PROVIDENCE, R.I. (WPRI) – The day after Christmas, 77-year-old Miguel Leon was feeling chest pains and having trouble breathing.

Within minutes of calling 911, firefighters in a ladder truck arrived at the Burns Street apartment complex where he lived. But all seven of the city’s ambulances were tied up. Providence had already called for backup from East Providence, North Providence, and North Smithfield to respond to 911 calls at that time, so the dispatcher turned to a fourth community for help at Burns Street.

“You have a Central Falls rescue,” the dispatcher told the ladder company, according to a Target 12 review of hours of Providence Fire Department dispatch transmissions during that day. “I will let you know when they sign on.”

Less than two minutes later, firefighters at Burns Street alerted dispatch that the situation was dire: Leon was in cardiac arrest.

“This is a code 99,” the firefighter said over the radio.

Eleven minutes after the original call came in, the dispatcher diverted the North Smithfield ambulance that was already on its way into the city on a separate call to the Burns Street incident.

Elsa Leon of Providence

“They will be there in about three minutes,” the dispatcher told the firefighters.

Leon later died at Rhode Island Hospital, according to his wife, Elsa.

Weeks later, Elsa told Target 12 she remembered firefighters getting to their home quickly, but that it took what felt like a long time for the rescue to arrive. Amid the chaos, she didn’t notice the lettering on the side of the ambulance that hauled her husband away was “North Smithfield,” not “Providence.”

It’s unclear whether the outcome would have been different if a rescue from inside the city was available to respond, but data from the R.I. Department of Health shows Providence’s reliance on out-of-town rescues – also known as “mutual-aid” – has climbed steadily in recent years.

The state estimates 1,093 out-of-town rescues responded to 911 calls in Providence in 2018, a number that grew to 1,147 a year later. In 2020, when many people were avoiding hospitals during the height of the pandemic, the calls for out-of-town help fell to 872. By 2021, however, the number soared again to 1,444, according to the Health Department.

In all, mutual-aid rescues in Providence increased by 33% between 2018 and 2021.  

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A total of 30 Rhode Island agencies responded to Providence for mutual aid rescue calls between 2018 and 2021. The most came from Cranston, North Providence, East Providence, Johnston and Pawtucket.

The data does not include rescues that come from Massachusetts, but it’s not unusual for an ambulance from Seekonk or Attleboro to be dispatched to the city for a mutual-aid run, according to radio transmissions.

Providence Public Safety Commissioner Steven Paré – who is also acting fire chief – called the system “broken” and attributed a big part of the problem to residents calling for ambulances for non-emergency situations. The issue has worsened throughout the pandemic and Paré said the city’s growing population hasn’t helped.

“We are going to too many calls for rescue and there’s got to be a better way,” Paré said. “The neighboring towns sending resources then doesn’t avail those resources to their own community.”

Fire chiefs from other towns interviewed by Target 12 agreed with Paré, and called it a “domino effect.” One community sends an ambulance into Providence on mutual aid, then must call on a neighboring town if they need help, and so on.

In North Providence, Fire Chief John Silva said they were sending so many rescues to Providence several years ago, they enacted a new policy where the department will decline to send a rescue to Providence if two of their three ambulances are tied up.

“We just want to ensure that we aren’t taking away from our own residents,” Silva said. “Unless there was some major catastrophic event like a mass casualty incident, then we have to take care of the problem. But for basic medical calls, we won’t send them our last rescue.”

In Cranston, Fire Chief James Warren said they added a fifth rescue just during the day staffed with two firefighters on overtime in a method called “peak-shaving.”

“That truck is a busy truck, it really is,” Warren said. “And it’s close to the Providence line.”

The idea is supported by data from the Health Department. On average, 11 a.m. to 6 p.m. on Mondays through Fridays are when Providence seeks mutual aid the most. More than 770 out-of-town rescues were called to Providence on Wednesdays compared to just 372 on Sundays (3 p.m. is the busiest part of the day).

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Cranston — which Warren said added a sixth rescue in 2020 for a time to deal with the increase in COVID calls — offsets the cost of overtime because the city bills insurance companies every time they pick someone up and bring them to the hospital, even when those calls come other communities.

Paré said he is reluctant to add more rescues, even like the peak-shaving model Cranston uses, because he’s skeptical it would improve the situation.

“I could go to 10, they’d probably be busy,” Paré said. “That’s not the solution in my mind – expanding. The solution is for an educational piece that you don’t call for a public rescue unless there is a real emergency.”

Yet even Paré acknowledged public awareness campaigns have not worked to alleviate the demand on mutual aid in his 11 years at the helm of the city’s public safety department.

Certainly, the impact of the pandemic has affected demand for rescues and wait times. Firefighters often wait outside the ramp that only ambulances can use behind the emergency department at Rhode Island Hospital because of overcrowding. And emergency departments often go on “divert” status, which means they no longer accept rescues except in critical situations, further complicating the overarching response time.

Paré said he thinks firefighters and dispatchers should be given more discretion on when to send a rescue, and when to tell people they must find their own way to the hospital. Firefighters are licensed by the Health Department, which has the authority to suspend or revoke their EMT-C licenses that allow them to work on a rescue.

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“There’s a fear that if I don’t, or if I say I’m not coming, and we end up with a tragedy, then there’s a fear with our employees that they’re on the hook and there’s a fear that our firefighters lose their EMT license if they just don’t pick up and deliver to the hospital,” Paré said. “It’s not the mindset we should have when we know the system is overused and the real emergency calls we can’t get to because we’re tied up on non-emergency calls.”

Two Warwick firefighters had their EMT-C licenses suspended last year after they declined to transport a patient to the hospital. She later died. The firefighters have since had their licenses reinstated.

“I just think that it needs a drastic change because we can’t continue doing what we’re doing,” Paré said.

Tim White (twhite@wpri.com) is the Target 12 managing editor and chief investigative reporter at 12 News, and the host of Newsmakers. Connect with him on Twitter and Facebook.