Anthony SanFilippo was getting angrier by the minute at 70th Street and Buist Avenue as he waited for a Philadelphia Fire Department ambulance to arrive at the scene of an accident, and he wasn't even involved in it.
SanFilippo was one of two Good Samaritans who called 911 in May after a young woman's car was broadsided by a truck in Southwest Philadelphia, sending her car spinning, its airbags deployed.
"We're waiting 20, 25 minutes and nothing," he said. "Not a cop, not a paramedic."
When SanFilippo called 911 to remind the dispatcher that he was on the scene of a serious accident, he said, the dispatcher was dismissive and told him he would have to wait. Then a police car drove through the scene without stopping.
"What if this poor girl had internal bleeding?" he asked. "She could have been in real bad shape. And they don't care. They're not sending anyone."
The ambulance did not arrive until 53 minutes after the first 911 call, according to SanFilippo. By that time, the woman's fiance had driven there – from Chestnut Hill.
"It was an epic failure," SanFilippo said, "by multiple people."
The delayed response time in that case is an outlier – the Fire Department says the majority of ambulances arrive in less than nine minutes – but a reminder that paramedics are still scrambling to get to an ever-increasing number of emergencies. The problem goes back at least a decade.
"It seems to be taken as just a fact a life," said City Controller Alan Butkovitz, who issued audit reports in 2007 and 2011 that criticized the Fire Department for taking too long to respond to emergencies, arriving late about 40 percent of the time.
In 2014, the Inquirer and the Daily News reported on a particularly busy day in July when there were no ambulances available citywide, at least twice. Union officials said then that it was a common occurrence in the summer and blamed Mayor Michael Nutter's administration for understaffing the department.
"The Fire Department has consistently made excuses on this," Butkovitz said. "Now, it's 2017, and there are still 37 percent [of ambulances called] not getting there on time."
Fire Department brass and union officials say improvements are being made under Mayor Kenney's administration. The department is hiring dozens of new paramedics and on Friday deployed five additional peak-time ambulances, bringing the number citywide to 55. With the new hires, the city will have about 300 paramedics.
"The demand continues to increase, so we are certainly grateful to be able to increase the supply," said Fire Commissioner Adam Thiel, appointed by Kenney in May 2016.
The department responded to about 263,000 emergency medical incidents in fiscal year 2016, up from 243,000 the previous year, Thiel said. Another increase is expected in fiscal year 2017, which ended Friday.
"We add units, and the demand keeps rising," Thiel said, acknowledging that the department does still "max out" at times, leaving the city without an available ambulance.
The Fire Department states on its website that the average response time for medic units is 6.5 minutes. In the city's quarterly managers report, released in May, the department reported that 65.9 percent of ambulances arrived in less than nine minutes to date this fiscal year, although that figure has a 10 percent to 15 percent margin of error that department officials are working to reduce.
The goal, according to the report, is to respond to 90 percent of incidents in less than nine minutes.
Thiel said he is looking for ways to reduce demand, which could include delivering medical care before an emergency, and better triage communications to determine whether an incident can be resolved without a paramedic and ambulance.
But, Thiel added: "We're the Fire Department. If people call us, we're going to come and help them. We will always do that. We don't want to discourage people from calling 911."
In a 2009 report, Butkovitz recommended using "tele-nursing" to separate non-life-threatening situations from emergencies.
"Or even send someone an Uber or a cab," Butkovitz said Thursday. "The city could have a contract with Uber, and somebody calls up and you ask them, 'How bad are your symptoms?' and they say, 'Not really that bad, but I have to get to the emergency ward.' How about we send you an Uber for $5 instead of an ambulance for $1,100."
Ed Marks, president of the International Association of Firefighters Local 22, welcomed the hiring of additional paramedics, as well as a plan to get current EMTs training to upgrade to paramedics. He said Thiel and his deputies are "really committed to improving the services we provide to the public."
Marks conceded, though, that there remain moments of high demand when all the city's ambulances are dispatched.
"If you get an extremely hot or cold day, the potential is there," Marks said. "You can't really predict the number of calls that come in. I'm sure there are times when we are down. But it's not nearly as bad as what it was in years past."
For SanFilippo, who called 911 from the scene of the Southwest Philadelphia accident, there's still room for improvement.