Stephanie Klein-Davis | The Roanoke Times

(l)Bryan Adkins, 35, and Craig Champney, 39, with Station 1 EMS, respond to a call about a man passed out in a backyard on Montrose Avenue, SE.

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Audio Gallery: See and hear EMS personnel respond to calls

The air smells foul.

Paramedic and firefighter Craig "Chappy" Champney and his partner, Bryan Adkins, hop out of Medic Truck One and head toward the stench's source.

The 911 call went out as a man with stomach pains at the downtown Roanoke library. A man, as it turns out, who didn't make it to the bathroom on this hot August afternoon.

Champney covers the man's shoes with a towel and loads him into the truck. Adkins rolls down the ambulance's windows and cranks the air conditioner on the cross-town journey to Lewis-Gale Medical Center in Salem.

After dropping the man off, Champney and Adkins type up paperwork, spritz some air freshener in the back of the ambulance and make their way back to the station.

The call has taken 62 minutes.

Not always emergencies

Emergency medical service workers have seen people burned alive and searched for severed body parts. They have delivered babies and pulled animals from fires.

But often the ding-ding-ding alert that sounds in the middle of the night is for callers with chronic colds and sunburns. A neighbor's dog barking too loudly. A fingernail cut too short. EMS workers have taken as many as 40 calls from a single person in a few months, said Roanoke Fire-EMS Department Chief David Hoback.

"That's their only way to either get attention, get someone to come visit with them or to help them with their health care needs because they don't have any other direction," Hoback said.

Abuser calls make up about half of the dozen or so calls received by Station No. 1 in a day, Champney said.

"The worst part of this job is the people that will use us to get to the hospital," he said. "I've had people call for a toothache, been sick for six months, fell down last week or got in a fender bender six weeks ago and their right elbow hurts. But if they call and say 'I need help,' they get an ambulance."

The call for the man at the library was a perfect example, he said. "There's your abuse. It's not life-threatening -- he knew what to say to get a ride to the hospital."

Legally, an ambulance must respond to a call. Once the medic truck arrives, the paramedic decides whether to take a patient to the hospital.

The most frequent non-transport calls are "man down" calls, Hoback said. These calls are usually a drunk taking a nap or a worker lying down to check a water meter.

From January to August of this year, 534 man-down calls resulted in just a 10 percent transport rate in Roanoke.

The number of calls for non-life-threatening injuries has increased over the past few years. In 2004, the city's dispatch center received 2,247 such calls. The number grew by more than 250 calls in 2005 and another 500 in 2006. When compared to the total number of calls handled, non-emergency calls have risen from just above 10 percent in 2004 to 13 percent in 2006.

Although the category doesn't single out system abusers, EMS officials said it is a good measure of the non-emergencies they deal with.

The department charges $350 for a basic life-support call, which is often the classification when there is not an emergency. If the patient has Medicaid or is uninsured, taxpayers foot the bill.

Hoback said that his department only recovers costs for about 60 percent of all the calls it answers. Overall, the city spends about $2.4 million per year on EMS services.

In extreme circumstances, callers are charged with abuse of the ambulance service, a misdemeanor. Hoback can recall only three or four cases in the past several years that have gone before a judge.

Often, Hoback said, EMS workers will first talk to family members or social services to find help for an individual who abuses the system.

That doesn't always help.

Champney and Adkins once went out four times in one night for the same person -- a drunken man who had lost his glasses.

Now, when EMS personnel are dispatched to his address, they have to tell him they can't transport him unless his life is in danger, Champney said.

911 instinct

Much of the problem stems from intense marketing. For years, three digits have been pounded into the heads of Americans: 9-1-1.

"It's the only one they remember," said Michael Scott, director of the Center for Problem-Oriented Policing, a national nonprofit group that analyzes ways to address crime and disorder issues.

Local EMS officials are hesitant to crack down for fear that people will stop calling 911 altogether.

Retraining people is almost impossible, Scott believes. You can't tell someone not to call 911, and EMS personnel don't know what is wrong until they arrive at the scene. Some callers cry wolf while others underestimate their need for an ambulance.

"I don't care what community you live in -- how big or small -- we all have our system abusers, and a lot of those folks are frequent contributors to that abuse," said Jerry Johnston, president of the National Association of Emergency Medical Technicians. The abuse is not as bad as it used to be, mainly because of the increasing cost of rides, he said.

But Johnston said that EMTs and paramedics-in-training are told that only 5 percent to 10 percent of the ambulance calls in their career will constitute life-threatening emergencies.

Bill Ferguson, chief of division operations for the Franklin County Public Safety department, said that although abuse of the 911 system is not as prevalent in his county as in Roanoke, it still happens.

"It's disheartening when we're out with somebody who has been throwing up for two days and there's a wreck or cardiac arrest and your trucks are tied up," he said.

Ferguson posited that some of the abuse might come from the history of the EMS system, which began as a community service. He remembers taking patients back and forth to the hospital when he was a volunteer.

These days, it's a one-way ride.

A woman is sitting on a curb in downtown Roanoke, flustered and upset. She tells EMT Amy Barger that she was supposed to meet a friend for a date but was stood up. She is feeling moody and asks to go to the hospital.

Barger guides the patient into the back of the ambulance and buckles a safety belt. The sirens are silent as Barger asks questions.

The woman has been crying and feels depressed. She is going through a divorce. After dropping her off at Carilion Roanoke Memorial Hospital, Barger mentions a frequent problem.

The woman has no insurance.

"The citizens of the city paid for it," Barger says.

All types of calls

Abusive callers range from the homeless to the elderly to the just plain lonely.

The Roanoke Rescue Mission is a frequent source of 911 calls, Hoback added.

"You have a lot of homeless people down there, and they fall a lot and they get into fights and they drink, and they have a lot of problems and don't necessarily need to go by us, but they really don't have any other means," he said.

The Rescue Mission houses 300 people a night, said Joy Sylvester-Johnson, its chief executive officer. And although residents are urged to use the free clinic at the mission, calls to 911 for non-emergency conditions do occur.

"We don't prohibit them from doing it even when from the outside, us looking at the situation, feel that maybe 911 should not be called," she said. "There have been a few times when we've called 911 and the people arriving thought that it was an unnecessary call and later it proved that it was a very necessary call."

Other non-emergency calls are from elderly people who have fallen and cannot get up on their own, or who need help getting from their bed to a wheelchair. Barger recalled transporting a nursing home resident who was discharged before the EMT finished her paperwork.

Another elderly woman was constantly calling 911 for shortness of breath, added EMS Capt. Loren Thompson.

"She just wanted someone to talk to," he said.

EMS workers never know what will face them once at the scene.

"This job is as good or as bad as you let it be," Champney said. "If you let the abusers get to you, then you'll just get bitter."

A man, his blue dress shirt soaked in sweat, is passed out in a yard where the grass hasn't been cut for a few days.

His hound dogs are waiting patiently, their leash secured by a police officer just up the hill.

The man's blood sugar has dropped dangerously low. Champney injects a high dosage of glucose, and his patient comes to.

If the man had waited much longer, he would have died of heat stroke, Champney says.

The patient refuses transport to the emergency room and promises to eat as soon as he gets home. He signs a waiver and is on his way.

The two men on Medic Truck One have saved his life.