A member of Troy City Council is finally beginning to talk about measuring actual patient outcomes, improving CPR instructions, expanding AED access and reducing dispatch delays. Those are all worthwhile ideas. Troy absolutely should track cardiac-arrest survival and determine whether its EMS system is actually saving lives.
But the rest of the message is a very polished attempt to rebrand a contract failure as a success.
Good ideas about patient outcomes should not be used to move attention away from what Troy actually purchased, what STAR EMS promised to provide and what STAR has failed to deliver.
The biggest problems
1. Six minutes is not an “ambitious goal” or a “stretch goal.”
The signed purchase and service contract says STAR “shall meet a minimum emergency response time of 6 minutes 00 seconds for 90% of emergency responses.”
The performance-based option selected by Troy was expressly priced to meet that requirement. This was not an inspirational goal placed on a vision board. It was the service requirement written into the contract and approved by City Council.
STAR has failed to meet it in every one of the first six months.
Calling the requirement a “stretch goal” after the contractor repeatedly misses it is not accountability. It is moving the goalposts.
2. The post substitutes averages and medians for the contractual measurement.
A median response time under five minutes sounds impressive, but that is not how the contract measures performance. The contract asks a simple question: Did an eligible unit arrive within six minutes for at least 90% of emergency calls?
In June, the average response time was 4:43, yet only 76.48% of emergency calls met the six-minute requirement. Forty-three calls exceeded eight minutes, with an average response time of 9:31.
Both numbers can be true.
An average or median can look very good while a substantial number of residents wait much longer than promised. That is exactly why the contract uses a 90% compliance standard. The median tells us what happened near the middle of the dataset. It does not tell us what happened to the people waiting eight, ten or twelve minutes for an ambulance.
3. The before-and-after comparison blurs different clocks.
The 2023 feasibility study separately measured dispatch, turnout, ambulance travel and the complete time from the 911 call until arrival. It reported approximately:
- 3.3 minutes for dispatch
- 10.1 minutes for ambulance travel
- 13.5 minutes total from the 911 call to arrival
The current STAR contractual response clock begins later, after the call has already been processed and transferred. In June, Troy’s emergency call-processing time averaged another 1:49 before STAR’s response clock began.
Comparing an older 911-call-to-arrival measurement with a newer post-dispatch ambulance measurement creates a clean “over ten minutes to the high sevens” story, but the numbers are not measuring the same thing.
It is not an honest comparison unless the entire timeline is shown.
4. Meeting the county’s nine-minute standard is irrelevant to whether STAR fulfills Troy’s contract.
Troy intentionally contracted for six minutes, not nine. Saying STAR comfortably meets a less demanding county standard is like saying a contractor failed to meet Troy’s construction specifications but complied with the basic building code.
That may demonstrate that the service is not completely unacceptable by some other standard. It does not mean STAR has provided what Troy purchased. The relevant standard is the one written into Troy’s contract: six minutes for 90% of emergency responses.
5. The “one-third of the cost” comparison leaves out what Troy bought.
The selected performance-based, non-dedicated model costs approximately $24,328 per month, or about $292,000 annually.
STAR also offered an option providing five daytime and four nighttime dedicated ALS units, 24 hours a day, 365 days a year, for approximately $64,262 per month, or about $771,000 annually.
That dedicated-service price is much closer to the approximately $830,000 cited for the previous arrangement. The current contract is cheaper primarily because Troy selected a cheaper, non-dedicated deployment model. That does not automatically make the decision wrong. But it is misleading to suggest Troy simply found a company capable of providing the same or better service for one-third of the cost.
Troy bought a different service model. Residents deserve to know what was removed from the service, not just how much money was saved.
6. The transparency claim is wildly overstated.
The city publishes contractor-produced monthly summary tables containing response-time categories, averages and totals. That is useful, and it is better than publishing nothing. But Troy is not publishing the underlying call-level CAD data needed to independently determine:
- Which unit was dispatched
- Where that unit was located
- Whether a Troy-assigned unit was available
- Whether mutual aid was requested
- How long the longest responses took
- Whether calls were downgraded or reclassified
- Whether timestamps were changed
- Whether calls were excluded
- How long each part of the dispatch and response process took
Monthly summaries produced from contractor-supplied data are not full transparency. Calling Troy “one of the more transparent cities anywhere” is self-congratulation, not a conclusion supported by the information currently available to residents.
7. The proposal to add accreditation standards later is especially strange.
The original bid specifications already said the contractor “shall also hold” Commission on Accreditation of Ambulance Services accreditation.
STAR openly disclosed that it was not accredited. Troy awarded STAR the contract anyway.
Now accreditation is being presented as something City Council might consider adding to the contract in the future—as though it were a newly discovered idea.
It was already there. The real question is why the city disregarded or removed that requirement when it selected the contractor.
8. “Our officers carry AEDs” leaves out an important fact.
The police chief specifically explained that not every patrol vehicle has an AED. Dispatch must determine which available police vehicle is carrying one and send that vehicle when appropriate.
Police officers frequently arrive before ambulances, and strengthening their role as medical first responders is absolutely worth discussing.
But saying “our officers carry AEDs” implies much broader and more consistent coverage than currently exists. A serious improvement would be placing an AED in every patrol vehicle, not simply using incomplete AED coverage to reassure residents about ambulance response times.
Outcomes matter, but so does the contract
The outcome-tracking portion of the proposal is reasonable.
Troy should:
- Measure survival from cardiac arrest
- Track neurologically intact survival to hospital discharge
- Improve dispatcher-assisted CPR
- Expand community CPR training
- Place AEDs in every patrol vehicle
- Create a reliable public AED registry
- Reduce the nearly two-minute dispatch and handoff process
- Publish complete clinical and operational performance data
But outcomes and response times are not mutually exclusive.
Response time matters during cardiac arrest, stroke, severe bleeding, respiratory failure and other time-sensitive emergencies. A strong EMS system should measure both how quickly help arrives and what happens to the patient afterward.
You do not improve clinical accountability by abandoning contractual accountability.
It is encouraging that a council member is finally beginning to recognize that EMS performance should be measured by more than a favorable average. Now the rest of the way needs to be traveled.
The six-minute standard is not a “stretch goal we set for ourselves.” It is the minimum performance requirement STAR contracted and priced its proposal to meet.
STAR has met it in zero of its first six months.
A median under five minutes and compliance with the county’s less demanding nine-minute standard do not satisfy Troy’s contract. The “one-third of the cost” claim omits that Troy selected STAR’s approximately $24,328-per-month performance-based model instead of its approximately $64,262-per-month dedicated-ambulance option.
And measuring patient outcomes, while absolutely worthwhile, does not erase six straight months of contractual noncompliance, replace the missing call-level data or explain why city officials are already attempting to redefine a binding requirement as merely aspirational.
A council member may finally be waking up on EMS. Now City Council needs to stop rewriting the contract and start enforcing it.