News & Updates

Outstanding article in this month’s Public Management Magazine – the official publication of the ICMA…

https://icma.org/articles/pm-magazine/reimagining-fire-and-paramedic-services-21st-century

Love these quotes in the article:

• “EMS is a healthcare function, not a public safety function.”
• “Analysis of Computer Aided Dispatch (CAD) and workload analysis data is critical in understanding your community’s actual risk profile and developing a new service model.”
• “Separating fire protection and prevention services from emergency medical services reduces cost, reduces response times, and improves the overall quality of both services.”

We were part of the CPSM team that worked with the city of Placentia on this model.

Placentia city leaders will be presenting this model at the 2022 ICMA conference in Columbus, OH in September.

We will be part of a 4-hour workshop at the same conference, educating city and county leaders on effective EMS system design.

Atlanta to start city ambulance service after frustrations mount with Grady EMS

Complaints of slow response times force city’s hand: “We can’t continue to wait on them.”

By Dylan Jackson, The Atlanta Journal-Constitution

June 29, 2022

https://www.ajc.com/news/atlanta-to-start-city-ambulance-service-after-frustrations-mount-with-grady-ems/6L6NAXCMQJB23A3SXZUFP7BJUM/

In the wee hours of the morning of April 30, Vanessa Ward dialed 911 and tried to summon an ambulance to her West Atlanta home, where her 4-year-old grandson was unresponsive and feverish.

That was the beginning of her nightmare with Grady EMS, Ward said.

As the minutes ticked away, no ambulance arrived. She dialed 911 again, then again. Each time, the dispatcher assured her help was on the way, Ward said. After roughly an hour Ward could wait no longer. She dressed Kawan, put him in the back seat of her silver sedan and set out for help on her own.

Nearly two hours after Ward had called 911, Grady’s ambulance finally showed up at her door. By that time, Ward was with her grandson at the Egleston Children’s Hospital near Emory University. The doctors told her that Kawan’s episode was caused by a heart defect. Her confidence in Grady EMS was shattered.

“I didn’t expect them to take that long when I told him that his heart was racing,” she said. “I told them he was 4 years old. I told them I didn’t know how to handle it.”

The harrowing episode is all too common across Atlanta, critics of Grady EMS say. Residents as well as city leaders and other first responders have complained that the hospital’s emergency medical services (EMS), which has been the ambulance provider in the city for more than 100 years, is too often late when residents call for help.

The tardiness, they say, puts patients at risk while also draining time and resources from the Atlanta Fire Department, which is often the first at a scene. A fire unit is required to wait for a Grady ambulance to arrive before it can respond to other emergency calls.

With complaints piling up, Atlanta city officials are on the cusp of a new venture: The city is planning to start its own ambulance service in southwest Atlanta to help stem the delays at Grady EMS.

The Atlanta Fire Department has so far spent $250,000 to purchase two ambulances and begin transporting patients themselves. The department will station them in a newly built station on the city’s border with Fulton County at the end of the year, with more to come later.

“We can’t continue to wait on them,” said Atlanta City Councilman Dustin Hillis, who chairs the council’s public safety committee.

While acknowledging longer wait times for some calls and a pandemic-induced staffing shortage that has impacted operations, Grady officials say the broader criticism is unwarranted. Still, last month they implemented a restructuring of Grady’s dispatch system to try to direct more personnel to life-threatening calls, including heart attacks and strokes.

“We are constantly looking at methods to do it better,” said Grady EMS operations head Erin Vickery. “And we would do that with or without staffing challenges.”

The pandemic has affected not only Grady, but the entire EMS industry, experts say. The Atlanta fire department and other EMS companies in Georgia and across the nation have likewise faced struggles in staffing and equipment. And there appears to be no end in sight.

“If there’s one thing we learned, things cannot operate how they did before,” said Pete Quinones, CEO of Metro Atlanta Ambulance Service. “The people aren’t there. The parts aren’t there.”

“Uncomfortable Conversations”

A series of response breakdowns by Grady over the past year have frustrated Atlanta City Council members, who have been receiving a steady stream of complaints from constituents about the hospital’s ambulance service.

Because Atlanta has no direct authority over Grady, the city has turned to the head of Atlanta’s EMS operation, Atlanta Fire Chief Roderick Smith, for solutions. Several city council members have expressed their concerns about Grady publicly to Smith, urging the fire department to start ambulance service in southwest Atlanta to address the problem.

Currently, the fire department only does transport at the Hartsfield-Jackson International Airport.

“We can only control what we control,” Councilman Hillis said.

In May of last year, an 85-year-old woman, who had been seriously injured in a car crash near Midtown, was left stranded for close to an hour without a Grady ambulance in sight. That episode made the local news on Fox 5.

When Hillis grilled the fire chief at a council meeting two weeks later, Chief Smith acknowledged there was a problem.

“There are some uncomfortable conversations we’re having with Grady, but we’re setting clear expectations,” Smith said.

Several months later, then-city council member Joyce Sheperd confronted the fire chief at a meeting with a complaint from a constituent. Sheperd said the woman told her that Grady took 45 minutes to arrive and transport her sick father to a hospital.

In February, a man in neighboring South Fulton City suffering from a stroke had to wait an hour and a half for a Grady ambulance to arrive at his home. In April, Atlanta firefighters transported a bleeding 60-year-old man to Grady Hospital themselves, loading him on a fire truck. The department praised the firefighters on Twitter for their decisive action.

“Due to massive blood loss, AFR members quickly decided to transport the patient in the fire engine to Grady Memorial Hospital instead of waiting on an ambulance,” the department wrote.

The delays have caught the attention of Atlanta Mayor Andre Dickens, who said he’s spent the first months in office getting up to speed on the issue. At a press conference this summer to discuss the need to increase fire department funding, Dickens said any problems need to be addressed.

“We can’t have any delays in service when people are in an emergency,” he said.

Atlanta isn’t the first local fire department in the metro area to launch its own city ambulance service. Years of complaints about slow response times in DeKalb, which has a contract with American Medical Response ambulance service, led the county in 2018 to create its own ambulance service. DeKalb’s fire department started with just three ambulances, but added six more in 2020 to help fill gaps in service.

Atlanta’s plan to move ahead with a city ambulance service has accelerated in recent months.

In April, the city purchased two new ambulances at cost of $123,000 each, according to Atlanta Fire Deputy Chief Royce Turner. The city expects to have them operating by October. The fire department is also outfitting five pick-up trucks with medical equipment so they can respond to EMS calls.

“We can't continue to wait on them."

- Atlanta City Councilman Dustin Hillis, who chairs the council’s public safety committee

The ambulances will be based at a new EMS station on Campbellton Road, near the city’s southern border with Fulton County — an area that has historically had gaps in ambulance service. The station will be completed by October and is funded by $4 million in bonds approved last year.

Hillis and Turner say the plan is to eventually station Atlanta Fire ambulances throughout the city, although there have been no concrete plans for expansion. The city hopes to account for gaps in Grady’s coverage, whether that means a geographic gap, a predictable increase in call volume due to a large event, or lack of Grady ambulance availability.

“We always try to match the services to the demand,” Turner said.

Response Times

While response time standards vary from provider to provider, the National Fire Protection Association’s guidelines for life-threatening situations call for a response within nine minutes.

Grady assured the community it would meet nine-minute response times for emergencies when it took over ambulance service in south Fulton County in 2018.

Metro Atlanta Ambulance Service — which is the 911 responder for Cobb, Bartow and Paulding counties — strives to arrive within ten minutes for life-threatening calls, Quinones said.

Critics say Grady has been falling short, and its own data suggests that criticism may be warranted. For the first five months of this year, Grady’s monthly average response times for life-threatening calls have ranged from 10.5 minutes to 13.6 minutes. The monthly average for non-life threatening calls was more than 17 minutes.

Grady’s response data, however, is incomplete. It doesn’t capture the time from when the 911 call was answered to the time the call was assigned to an ambulance, which could add several minutes to the response time, experts say. The industry standard nine-minute response includes that crucial period in its calculation.

In recent months, Grady EMS has tried to refocus on the most critical calls and put additional resources to respond, according to Vickery, the EMS chief. In May, Grady restructured its dispatch protocols to ensure paramedics and advanced emergency medical technicians (EMTs) only get dispatched to life-threatening emergencies.

They make up 70% of the hospital’s emergency responders, which means non-life-threatening calls have fewer personnel to respond and may take longer, she said.

Basic EMTs, which account for a smaller fraction of Grady EMS’ workforce, will be assigned to the rest of the calls. These calls can run the gamut, from a sore throat to a car accident without immediately life-threatening injuries, and account for roughly half of the total calls Grady receives.

Vickery said the new system is a trade-off that will decrease response times for life-threatening calls such as heart attacks or stroke.

“Fifteen years ago, we lived in a world where everybody got the same sort of response if you call 911. We realized that we no longer operated in that environment,” she said.

Staffing Woes

Grady’s staffing challenges have made maintaining prompt response times more difficult, Vickery said. Grady has offered a raft of financial incentives in order to try to attract emergency responders, including hourly wage increases and retention and training bonuses.

Even with these incentives, attracting new personnel has remained a challenge, Vickery said.

“They’re just not out there,” she said.

Grady is not alone. Across the emergency services industry, leaders say they are struggling to maintain staff and equipment.

The Atlanta Fire Department has been hemorrhaging firefighters during the pandemic. In the first three months of 2022, more than 80 firefighters have left the department, including 48 who resigned, according to city records.

“Fifteen years ago, we lived in a world where everybody got the same sort of response if you call 911. We realized that we no longer operated in that environment."

- Erin Vickery, Grady EMS operations head

Any time a Grady ambulance is delayed, the already-stretched fire department has a unit stuck at the scene until the ambulance arrives to transport a patient. The fire department had its average response time go up by about two minutes over the 12-month period ending in February, according to the department’s data.

The fire department has had to make adjustments. It recently informed Grady it will no longer respond to some less-severe 911 calls. And the two organizations are negotiating a deal in which the fire department will no longer have to wait for an ambulance to arrive if the caller’s injuries are minor.

“You’ll have multiple engines waiting and a fire will be called in, and our fire engines can’t leave the patient to go to the fire, meaning there’s an extended wait period to respond to the fires,” said Nate Bailey, president of Atlanta’s firefighter union.

Throughout the pandemic, the Atlanta fire department has also had issues maintaining its airport ambulance fleet due to supply chain shortages and has faced criticism over lengthened response times.

Ambulance companies have likewise seen a worker exodus the past two years, and some leaders wonder how the industry will recover.

Thomas Kamplain, who operates the Georgia Institute of Emergency Medical Services, an EMS training academy in Covington, said the institute is graduating about half the number of EMTs it did pre-pandemic. And while wages for EMTs have risen from roughly $12 per hour to $17 per hour, so have wages for jobs throughout the economy as the tight labor market pushes incomes higher.

“I’m not wanting to say that you can’t say that (Grady) is not culpable either because they can do better as well,” he said. “But you’ve got to look at everybody.”

Quinones said the shortage is affecting more than the workforce. A scarcity of parts has also caused disruptions, he said.

His company sidelined 15 ambulances due to a shortage of repair parts that are backlogged months. Metro has had to continually rehabilitate aging parts, he said.

“We don’t know how long this shortage is going to last,” Quinones said.

The latest ambulance closure.  Interesting honesty and transparency from the hospital owner about the reasons for the decision to close the sole and exclusive ambulance provider for 3 communities in Central Illinois.

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HSHS to close Decatur Ambulance Service on Sept. 1

Brenden Moore

6/27/22

https://herald-review.com/news/local/public_safety/hshs-to-close-decatur-ambulance-service-on-sept-1/article_b33318b4-f653-11ec-9e74-9f830d238b04.html

DECATUR — Efforts are underway to find another emergency medical transport provider after Hospital Sisters Health System confirmed Monday that it would close Decatur Ambulance Service as of Sept. 1.

Founded in 1959 and purchased by HSHS St. Mary's in 2018, Decatur Ambulance Service has long been the sole provider of ambulance services in the city. It also serves Pana and Shelbyville.

The hospital said it was working with city officials to secure another vendor to serve the community before the closure. Spokeswoman Jennifer Snopko said factors that drove the decision included the difficulty of finding qualified candidates for open positions and the cost of equipment and vehicles.

"This decision was weighed heavily, as we have been proud and privileged to serve the residents of Decatur, Pana and surrounding communities," Snopko said in an emailed statement. "We are dedicated to ensuring that the community continues to have access to emergency care delivered at a high level."

It was not immediately clear how many employees would be affected, and a Decatur Ambulance Service representative could not immediately be reached for comment Monday. As of February 2020, the company had a fleet of 19 ambulances staffed by 24 emergency medical technicians and 50 paramedics, who have a higher level of training.

Deputy City Manager Jon Kindseth said city leaders were aware of the impending closure.

"I think long story short, HSHS has been losing money under Decatur Ambulance Service," Kindseth said. "And I think that they've just kind of finally come to the end of the line to say that we can't continue to run the ambulance service and take a loss year-after-year."

Kindseth said city officials have been working with HSHS and Memorial Health to find a replacement service to serve Decatur. This may come in the form of a request for proposal, though the city's only formal role is to issue licenses for ambulance companies to operate within city limits.

"Our goal would be to try to get as many respondents to the solicitation for proposals," Kindseth said. "Competition is always a good thing. Whether it ends up being one company or multiple companies ultimately getting licensed, we'll have to wait and see how those responses come back."

State law requires large employers to give 60 days advance notice before mass layoffs. Despite the Sept. 1 termination notice, Kindseth said that HSHS has committed to keep the ambulance service around until there's a transition to a new provider.

The closure comes four years after a competing ambulance company fell one vote short of being licensed by the Decatur City Council. Champaign-based Arrow Ambulance, which was being backed by Decatur Memorial Hospital, had sought to become the city's second licensed provider.

St. Mary’s and Decatur Ambulance Service leaders fought the move, arguing that the city did not need additional emergency transport, and that introducing another company would hurt the current business and put paramedics out of work.

Decatur Ambulance Service leaders and employees also expressed serious concerns in 2015 when city officials considered the possibility of operating their own ambulance through the fire department.

Nationally, emergency medical transportation providers have been having issues for years. The National Rural Health Association found in 2018 that a third of rural emergency medical services were struggling with inadequate funding.

Decatur Mayor Julie Moore Wolfe, who is the executive director of philanthropy, advocacy and community relations at HSHS St. Mary's, declined comment, citing a conflict of interest given her job.

The hospital system's full statement is below:

After detailed research and discernment, HSHS St. Mary’s Decatur leadership has decided to dissolve the pre-hospital service line of Decatur Ambulance Service (DAS) in the coming months. We are working in collaboration with city officials to secure another vendor to service the community before the closure of September 1, 2022. Our objective is for the public to not see any disruption in service when the need for emergent care arises.

This decision was weighed heavily, as we have been proud and privileged to serve the residents of Decatur, Pana and surrounding communities. We are dedicated to ensuring that the community continues to have access to emergency care delivered at a high level.

The pre-hospital care environment is a specialized one. There are numerous external agencies whose sole business is in-the-field care and transport who can take over and continue to deliver this service at the expert level currently given. Factors that led us to this service closure include the current and very difficult landscape for filling open positions with quality candidates in this high-demand field and the ongoing cost of upgrading necessary equipment, vehicles and other supplies

The colleagues of DAS deliver high-quality care and the performance of their duties has not impacted this decision and we truly thank them for their years of service. Colleagues will be considered to transition to open positions within St. Mary’s Hospital or other HSHS entities if they are qualified and want to remain with HSHS. In addition, there is high demand in the field of pre-hospital care and their skill and expertise could be an asset to any future agency in our area.

Overall, we’ve laid a strong foundation of pre-hospital care in the community and we will continue collaborative discussions to open opportunities for additional pre-hospital businesses to join our community.

This is an excellent report on the EMS worker shortage issue, and the underlying causes.

Strongly suggest you watch the video report – well worth the 3 minutes.

The press conference was a great idea, one that perhaps should be replicated across the country!

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Low pay, high stress lead to EMT shortage across country

By Kelsey Kernstine, Cassie Buchman

JUN 14, 2022

https://www.newsnationnow.com/health/low-pay-high-stress-lead-to-emt-shortage-across-country/

(NewsNation) — Emergency medical technicians are putting out their own call for help, asking for change as many leave the profession because of its long hours, low pay and high level of stress.

According to the Bureau of Labor Statistics, being an EMT is one of the worst-paid jobs in health care. On average, they make 30% less than other working Americans, with most making less than $37,000 a year.

“In many cases, they can walk into a fast-food restaurant right now with no experience and earn the same or more as they would in an entry-level EMS position,” Lee Alameda, president of Local 12911, a union that represents health care workers in Turlock, California, said.

Because of this, fewer EMTs are entering the profession, causing a potentially dangerous shortage. A survey conducted by the American Ambulance Association found that the turnover among paramedics and EMTs ranges from 20 to 30 percent annually, meaning there’s 100 percent turnover every four years, The Hill reported in 2021.

The survey stated that 258 emergency medical service organizations across the country saw nearly a third of the workforce leave their company after less than a year, The Hill said.

“I’m seeing systems now where job openings are north of 20%,” health care expert Todd Furniss said.

Exacerbating the problem is that some EMTs are leaving their local hospitals to do travel work for better pay. Health care providers say they can’t increase pay because Medicaid and Medicare take months to reimburse them, and often pay less than half of what EMTs are worth.

But there could be issues if this problem isn’t fixed soon.

“What we’re going to see is a whole lot more folks who are underserved,” Furniss said. “And so that means bad things are going to happen to our population at large.”

Apparently, the EMS worker shortage is not just a U.S. issue….

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Paramedics are ‘leaving in droves’ as ambulance callouts almost double

Frontline NHS workers are under pressure as the number of emergency calls in England rises 10 times faster than the number of staff

6/13/22

https://www.theguardian.com/society/2022/jun/12/paramedics-are-leaving-in-droves-as-ambulance-callouts-almost-double

The number of calls for an ambulance in England have almost doubled since 2010, with warnings of record pressures on the NHS that are seeing A&E patients stuck in corridors and many paramedics quitting the job.

Ambulance calls have risen by 10 times more than the number of ambulance workers, according to a new analysis of NHS data. An increase in people seeking emergency treatment, GPs unable to cope with demand and cuts to preventive care are all being blamed for the figures.

The analysis, carried out by the GMB union, found that there were 7.9m calls in 2010-11. By 2021-22, however, the number had risen to 14m, an increase of 77%. Over the same period, the number of ambulance workers has risen by just 7%, heaping more pressure on staff.

While the figures represent all calls for an ambulance, some of which go unanswered and do not lead to a vehicle being sent, they reveal the increasing pressures that have led to claims that patient safety is being put at risk by ambulance waiting times. There has been a significant increase in the number of the most serious safety incidents logged by paramedics in England over the past year.

Ambulance workers will hold a demonstration on Sunday outside the GMB’s annual congress, which begins in Harrogate. There have been repeated warnings that cuts in social care are also having knock-on impacts, with emergency services often picking up the slack and dealing with patients in crisis.

The average response time for serious ambulance calls was 51 minutes in April 2022 compared with 20 minutes a year before. Meanwhile the GMB said more than 1,000 ambulance workers have left since 2018 to seek a better work-life balance, better pay or to take early retirement.

Paul, a paramedic and GMB deputy branch secretary, said he had recently seen a crew waiting almost 10 hours between arriving at hospital and transferring a patient to hospital care. “They arrived at the hospital at 20.31,” he said. “They then cleared from the hospital at 05.48 in the morning. The impact of the lack of resources is affecting the ambulance service.

“We are also seeing people become aggressive to the ambulance crew, because they’ve waited hours upon hours in an ambulance.

“We used to have crew we called ‘lifers’ – you join and you’re there for the rest of your life until you retire. But now we are seeing people do two or three years and then going to better jobs – maybe a GP practice or become a university lecturer. There are no nights, no weekends; you’re in a nice, clean environment.”

It comes after a nurse was filmed warning patients at an overcrowded A&E department that they could wait up to 13 hours to see a doctor.

Rachel Harrison, GMB national officer, said ambulance workers had faced “more than a decade of cuts”. She said: “It’s no wonder they are leaving in droves while the service itself is teetering on the brink of collapse. The explosion in demand is due to savage cuts to essential services since 2010.

“Cuts to preventive and community care result in higher demand on emergency services, including in mental health. This means that patients are entering the system later and with more complex symptoms. Some people also used hospital care less during the pandemic and didn’t get essential treatment, and this has led to significant pent-up demand that is falling on ambulance workers.

“Our members face unbelievable stress and even abuse while they do their best to administer care and save lives. We need urgent investment across the health and care services, otherwise we risk an unprecedented crisis.”

A Department of Health and Social Care spokesperson said they recognised the pressures staff were under, with ambulance workers at the sharp end. “Response times are affected by various factors, so we’re taking a whole-system approach,” they said.

“The NHS has allocated £150m of additional system funding to address pressure on ambulance services, and we are tackling the Covid backlog by setting up surgical hubs and community diagnostic centres – over 90 of which are already open and have delivered over a million additional checks.

“NHS staff received a 3% pay rise last year, increasing nurses’ pay by about £1,000 on average despite a public sector pay freeze, and we are giving NHS workers another pay rise this year.”

Another blow to the fragile EMS economic model….

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How rising gas prices are impacting first responders

The average price of a gallon of gas nationwide reached $5 on Thursday.

By Meredith Deliso

June 09, 2022

https://abcnews.go.com/US/rising-gas-prices-impacting-responders/story?id=85260667

As gas prices continue to rise, first responders are among those feeling the pain at the pump.

MedStar Mobile Healthcare, an emergency medical services system in Fort Worth, Texas, has seen its gas expenses increase dramatically. During the month of May last year, MedStar spent $96,547.94 on fuel; this past May, it spent $223,582.55, according to Matt Zavadsky, chief transformation officer for MedStar.

The response volume only marginally increased while the fuel costs rose, he said.

"It's a significant impact, on top of the other financial impacts adversely affecting EMS agencies," Zavadsky told ABC News. "For rural EMS agencies that travel great distances, and have more challenging finances, the impact could be even greater."

A travel boom that's increasing the demand for gas also comes amid a shortage of crude oil supply due to sanctions over the Russian invasion of Ukraine, driving up prices at the pump in recent months, experts told ABC News.

The average price of a gallon of gas nationwide reached $5 on Thursday, according to GasBuddy. As of Thursday, AAA had the average price of a gallon of gas just under $5 -- at $4.97, up from about $4.33 a month ago and $3.07 a year ago.

The increase has caused agencies like sheriff's offices and fire departments to closely monitor their fuel budget and issue new policy directives to limit gas mileage -- without impacting emergency response.

"Most sheriffs that I know will budget what their need is and maybe 10% more, but not 100% more," Matthew Saxton, CEO and executive director of the Michigan Sheriffs' Association, told ABC News.

This week, the Isabella County Sheriff's Office in central Michigan announced that it has "exhausted" its fuel funds, with several months to go before a budget reset. As a result, it said it will be managing what non-emergency calls it can over the phone.

"Deputies will continue to provide patrols to all areas of the county, they will respond to those calls that need to be managed in person. Any call that is in progress with active suspects will involve a response by the deputies," Sheriff Michael Main said in a Facebook post. "I want to assure the community that safety is our primary goal, and we will continue to respond to those types of calls."

County officials told Flint, Michigan, ABC affiliate WJRT they plan to address the budget concerns in the coming weeks.

"I know that once we meet, we're going to resolve this," Isabella County Commissioner Jerry Jaloszynski told the station.

As director of the Franklin County Emergency Management Agency, Ryan Buckingham said he issued a policy directive regarding non-emergency activities a couple of months ago when gas prices in the southern Illinois county were approaching $4 per gallon.

"I have a small budget to work with. I have to look out for that pretty quick," Buckingham told ABC News. "When it hits $5 a gallon, it gets even worse."

Buckingham said the agency has used up 76% of its fuel budget so far this fiscal year, which started Dec. 1, 2021.

"We're about 25% over the mark right now as far as where we should be budget-wise," he said, noting that the agency typically doesn't go over its allotted budget unless it's had to respond to something like a major disaster.

To help curtail fuel costs, Buckingham said the agency is looking to limit travel for meetings and training. For instance, instead of driving an hour away for specialty dive training, personnel may train in a local pool.

Emergency response will not be affected "no matter what," he said.

In rural Colorado, near Durango, Upper Pine River Fire Protection District Fire Chief Bruce Evans started noticing a "significant" increase in gas prices in January. In the last three months, fuel expenses have increased 36%, said Evans, cutting into the fuel budget.

"We've used 65% of that budget," said Evans. "We should have only used 45%."

The department has started exploring ways to reduce the number of vehicles that it has on the road outside an emergency response, including "no drive Friday," where personnel work from home if they can, Evans said. They may need to look to reallocate more funds to their fuel budget.

"We know we're going to have to put more money in, but we're also trying to be conservative," he said.

For EMS systems, the higher prices come as agencies have also increased wages to retain workers during the pandemic, Zavadsky said. Agencies will likely need to dip into their reserves or reallocate funds to cover the rising costs, he said.

Volunteer EMS personnel who use their personal vehicles to go to calls "may be less able to respond due to the high fuel prices," he said.

"Those double-whammy cost increases, without any real mechanism to generate more revenue, is crippling most EMS agencies," Zavadsky said.

The EMS Community should keep a close eye on developments related to this new law. 

Reading the actual text of the Bill (here), and chatting with an Arizona provider agency leader, it appears that organized treat and refer programs, conducted consistent with protocols established by the agency Medical Director, are still allowed (such as the current AZ Medicaid Treat and Refer program, and initiatives such as ET3), but we should be wary of potential drift in interpretation.

Recommend that you watch the video of the story in the news link for additional context.

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Governor signs bill prohibiting Arizona's EMTs from persuading patients into not going to hospital

House Bill 2431 prohibits Arizona's EMTs from diagnosing patients out in the field and persuading them into not going to a hospital.

June 7, 2022

https://www.12news.com/video/news/politics/arizona-bill-would-prohibit-emts-from-diagnosing-patients/75-9ec3cb3c-8459-4c72-86df-c47a36018693

Gov. Doug Ducey has signed legislation that prohibits emergency medical technicians from diagnosing patients or discouraging them from seeking transport to a hospital. 

House Bill 2431 sets new parameters for what Arizona's EMTs can or cannot recommend to patients they're treating out in the field. 

The new law prohibits EMTs from giving a presumptive medical diagnosis and using that diagnosis as justification to not transport the patient to a hospital. 

State Rep. Amish Shah, a medical doctor representing District 24, introduced the legislation after coming across research suggesting Phoenix had a high rate of "non-transports" compared to other jurisdictions.

“We have reviewed a lot of different cases that have come through, not only Phoenix. What we’ve seen in these cases is a pattern of counseling people out. And that doesn’t fit in best practice,” Shah told 12 News earlier this year.

The law further clarifies that EMTs can still inform a patient about their right to accept or decline transportation to a hospital.

Phoenix fire previously told 12 News that its paramedics and EMTs were already following the state's protocols. 

HB 2431 passed through the Arizona House of Representatives in a final vote of 34-17 before it was signed by the governor this week.

Eight state representatives declined to make a final vote on the bill.

This is a similar news report sent out a couple of days ago about the Orange County (CA) Grand Jury report. 

There is an interesting debate about the ‘expense’ of using of fire engines for medical first response (MFR).  Fire engines are staffed with firefighters typically based on a fire response deployment model (assembly of personnel for fighting a fire, etc.), which is why they typically have 3 to 4 firefighters on board).  In many departments, most of their response volume is EMS responses, with relatively few actual fires.  Some feel that using resources that are already on-duty and staffed for a fire response for MFR is very cost effective.  In essence, if the engine stopped going on medical calls, would you still retain those personnel for fire calls?  If yes, then the cost of the MFR is marginal.  Yes, the engine is expensive, but most fire engines are often replaced because they become outdated, not because they wear out due to things like high mileage.

Additionally, very few EMS calls are for time-life-sensitive emergencies, and therefore may not require an immediate MFR.  Life-threatening calls (cardiac arrest, severe trauma, severe difficulty breathing) represent only about 10% of EMS calls in most communities.  Perhaps it may be better to keep MFR resources available for the true life-threatening calls, as opposed to having them respond to call in which they will likely not have an impact on the patient’s outcome?  If a MFR unit is tied up on a non-life threatening call, they may not be available to respond to the cardiac arrest that comes in 3 blocks away.

Perhaps reserving MFR resources for the calls they are truly needed for would reduce wear and tear on the engines (and the streets), reduce firefighter fatigue, and help assure the MFR resources are available for the calls they will make a difference on?

And, as we know from numerous studies, HOT vehicle operations put providers, and the public, at significant risk of injury and death, and should only be used in cases where that mode of operation may make a difference in the patient’s outcome.

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Stop Sending Fire Trucks on Medical Calls, OC Grand Jury Report concludes

BY JESSE LA TOUR

MAY 31, 2022

https://fullertonobserver.com/2022/05/31/stop-sending-fire-trucks-on-medical-calls-oc-grand-jury-report-concludes/

A recently released Orange County Grand Jury report entitled “Where’s the Fire? Stop Sending Fire Trucks to Medical Calls” questions this widespread practice.

In Orange County, nearly 80% of all 911 calls to fire departments are for medical services. The report highlights potential problems with the deployment model of the Orange County Fire Authority (OCFA), which Fullerton is considering joining, as well as other city fire departments.

“Sending a 36,000 to 60,000-pound fire engine or aerial ladder truck down residential streets for strictly medical calls is not only dangerous and costly, but it also results in unnecessary wear and tear on our streets,” the report said.

The Grand Jury’s findings include:

• Despite use of a tiered dispatch system, Orange County Fire Authority deployment of resources for medical responses are the same for nearly all calls, resulting in unnecessary wear and tear on expensive fire-fighting equipment and public infrastructure.

• Ambulances or smaller squad vehicles are often the most appropriate response to medical calls and do not compromise the quality of medical care

• Over-deployment of firefighters for medical calls contributes to the current climate of firefighter fatigue.

• Code 3 response (lights and sirens) is over utilized by OCFA, unnecessarily putting the responders and public at risk.

The Grand Jury’s recommendations Include:

• All Orange County fire agencies utilize criteria-based dispatch protocols and send a single unit response [ambulance] to those incidents triaged as non-life threatening.

• OCFA should station a paramedic squad vehicle, which is more nimble and less costly to operate, in place of a second engine in stations with high volumes of medical calls.

The Grand Jury’s investigation “also revealed a breakdown in communication and trust between Orange County Emergency Medical Service (OCEMS) and Orange County Fire Chiefs, which includes Fire Chiefs of the Orange County Fire Authority (OCFA) and various city fire departments.”

The report commended the city of Placentia’s recent changes to their emergency medical response protocols after leaving OCFA, which have resulted in improved medical call response times.

To read the full report visit http://www.ocgrandjury.org.

Turf war brewing between OCFA and county over medical calls, grand jury says

Report slams use of extra personnel and expensive equipment to calls where they are not needed

By SCOTT SCHWEBKE

May 20, 2022

https://www.ocregister.com/2022/05/20/turf-war-brewing-between-ocfa-and-county-over-medical-calls-grand-jury-says/

Distrust and poor communications are fueling a heated turf war over medical responses involving Orange County’s Fire Authority, Fire Chiefs Association and Emergency Medical Services, a grand jury investigation has found.

“Although their mandated responsibilities are clear, there is a mutual reluctance to acknowledge their respective spheres of authority, in particular the critical role of Orange County Emergency Medical Services as an independent regulatory body,” the Orange County Grand Jury said in a 22-page report issued Friday, May 20.

The grand jury examined the efficiency of the Orange County Fire Authority and various municipal fire agencies in responding to emergency medical calls.

The grand jury recommend that fire departments implement a universal tiered response system to dispatch ambulances to most medical calls rather than deploying larger fire engines as a standard response.

‘Dangerous and costly’

“Current protocol requires sending multiple vehicles to the scene, which involves not only additional personnel but also expensive fire equipment,” the report says. “This is the case even when an ambulance or rescue squad vehicle could provide all the necessary medical supplies and personnel. Sending a 36,000- to 60,000-pound fire engine or aerial ladder truck down residential streets for strictly medical calls is not only dangerous and costly, but it also results in unnecessary wear and tear on our streets.”

The OCFA is reviewing the recommendations, spokesman Matt Olson said Friday. “We received the Orange County Grand Jury report and appreciate the work that went into it. We look forward to commenting further after a thorough review of the report and its recommendations,” he said.

The Orange County Health Care Agency, which manages the OCEMS, and the Orange County Fire Chiefs Association did not respond to requests for comment.

Appropriate level of response

The goal of a tiered dispatch system is to match the emergency with the appropriate level of response in terms of urgency, personnel and equipment.

As part of its investigation, the grand jury reviewed records, memorandums and other documents. It also interviewed OCFA and OCEMS officials, private ambulance company executives and firefighter union representatives.

The OCFA has 77 fire stations in Orange County and contracts its services to several cities. Municipalities with their own fire departments are Anaheim, Brea/Fullerton, Costa Mesa, Fountain Valley, Huntington Beach, Laguna Beach, Newport Beach, Orange and Placentia.

OCEMS has established a minimum requirement that one paramedic and one emergency medical technician respond to emergency medical calls. However, it is left up to the individual fire departments to determine how to deploy personnel and whether to exceed these minimum staff requirements, according to the grand jury report.

At the OCFA, regardless of the preliminary assessment of the medical emergency, a fire engine or truck staffed with four personnel — at least two of whom are paramedic/firefighters — are sent to the scene. A transport ambulance with two EMT trained attendants also is dispatched.

Ambulance use causing friction

The use of ambulances is causing friction between the OCES, the OCFA and the Orange County Fire Chiefs Association, the grand jury said.

The report noted that that Fire Chiefs Association wrote a seemingly contradictory letter to the OCEMS, describing the agency’s implementation of policy changes without prior notice or collaboration as “offensive.”

“This complaint was made despite the fire chiefs’ specific acknowledgment in the same letter that a joint advisory committee had been formed and had been discussing the issues,” the report says.

Despite the fire chiefs’ complaint about OCEMS overstepping its authority, the only example provided was an emergency action taken by OCEMS in 2021 when hospitals were backed up, causing long wait times for first responders.

In response, OCEMS introduced an emergency measure that allowed emergency medical technicians and paramedics to leave patients in the hands of the hospital on a portable cot, according to the grand jury.

“Although OCEMS could possibly have provided better notice to OCFA and the independent fire chiefs, the OCEMS appeared to be working in the best interest of all parties involved,” said the report. “This was a fact that was, at best, only begrudgingly acknowledged by a few OCFA union representatives and other fire agency personnel.”

Tensions have been exacerbated by the COVID-19 pandemic and the demand placed on ambulances, which have been struggling to respond to calls in a timely manner, prompting the OCFA to take matters into its own hands, the grand jury noted.

‘Code 3’ responses

In December 2021, the OCFA directed that all emergency medical services responses be classified as “Code 3” — requiring vehicles to use emergency lights and sirens — to speed up ambulance response times, according to the report.

“Code 3 responses have been shown to pose a significantly greater danger to the public and emergency personnel,” said the report. “The Orange County Grand Jury is concerned that this OCFA directive and the power struggles existing between the fire chiefs association and OCEMS may be viewed as self-serving rather than serving the best interests of the public.”

The report recommends that the OCFA immediately stop the practice of requesting Code 3 responses on all non-life-threatening calls. “Code 3 response is over-utilized by OCFA, unnecessarily putting the responders and public at risk,” the grand jury said.

The grand jury also recommended:

By 2024, all Orange County fire agencies utilize criteria-based dispatch protocols and send a single unit response to those incidents triaged as non-life-threatening. Additionally, the OCFA should station a paramedic squad vehicle, which is more nimble and less costly to operate, in place of a second engine in stations with high volumes of medical calls.

That OCEMS should recognize how certain policy changes may pose operational challenges to emergency responders in the field, and fire leadership should recognize and respect the independent oversight authority and expertise of OCEMS.

Departments with publicly owned ambulances should allow OCEMS to inspect their ambulances for compliance with state emergency medical services guidelines and adopt OCEMS recommendations.

“Despite fire departments throughout Orange County having evolved into emergency medical departments, most have not updated their emergency response protocols accordingly, but have simply absorbed emergency medical responses into their existing fire response models,” the grand jury concluded.

A day on the job at MedStar: What’s it like to be a paramedic or 911 dispatcher?

BY JESSIKA HARKAY

MAY 23, 2022

https://www.star-telegram.com/news/local/article261635822.html

For first responders at MedStar, no day is ever the same, and not every day is high-intensity. But there’s one thing that remains the same day in and day out when they clock in for their 12-hour shifts — maybe they’ll help save or change a life that day — and that alone is enough to make them love what they do.

The Metropolitan Area EMS Authority, also known as MedStar, serves millions of people in Tarrant County across 15 cities. The ambulance service responds to upwards of 155,000 calls per year with its 65 emergency vehicles, 550-person staff and an efficient operations system that other ambulance service providers from 46 states and five countries have come to Fort Worth to pick up tips from.

Matt Zavadsky, a spokesperson for MedStar, said that though there’s a shortage or even a “crisis in true EMS” staffing nationwide, in Fort Worth “we’ve had a waiting list for the most part.”

Last year, NBC reported that a mix of low wages and the pandemic has contributed to a shortage of EMS workers in the U.S. and Texas. In 2020, almost a third of the workforce left after less than a year and 11% left within the first three months, according to a national AAA survey of 258 EMS organizations. In Texas, by mid-August, only 27 percent of licensed EMS workers had submitted a patient care record for 2021, meaning more than 70 percent didn’t work on an ambulance in the first eight months of the year, NBC reported, citing the Texas Department of State Health Services. “People want to come here, which is a blessing, but that’s also because of our reputation, the way we do things,” Zavadsky said. “Our field EMTs and field paramedics don’t need to stock their trucks, they don’t need to push their trucks, where in most systems you have to do that. People know that’s how we operate, plus we do a lot of cool, innovative programs.”

With flexible deployment methods, in-house logistics to keep ambulances stocked with emergency materials and a community paramedic program, MedStar is an example of how EMS is evolving as a “young field” and finding new ways to not only stay efficient in helping those in need in times of emergency, but also to provide preventative care. But the ambulance company wouldn’t be the same without the people who make operations run smoothly, including its dispatchers, EMTs, paramedics and field supervisors. As National EMS Week came to an end last week, some local first responders shared their stories.

DISPATCH

Jamey Clark sits in a dark room off of the lobby of the MedStar headquarters in Fort Worth. In front of her, seven computer screens filled with data, maps and incoming 911 calls reflect off her eyes and black headset as she types rapidly. “MedStar, this is Jamey, how can I help you?” she says before the typing takes off again.

Clark never imagined she would be a dispatcher. She woke up one day out of high school and thought being an EMT would be fun. She enrolled in classes to receive her certification, and once she graduated, found out she was pregnant. A year later, at 22, Clark was ready to begin her career. The first job that opened up was for a dispatcher, and seven years later, she’s still there.

“It was definitely a switch than what I was used to with my typical daytime-type job. The hours are much more demanding, there’s a lot more time spent away from home but (my daughter) throughout the years has always been very supportive and really proud of what I do,” Clark said.

“She used to call the ambulances, ‘Mommy’s trucks.’ So she would see one driving down the road, and she’d be like, ‘Mommy’s truck, Mommy’s truck!’” Clark’s now 8-year-old daughter isn’t the only one who has pride in her mother’s profession.

Clark said there are many moments that make her job rewarding, especially recalling a time she helped a grandmother deliver her grandchild over the phone.  “[MedStar] actually organized a meeting so I could meet the mom and the baby, and that was a really sweet coming together,” Clark said, noting that in a MedStar hallway, a Star-Telegram article is framed on the wall with a picture of her and the baby. “Her name is Carter, and her family gave me a plaque picture they made, painted with her baby feet prints on there, and I have it up on the wall in my house,” Clark said.

But like most first responder professions, there’s also an important balance with difficult situations and being able to compartmentalize. Clark remembered a call when a man said his wife had fallen and was bleeding, and after being on the phone for several minutes as she dispatched an ambulance, she realized there was more to the story.

“He just kept telling me, ‘My son is standing there like nothing’s wrong,’ and I was like, ‘Red flag. Weird, weird, weird, something is off about this. He’s not being completely forthcoming with me,’” Clark said. “I could hear the patient in the background, she was distressed and having difficulty breathing …

I was giving (the husband) instructions on how to control the bleeding and he kept telling me there’s so much blood and he didn’t know where it was coming from.”

Clark said that she had to deviate from protocol and tell the man to wipe all the blood away to find the wound, and while he did that, she said the woman’s voice in the background grew more and more faint, and the man finally admitted a knife was on the table.

The son had stabbed the woman over 50 times, police later concluded, Clark said. “I heard her ask her husband, ‘Why did you wait?’ And he said, ‘I’m sorry I didn’t think it was this bad,’ so I think there was a history of domestic violence between the son and the mother,” Clark said. “She then told her husband ‘I love you,’ and it was like 10 seconds of silence and all of the sudden the police department busted in.”

Clark said that call stuck with her for years, not because of the nature of the call, but the final words of the woman. “It just goes to show that no matter what the situation is, no matter what has happened or has transpired, people take those moments of care, with concern and love, truly, to the end,” Clark said. “It changes how you look at certain aspects of life in general.”

Clark said she’s had to learn not to emotionally invest in her work, which can be difficult being in a non-visual environment where sometimes the event sounds much worse over the phone than what it actually is. “It comes with practice, and it comes with time, learning how to disconnect from some of those things so that you can function professionally,” Clark said.

“It’s not every day that you get something like that, but you never know when it’s going to happen. And when it does, you need to be able to keep yourself calm and to perform in the aspect that you need to make sure that you’ve gotten help where it needs to go. …

Then take care of yourself on the backend.” When asked something she’d like the public to know about her job, Clark said that though she often has to repeat information, which can be frustrating to those under distress, it’s to ensure the right care. “We need to make sure that the address that we’re sending the units to is correct, and make sure that we understand what’s going on at the scene because we work in a non-visual environment,” Clark said.

“And we use the details that the caller provides to us to navigate that call, triage that call and provide instructions before the first responders get there.”

AMBULANCE CREW

Chandler Ashley and Matt Willens, two paramedics with MedStar, spent a recent Tuesday preparing for a press conference announcing new technology that could save lives. That afternoon was a testament to what both men said they love about their careers — the day never repeats twice.

For Willens, who serves as a clinical practice coordinator, he always knew he was going to end up in emergency services. Originally from New York, he spent his childhood watching his neighbor, who was a paramedic. “I heard the stories that he was telling me, and how he changed patient outcomes daily and no day was ever the same, and that really was something that I wanted to be involved in,” Willens said.

“Once I was an EMT and I went on my first call, I really saw how the paramedics at that time were interacting with not only the patient but the patient’s family, and how that interaction can have a change on that patient outcome in the long run.” For Ashley, though he has family that had EMT training, his interest in the field came in college, while he was studying to be a band teacher. He grew up playing the saxophone and loved music, but it didn’t take long until he realized some passions are better left as hobbies instead of careers.

“I actually went to college in a really small town out in Commerce and the dorm hall I stayed in, oddly enough, had this just massive parking lot, and being a small town, there’s not a lot of hospitals out there,” Ashley said.

“So they landed the helicopters out there all the time, and there was one day we had three or four EMTs out there and I ended up going and talking to them while they were waiting for a patient. I was picking their brain on what things were, what they did and stuff like that.” It piqued his interest, which led to Ashley speaking with his uncle who was a firefighter, and from there, “it just kind of spiraled.”

Both men said that although they’ve been in the field for years, Willens since 1996, and Ashley since about 2016, they still consistently learn something new. “People in ambulances — EMTs, paramedics — they’re some of the most highly-trained people out there.

We have to be prepared for whatever type of emergency we go on,” Willens said. “We don’t specialize in, just say, cardiac or OBGYN … it’s not just, you take one class and you’re done. People in this field are constantly learning and constantly bettering themselves to take care of the patients. We’re always learning because we have to be masters at so many things because we never know what’s going to be thrown at us.”

Ashley added that he hopes patients can re-frame their thinking of what an ambulance crew does and can do. “If we can stay and stabilize on scene and use the medications we have to start those IVs and secure the airways, that person is going to show up at the hospital with all the nitty gritty done, and the doctors can really start to delve into why did this happen? What are we going to do to fix this long term?” Ashley said. “And typically that almost always has a better outcome than if we just summon the ambulance and drive like people think we do.”

FIELD SUPERVISOR

George Church began working in EMS after having friends who volunteered at local fire departments and would come back with interesting stories. “Back in those days I didn’t really know what I was going to do or where I was going to go. So many kids that I remember growing up with didn’t have much planned out back then,” Church said. “I was working for a custom cabinet shop, making pretty decent money at that time, and I thought that I would always do that, but it wasn’t very exciting.

That’s why the lure of volunteering as an EMT was there.” He thought it would be a temporary thing, just for fun, and now it’s been 30 years. It starts as an EMT basic, where you can move up into an EMT paramedic and from there, the options open. Some become field training officers, others become critical care paramedics and the branches continue until you can become a supervisor like Church, who is one of eight at MedStar.

He spends his time in his own truck, watching a tablet that has a map with where ambulances are dispatched, fixing any scheduling or personnel problems and rushing to scenes when another paramedic is needed.

After spending a short lifetime as a first responder, he’s seen a little of everything, including his profession mixing into his personal life, for better and for worse. “It really has influenced me quite a bit. In the early years, I think I didn’t have the coping mechanisms that I have now. While I don’t blame my career for any failed relationships, I could see where at that young age, not having the coping skills that I have now, made it hard to balance the two [worlds],” Church said.

“Since that time I’ve learned the hard way to balance that.” Part of that was working long hours, sometimes being desensitized to little things like cuts and bruises and sometimes feeling there were things he couldn’t speak about to people who weren’t in the field and wouldn’t understand. “After two divorces, I’m in a relationship with someone that really, truly, understands what I do and why I do it. She was a paramedic at one time and worked for the Denton County Emergency Management, where it’s not exactly what I do, but with a lot of similarities,” Church said.

But there were also good moments, he said. Similar to Clark, he helped deliver a baby, but this one was in person. His name is even on the child’s birth certificate, he laughed. And somewhere along the way, Church’s love for his work transferred to his 28-year-old son, who is an EMT in Austin. “I didn’t think he would follow my footsteps. I really didn’t think he would,” Church said. “He wanted to do something different, looked into and is really enjoying it. I’m really proud of him.”