5 percent of the time we didn’t do a good job. And are we willing as a community to accept that?” Starr said.

The City will review Paramedic Plus’s first year on the job coming up next month.  Starr says he’d like to see the City consider subsidizing the ambulance service to increase staff and the number of trucks stationed throughout town.