Donna Echols had just returned to her north Jackson home from her eldest son's fairytale wedding in the Bahamas and expected to greet the groom's father who had stayed behind to watch the house and her pets.

What she didn't expect was the start of an emotional rollercoaster.

That night, April 27, Echols found her ex-husband, “Diamond Jim” Mabus, on the living room floor unresponsive. Furniture was strewn around. She called 911 to ask for an ambulance.

What followed were five calls and an excruciating 90- minute wait before the county's ambulance provider, American Medical Response, arrived and took Mabus to St. Dominic Hospital.

Mabus was in the intensive care unit for a week until his death on May 4 at the age of 76. An MRI scan revealed he had suffered a series of small strokes and a large stroke. He left behind two sons from his marriage to Echols, two other sons, and friends and family.

“It angers me so much,” Echols said about AMR's drawn-out response time. “It's so much a death sentence for someone.”

AMR spokesperson Nicole Michel said the night Echols called, the central Mississippi service area was at a level zero, meaning there were no available ambulances. Eight ambulances and two sprint medics were already responding to other calls, and during the nine o'clock hour, AMR received six service requests, including one for a heart attack.

Triage protocols are applied to service calls to determine if people are suffering or are likely to suffer a life-threatening illness or injury, the spokesperson said.

Medical providers say that seconds count when someone suffers a stroke because brain cells immediately start to die. Response time can determine whether someone fully recovers, faces complications such as paralysis or dies.

Echols made the first 911 call at 9:15 p.m., according to cellphone records shared with Mississippi Today. Within 10 minutes, four Jackson firefighters arrived and started tending to Mabus, but they were not able to render further medical attention because they are not trained EMTs or paramedics, she said.

When the ambulance still hadn't arrived, firefighters at the scene called the ambulance provider themselves and were told Echols' address was in the queue but nobody had been dispatched yet, Echols said.

At one point, Echols called someone she knows who works at Pafford Ambulance, another private company contracted with Madison and Rankin counties, to see if they could send an ambulance. There was an ambulance bus five minutes away, but she was told she needed to get AMR to give permission to Pafford to respond and cross over into Hinds County – AMR's territory.

Echols called 911 again, and asked the AMR dispatcher what needed to be done to have Pafford respond instead. They told her there wasn't anything they could do about that.

Finally, at 10:25 p.m. the AMR ambulance arrived. Echols saved the home security image of first responders wheeling Mabus out the front door around 10:30 p.m.

In its contract with Hinds County, AMR is required to meet 85% of its Jackson and Clinton emergency calls in eight minutes or less and outer-Hinds County calls in 18 minutes or less, Mississippi Today reported in 2018 after analyzing the company's contract.

That year, there were over 32,000 emergency calls countywide. A review of calls by Mississippi Today and WLBT found the average trip time is an hour and a half. Time starts from when an ambulance is dispatched to when a hospital admits the patient.

Hinds EMS Coordinator Joey Jamison did not immediately respond to a request to receive a copy of or review the most recent AMR contract.

Echols' experience waiting for an ambulance came as providers across the state – including AMR – have shared fears that an ambulance system collapse is near.

A combination of staff shortages, low wages and an incomplete reimbursement system have been exacerbated by the ongoing COVID-19 pandemic, which has greatly affected Missisisppi's ambulence system, Mississippi Today reported.

In 2018, Mississippi Today reported that “wall time” – the time ambulances wait at a hospital for a bed to become available – often contributes to long response times. AMR agreed that hospital wait times are a challenge its first responders face.

“Every minute a crew is waiting for a bed is a minute the crew cannot respond to assist a patient outside of the hospital,” the company said in a statement.

Weeks since Mabus' death, Echols has more answers about that night, but she wonders whether AMR will make changes to ensure other families don't have to go through what hers did.

She understands that staff shortages have plagued multiple fields, including police and fire departments and hospitals, but she wants to know what the company is doing to fix that.

While efforts are taken to build up staff, Echols sees a mutual agreement or “helping hands” clause in AMR's contract as a potential solution to help when they are overwhelmed by a high volume of calls.

For example, such an agreement could have allowed a Pafford Ambulance to come to her home to tend to Mabus sooner, Echols said.

An AMR spokesperson said mutual aid agreements among ambulance providers in Mississippi tend to be in place for natural disasters or mass casualty events, but not for daily service requests.

Mutual aid can be requested, but the ambulance provider who receives it isn't required to respond because their service area takes precedence, the spokesperson said. Providers strongly prefer not to send crews outside the primary service area and often they don't have the resources to do so.

The spokesperson did not respond to questions asked about whether it is possible for another ambulance company to respond to a call in Hinds County and whether there is a process for someone to grant permission for an out-of-county ambulance to come to them.

“What I don't understand is why AMR has not pushed for mutual aid for a helping hands situation if they can't do the job,” Echols said. “It makes you ask the question: Are they more concerned about territory and profit than saving lives?”

“Is it my family today and your family tomorrow?”

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.