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'Level zero': ABC15 investigates ambulance response times in Prescott area

Life Line Ambulances
Posted at 1:42 PM, Jan 04, 2022

PRESCOTT, AZ — On June 30, dispatchers inside the Prescott Regional Dispatch Center repeated the same thing again and again.

“(Unit 1201) is en route with a 41-minute ETA, and we’re in ‘level zero’ again.”

“And that brings us back down to to ‘level zero.’”

“I have no units available.”

Those are just a few of several dispatches captured on radio traffic obtained by ABC15 from that day.

In its simplest definition, 'Level zero' essentially means no ambulances are available to take calls.

And firefighters in the Prescott and Prescott Valley area said it’s a common occurrence when dealing with the private company Life Line Ambulance — the only provider licensed by the state health department for an area that serves more than 150,000 people.

“What happens in the past is that a critical patient may be transported in the back of their personal vehicle and treated by paramedics in the backseat,” said Scott Freitag, Chief of the Central Arizona Fire and Medical Authority (CAFMA), which covers a large area surrounding Prescott. “Some have opted to take an Uber or a Lyft or a taxi to the hospital because they couldn’t get a transport.”

Freitag’s department has been feuding with Life Line and its parent company, AMR, over ambulances response times for years. The fire department has started sending out its own unofficial ambulances on calls in case a Life Line unit is too far away.

The practice briefly had CAFMA under a state investigation, which has been closed.

CAFMA has also been closely tracking the number of “level zeros.”

“Since July 2 through (October 12), we have been at ‘level zero’ 400 times,” Freitag said during an interview with ABC15.

Jason Chisholm said it’s something his family experienced back on September 4.

His grandfather, who was undergoing chemotherapy, started to feel unwell and they called 911.

“When the paramedics (from a CAFMA fire truck) got there, there was no ambulance available,” Chisholm said. “There wasn’t going to be one available for some unforeseen time.”

Chisholm’s father drove his grandfather to the hospital in a personal car. When they got there, they learned his grandfather was having a heart attack, he said.

“To fix this, I think we need a secondary ambulance service,” Chisholm said.

CAFMA has recently applied for their own license to operate ambulances in the area. So has another private company, Priority Ambulance.

Those applications are under a lengthy review process that can take more than a year to complete. That’s in addition to legal challenges that Life Life is allowed to bring to stop others from obtaining a license from the Arizona Department of Health Services.

Life Line’s regional director, John Valentine, said that the concerns over 'level zeros' and response times are being overblown.

“So, the word ‘level zero’ is an industry term,” he said. “Every service will at some point run at the limit or at the edge of having any ambulance available.”

Valentine said that Life Line doesn’t specifically track the number of times they’ve hit “level zero.”

However, he said they have looked into CAFMA’s claims.

“We don’t track that data point in our CAD of ‘level zero’ because it can be a fraction of a second. When the word 'level zero' is said, that means the last unit is dispatched on a call. That doesn’t mean there’s another call for service yet, but there’s a call that’s been dispatched,” Valentine said. “What it doesn’t tell you is that though mutual aid or move-ups… we start moving units from other areas. So there could be an ambulance on the border of the quad-city area that moved in from Wickenburg that’s available to go into the next call. There could be an ambulance at the hospital that’s just completing their paperwork that’s been there for 30 minutes and they’re available to go on the call.”

He added, “I took time to look at their information and went through it and of the 400 calls that I looked at. We did transport about 220 of those patients that we supposedly had no ambulances available for.”

As described by Valentine, when there are limited ambulances available or a surge of calls in the Prescott area, it can have a ripple effect that reaches down into the Valley.

“If we’re at level zero, then we start pulling ambulances from Phoenix,” Freitag said. “Typically, what they’ll do is they’ll reach out and pull nits from Williams or Wickenburg if they haven’t already pulled them.”

That also can create long response times and stretches Valley agencies.

ABC15 has learned that the Phoenix Fire Department recently raised concerns to the state health department about the trickle-down impact from the Prescott area.

In a previous statement regarding the response time concerns, a spokesperson for the Arizona Department of Health Services sent the following statement.

“The state’s commitment to the health and safety of Arizona communities extends to its oversight of emergency medical services providers. We are aware of the community concerns and are following a process to ensure that residents have access to reliable EMS transport. ADHS has hosted stakeholder meetings and worked with the current certificated ambulance provider in the region (Life Line) to improve response times. This resulted in an amendment of Life Line’s Certificate of Necessity finalized in early 2021. An administrative hearing is currently underway to determine whether an additional CON can be granted to a second ambulance provider (Priority Ambulance) to operate in the area.

“Between late 2018 to mid-2021, the ADHS Bureau of Emergency Medical Services received and reviewed a log of EMS calls provided by CAFMA that included over 1,000 calls covering several years. ADHS has opened an investigation on the current ambulance provider (Life Line) to request additional information about any potential gaps in service or community need. The investigation has found Life Line to be in compliance with its improved ambulance response time requirements, which are measured over a 12-month period as required by Arizona Administrative Code. However, the investigation remains open at this time to gather more information.

“ADHS also has an obligation to make sure that medical transport provided by entities that are not certificated ambulance providers, including CAFMA, meet standards of medical necessity developed in the interest of public health and safety. To date, ADHS has sent CAFMA three Notices of Investigation requesting additional information about the use of CAFMA rescue units to provide EMS patient transport. Nothing is implied in these requests, which will help ADHS determine whether the transports were proper under ARS 36-2208(B). ADHS is currently reviewing additional information recently submitted by CAFMA, and the status of the investigation remains open.

“While we cannot disclose patient information, the Bureau is committed to working with EMS providers to ensure that patients are transported safely to get access to emergency medical care. All parties agree that patients should have access to the right resources in the right amount of time. We have deep respect for frontline workers, including those employed by Life Line, CAFMA and the area’s 911 system.”

Contact ABC15 Investigator Dave Biscobing at