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In some counties, emergency help isn't a call away - Duane D. Stanford - Staff - Sunday, January 27, 2002

Marshallville --- The stabbing pain in her chest was worse than anything Pat Crawford had ever felt. It snaked through the 53-year-old woman's back and down her arms to her tingling hands. Her grunts woke her husband sleeping beside her. He shook her. She grunted louder.

"Are you having a heart attack?" William Crawford asked. Pat could only nod. Adrenaline spiking, William Crawford grabbed the phone and dialed 9-1-1. He expected help. He got a recording. "911 is not a working emergency number for your area," the voice told him.

The Crawfords live in Macon County, one of 33 Georgia counties without an emergency 911 system. As many as 280,000 Georgians who live in these rural counties do not have access to the three-digit distress call most Americans take for granted.

While Florida, Tennessee and Alabama have some form of 911 in nearly every county, these Georgians continue to go without because of small populations, a lack of money and a reluctance by state lawmakers to subsidize local programs.

Sen. George Hooks (D-Americus) knows the situation well: Five counties in his district, including Macon County, do not have 911 service. In a tight budget year, Hooks, the Senate's appropriations chairman plans to try this legislative session to seek several thousand dollars from the state to help those counties develop a joint 911 center.

Some say rural residents aren't the only ones who suffer without 911 service. Travelers on I-75, I-20, I-16 and I-95 pass through non-911 counties every day. Dialing a cellphone after a wreck in those counties will get you to the nearest 911 center, where dispatchers can reach the local authorities, but valuable time is lost.

"People traveling to Florida expect to have 911 everywhere," said Clint Mueller of the Association County Commissioners of Georgia. "It's important no matter where you live."

Critical time is lost

Nationwide, all but 2.2 percent of the population has home access to 911 service. In Georgia, 3.4 percent of residents have no access to 911 where they live. That gap puts thousands of people at a greater risk of death or long-term damage when a health crisis strikes.

Until last week, the Crawfords hadn't needed to call. They moved two years ago to Marshallville --- between the city of Macon and Americus --- from nearby Houston County, which does have 911.

"It was just like I had my hands tied behind me and I couldn't do nothing for my wife," recalled William Crawford, who estimates he wasted 15 minutes trying to contact the county ambulance service early Tuesday.

After getting the recording, Crawford called the State Patrol, which gave him a number for a hospital in nearby Perry. Doctors there gave him another number for Macon County EMS, which rang in a Montezuma emergency room. A nurse took Crawford's information and called an ambulance. Meanwhile, the Crawfords' adult daughter opened the phone book and scanned a list of emergency numbers under a giant logo that said "Call 9-1-1". She dialed 911 on her cellphone, which rang in Houston County.

More than 30 minutes after Pat Crawford's chest pains began, an ambulance pulled up to the door.

"The whole point of 911 is to give people a quick, easy and memorable number," said Dr. Arthur Kellermann, chairman of emergency medicine at Emory University Hospital. He and other state trauma experts have said for years that 911 should be a priority in every county. "It's the step from which everything else follows," Kellermann said.

In emergency care, the first hour after an injury is sustained is the most important, Kellermann said. The chance of survival dwindles with each minute of that "golden hour" that passes without the administering of care.

"911 saves lives, there's no question about it," said Elaine Sexton, 911 adviser to the Georgia Emergency Management Agency, which oversees the state's 911 system. "Seconds are extremely important when you're dealing with an emergency situation. They are critical."

The 911 system isn't just about saving time dialing, however. With the majority of 911 systems, a caller's address automatically pops up on the operator's screen. Even if a caller is too young or sick or frightened to talk, dispatchers can send help. Plus, 911 dispatchers are almost always trained to talk callers through CPR, the Heimlich maneuver and other emergency procedures.

Financial obstacles

While most children learn to dial 911 even before they enter preschool, children in Macon County learn seven-digit numbers.

"Four, seven, two; eight and count backwards" is the trick Macon County EMS Director Andy Windham uses to help children remember his number: 472-8765. Windham said schoolchildren he visits routinely ask why the county doesn't have 911.

The short answer is money. Even though counties are allowed to charge $1.50 for every hard-wired telephone in their jurisdiction, those with small telephone subscriber bases still have trouble raising the necessary capital.

Macon County commissioners formed a committee last year to look into developing a 911 system, but the committee determined the cost was more than the county of 14,000 could afford.

Start-up costs for equipment, construction and telephone network charges would total nearly $500,000, the committee learned. Annual costs --- including personnel, equipment upkeep and a monthly $4,400 telephone company charge --- would total about $350,000 a year.

But with fewer than 6,200 local telephone subscribers, the county would collect roughly $108,000 from the $1.50 charged to residents on their monthly phone bills. County Clerk Roselyn H. Starling said commissioners would have to raise property taxes to cover the shortfall because the county's $4.9 million operating budget is already tight.

Commissioners delayed buying new police cars and road building equipment this year. Counties facing similar financial obstacles haven't given up. Most are working to form coalitions that can share the costs.

Macon County has partnered with Schley, Marion, Dooly, Sumter and Webster counties to investigate bringing a regional 911 center to their area. Hooks, the senator, said he will try to obtain $10,000 from next year's state budget to pay for a study evaluating the plan's feasibility and cost.

"The state has a certain obligation to assist in quality health care throughout Georgia, and that would include 911," said Hooks, who stopped short, however, of saying the state should step in and fully fund 911 systems in struggling rural counties. The Association County Commissioners of Georgia will form a committee this year to evaluate the state's 911 system. One concern is whether the maximum 911 fees counties can charge are high enough. Mueller expects the association to make recommendations before next year's legislative session.

For now, William Crawford keeps a piece of paper in his wallet with the phone number of Macon County EMS.

Doctors still weren't sure a couple of days later what happened to Patricia Crawford's heart. It's possible she had a minor attack. Her husband can't help but wonder what would have happened if she had been stricken by something worse.

"Fifteen minutes could mean life or death, I reckon." �

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