By Sally Beauvais
If you find yourself in need of a trip to the emergency room in the West Texas border town of Presidio, the odds may be stacked against you.
Low on resources and manpower, the local emergency medical services crew—responsible for roughly 1,500 square miles of the county—can operate only one of their two ambulances at a time. From city limits, it's a 90-mile drive to the closest U.S. hospital. A trip from one of the outlying communities, like Candelaria or Ruidosa, can run you close to three hours —barring interference from loose cattle, or a rain-flooded creek running into the road.
But there’s another, less obvious hurdle that can delay first responders in getting to you in this remote part of the state: finding your front door.
Eavesdropping on a police scanner in rural West Texas is typically a quieter experience than in a city like Abilene or Midland. Over the span of two days, you may hear only a single call out for emergency medical response.
But when the call does come in, the stakes can be unusually high. Isidro Pando, an Advanced EMT with Presidio Emergency Services, says spending more time in the back of the ambulance with a patient means he has to be ready to make challenging decisions about treatment, and managing medications and side effects.
When Pando's out on a call, scenarios like this one start running through his mind.
"If they're in cardiac arrest, you've got limited time to get there and start CPR. If you don't, they run their risk of brain damage. And if you do bring them back, there's there's a chance that they're gonna have some type of disability for the rest of their lives or they're going to be on life support," he explains.
But as Pando is on his way to the patient, his head spinning with potential outcomes, he’s often navigating another, more immediate problem.
Trying to find them.
"It's frustrating and it's embarrassing when you go to the wrong address, and you realize that you're on the wrong side of town," Pando says. "You’ve got to hurry up and make it to the other side of town. It’s just, it's a nightmare."
Presidio EMS staff and local police say it happens regularly. Dispatch relays an address, they rush to the scene and find they’re in the wrong place. It's not just a problem out on ranches or in the more remote communities nearby. Often, it’s right there in city limits.
Pando says in some situations, the extra time spent finding someone may mean the difference between life and death. He remembers one particular cardiac arrest patient with a tricky address.
"They wouldn’t answer the phone," he says. "And what should have taken us three minutes took us about 15 minutes to get there. By then, it was too late."
Pando grew up in Presidio. He's been an EMT for almost a decade, and he's frustrated that he hasn't seen the issue improve.
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So what exactly makes it so difficult for first responders to find people in Presidio? Turns out, this happens all over the country. Several years ago, the federal government ordered cell phone carriers to improve location technology for the benefit of people who call 911. But problems persist in rural America. A 2017 study found ambulance wait times in rural areas are almost double the national average.
In Presidio, there are layers and layers of issues standing between ambulances and people’s front doors. To demonstrate, Presidio EMS Director Malynda Richardson took me out for a drive in her Subaru.
"Let’s pretend that you have received a call to 411 Rosedale," Richardson says.
She emphasizes that this is just a hypothetical example. But it's an especially good one. In Presidio, there’s a Rosedale Avenue, a Rosedale Drive, and a Rosedale Street. Luckily, on this call, we know which one we’re looking for.
I enter the address into Google Maps, which is also what Richardson’s crew uses to navigate to unfamiliar houses. Almost immediately, we are incorrectly routed onto an unmarked street. But Richardson says spotty signage is just the tip of the iceberg.
"Head east on Commerce Street toward Harmon Avenue, then turn left onto Harmon Avenue," the app advises.
"This is another example," says Richardson. "Harmon is the old street name. Ralph England is the new one. So Google Maps has the old street name."
The city renamed a handful of streets to honor U.S. veterans almost ten years ago. Google hasn’t caught up yet.
There are other discrepancies that have nothing to do with the veracity of Google Maps' instructions. Some houses on the same street have duplicate numbers. Some don’t have numbers at all.
When we arrive at our destination, we're on a wide dirt road surrounded by unmarked houses. We don't know which one we're looking for.
This brings us to another problem. Here, and in many other rural areas, street names and house numbers are a relatively new phenomenon.
Richardson says many Presidio residents don’t actually know what their official address is. They might have one assigned by the gas utility, and another from the telephone company. In some cases, neither of those match up with what the city has on file.
Residents are required by local ordinance to mark their houses. But according to Richardson, "it's difficult to ask people to put a house number on their house when you may come back a month later and go, 'Oh, wait a minute, now we've got better information. And so we need to change that house number.' Because it’s not just changing a number on a house. It’s changing it on your driver’s license, with your bank. It filters out into a lot of different areas of your life."
It can be a lot to ask. Especially if you don’t know your 911 address—the term the city uses to refer to your official physical address.
According to Alma Martin, chair of Presidio’s Planning and Zoning Board, people often don’t think about this until they need an ambulance to show up at their house.
Martin’s street and her home are clearly marked, but I still got lost using Google Maps trying to find it.
"I really, really want to get our 911 addresses in order," Martin tells me once I finally arrive at her front door.
She says before the times of smartphones and car GPS, physical addresses weren’t really a part of life in Presidio. Residents relied on post office boxes for mail, and the town was smaller and closer-knit. Everyone pretty much knew where everyone else lived. But times have changed.
"You know, you can't get an I.D. card, you can't get a driver's license without a physical address," Martin says. "You can't get anything without a physical address anymore."
When the local effort to assign 911 addresses began over a decade ago, it wasn’t a seamless process. Houses and neighborhoods fell through the cracks. Martin wants this to change, and soon.
"We really need to get the word out that people need to look at their water bills," she says. That’s where residents can find their actual, city-assigned 911 address. But even those aren’t perfect across the board.
"Emergency services and law enforcement are not looking for a water meter," Martin laughs. "They’re looking for a front door."
She's proposing a boots-on-the ground, volunteer effort. She wants her committee to go door-to-door, block-by-block, to try and straighten out cases of address confusion. Just recently, the city of Presidio also secured funding to dedicate a part-time person to this task.
Martin hopes they can all work together, and, once and for all, ask people to post their house numbers "for ambulance services, for fire departments, for law enforcement services, for the poor UPS guy, the Fedex guy."
It’ll be a lot of work and once it’s done, Martin says maybe the city can even contact Google. She's not holding her breath.
If you’re a resident of the tri-county area and you don’t know what your official address is, you can call Tom Griffith, the area’s 911 GIS Coordinator for the Rio Grande Council of Governments, at (432) 837-7199.
