News & Updates

In cooperation with the American Ambulance Association, we and others have created a running compilation of local and national news stories relating to EMS delivery. Since January 2021, 2,093 news reports have been chronicled, with 46% highlighting the EMS staffing crisis, and 34% highlighting the funding crisis. Combined reports of staffing and/or funding account for 80% of the media reports! 104 reports cite EMS system closures/agencies departing communities, and 92% of the news articles reference staffing challenges, funding issues and response times.


Click below for an up to date list of these news stories, with links to the source documents.

Media Log Rolling Totals as of 7-9-24.xlsx

  • 7 Nov 2023 8:30 AM | Matt Zavadsky (Administrator)

    A well-researched news report. 

    It’s interesting that the EMS levies in IA cannot be used for salaries, only training, equipment and supplies. States looking at essential service designation may want to assure that salaries can be part of the funding eligibility.

    ---------------------

    ‘Broken system’: Iowa’s rural ambulance services strained

    In some parts of Iowa, 911 callers can’t be assured an ambulance will arrive

    Liam Hala with Emily Andersen

    Nov. 5, 2023

    https://www.thegazette.com/health-care-medicine/broken-system-iowas-rural-ambulance-services-strained/

    Radu Denghel always had been interested in medicine, but when it came time to decide what to study in college, he picked engineering — which also interested him but would require less time in school.

    While going to engineering school in Romania, where he is from, Denghel also attended some classes at the local medical school and volunteered at the local emergency room.

    Now, more than 20 years later, Denghel is in Iowa and still working in both fields — computer engineering in a full-time job with Collins Aerospace in Cedar Rapids, and medicine as a volunteer emergency medical technician for the Olin Ambulance service.

    “I got to a point where my work pays my bills, so I don’t have to look for additional income and spend my time that way. And I really do believe that time is much better spent serving the community instead of just watching TV or whatever,” Denghel said.

    But volunteer EMTs like Denghel are dwindling across the state, where emergency medical services are not considered an essential service statewide, meaning the Iowa Legislature does not regulate the service or provide funding for it. Two years ago, lawmakers passed a bill, Senate File 615, allowing voters in counties to declare EMS an essential service within their county and agree to pay taxes to support it.

    But the availability of ambulances still is inconsistent across the state — especially in rural areas — and providers say more needs to be done to support a waning EMS force.

    Even when EMS workers are paid and not serving as volunteers, ambulance providers struggle to maintain services due to high turnover, likely a result of low wages and increasing burnout. Pay for paramedics and EMTs in Iowa falls short of the state’s average wage of $25.73, with their mean wages falling at $23.31 and $17.74 respectively, according to the U.S. Department of Labor.

    Low wages, combined with an average cost of more than $12,000 to obtain a paramedic’s license, mean filling the physically demanding job is increasingly difficult despite a growing need. A 2022 survey by the American Ambulance Association found that, nationwide, paramedic and emergency medical technician turnover can range from 25 to 45 percent annually — resulting in 100 percent turnover every four years or less.

    Stresses on EMS providers

    Emergency medicine can be physically taxing — carrying injured patients down tight stairways or out of the woods, for example EMS providers face some of the highest rates of on-the-job injuries. In 2020, almost 17,000 EMS providers in the United States were treated in the emergency room for injuries sustained on the job, according to the national Centers for Disease Control and Prevention. Many of the sprains and strains seen in the emergency department — 56 percent — were from overexertion, typically from carrying patients much larger than the provider.

    Mark McCullough, legislative chair for the Iowa EMS Association, said technologies like stair-chairs and automatic gurneys help reduce injuries, but the equipment is expensive and some services — especially those relying on volunteers — don’t have them.

    He also pointed to the high rates of burnout and suicide in health care workers as reasons many providers are leaving the field or moving to urban services that pay more.

    Volunteer services struggle more than paid services to keep and retain providers, McCullough said. This is due to the massive time and financial commitment volunteer services require.

    While Denghel was studying to get his EMT certification earlier this year, for example, he said he was working about 60 hours per week at his job and attending about eight hours per week of EMT training. Now he often has to plan his schedule around the availability of the other volunteers, so someone is always reachable in an emergency.

    Kevin Stoolman, fire chief of Eastern Iowa’s West Branch, said rising costs leave many volunteer services like West Branch Fire stretched thin. The department provides fire and emergency medical services the town of 2,500, providing lifesaving care until a transport team from Tipton, West Liberty or sometimes Davenport arrives to take the patient to a hospital.

    “Our goal is to have them packaged up and ready to go by the time the ambulance gets there,” Stoolman said.

    But Stoolman said a rise in the number of calls the department has to answer is stressing the team and diverting money traditionally budgeted for fire protection and fire fighting to emergency medical services instead.

    Minutes can matter

    According to data from the Iowa Department of Health and Human Services, 75 percent of Iowa’s EMS services are entirely volunteer, though those volunteers respond to only about 10 percent of EMS calls in the state.

    Paid EMS services handle most calls in Iowa, but not all areas have enough paid emergency transport staff to cover the need, causing them to rely on other ambulance services to help pick up the slack. This can lead to longer wait times for care.

    Katrina Altenhofen, the interim director of the Washington County Ambulance Service, said Iowa lacks a standard of operation for ambulance services and the ongoing workforce shortage strains an already stressed EMS network.

    When a lack of staff causes a service to decrease the number of ambulances it runs, other nearby services may be required to pick up calls outside their normal coverage area — resulting in longer response times in both areas, Altenhofen said.

    “You have communities within the state of Iowa right now that don't even have ambulance services and don't have a hospital,” Altenhofen said. “So they are at the mercy of whoever is that next closest entity to be able to come down and help.”

    Cedar County Sheriff Warren Wethington said ambulances in Cedar County can take between 15 and 45 minutes to respond to an emergency call, depending on what else is going on and where in the county the call comes from.

    “Just last week, we had the Clarence ambulance out of service. Tipton has two ambulances and they went to take somebody to Iowa City and somebody to Cedar Rapids, and there was another call … and there wasn’t anybody to cover it. We had to wait until the crew came back from Cedar Rapids,” Wethington said.

    All the ambulance services in Cedar County currently are volunteer, but Wethington has been working with other county officials to create an EMS referendum that will be on the ballot Tuesday. If passed, the referendum would allow the county to implement an additional property tax of 75 cents per $1,000 of taxable value. The tax would be used to create two paid ambulance services and possibly an additional volunteer service.

    Wethington said some people have expressed concerns about the already existing ambulance services losing out on revenue they use for upkeep of equipment and other necessary expenses. But he stressed the new ambulances would not be meant to replace the volunteer services, but provide backup.

    “I want to make it very clear that we want a partnership. We don’t want to take anything away from anybody. This is purely a backup for when they’re out of service, don’t have a crew, or are out on another call,” he said.

    If the referendum is approved, Wethington said it could take up to two years before the new ambulances are fully operational.

    Few counties have adopted EMS tax

    Only a handful of Iowa counties have voted to make EMS an essential service and levied taxes to support it — leaving much of the state hanging in the balance.

    Jones County is one of the five counties where voters approved a levy in November 2022. Brenda Leonard, the Jones County emergency management coordinator, said the county’s two full-time ambulances and multiple volunteer ambulances all have been understaffed and overly busy recently. She said many of the volunteers hold fundraisers to pay for equipment and training, and she’s hoping the new levy will mean paramedics no longer have to spend as much of their time fundraising.

    “I think it has brought to light in our county that it was not an essential service. When you called 911, you were not necessarily going to get an ambulance,” Leonard said.

    Sheila Frink, services director of the Anamosa Area Ambulance Service — the largest service in Jones County — said that Anamosa’s service is planning to use the money they will receive from a levy approved there to buy a new ambulance.

    Anamosa’s ambulance staff are not volunteer, but the tax levy cannot be used for salaries. It can go only toward training, equipment and other expenses.

    Washington County has not passed a tax levy for ambulance services, but the county has been fully funding emergency medical services since 2020 when supervisors used general county funds to purchase several ambulances and the building they were kept in from a private owner, according to interim director Altenhofen.

    The county previously had subsidized the ambulance service in varying amounts each year, but took over completely when a contract with the private ambulance service ended. Since buying the ambulances, the funding has come from the county general fund and also the revenue brought in from the ambulance service, Altenhofen said.

    The county also developed a Washington County EMS Council in 2020 that is working to put a tax levy for the ambulance service on the ballot in coming years.

    “The Board of Supervisors recognized the need to be able to offer the citizens of the county emergency care. Waiting on an ambulance to come from Iowa City, Mount Pleasant, Marengo or Fairfield just was not a viable option,” Altenhofen said.

    Since EMS still is not considered an essential service statewide, there is no obligation for ambulance services to take calls from other areas. In areas where EMS is not declared an essential service, there is no guarantee an ambulance will come at all when a patient calls 911. Many counties that rely on volunteer services don’t have a hospital, and many don’t have the tax base to help support the service, Frink said.

    “It's a broken system,” Frink said.


  • 31 Oct 2023 11:04 AM | Matt Zavadsky (Administrator)

    How Little Placentia Broke a Fire Powerhouse’s Back

    The results of this ‘dangerous’ experiment are in, and may be the old guard’s worst nightmare

    By Teri Sforza

    October 30, 2023

    https://www.ocregister.com/2023/10/29/how-little-placentia-broke-a-fire-powerhouses-back/

    Burly men packed the room, arms folded across their barrel chests. There wasn’t enough space for them all. Hundreds spilled into overflow rooms.

    Dangerous. Destined to fail. Deceitful. Horrific mistake. 

    One after another, firefighters and their union reps paraded to the microphone, trying to scare the bejeezus out of the mild-mannered councilfolk of little Placentia.

    Risky gamble with people’s lives. Half-baked. Untested. Extreme.

    It was 2019 and the wee city was contemplating the unthinkable — being the first to pull out of the regional (and very expensive!) Orange County Fire Authority (with its state-of-the-art water-dropping helicopters and bulldozers and hazmat equipment and swift water boats) to form its own “Fire and Life Safety Department.”

    But it wasn’t just that. Placentia would do the even more unthinkable: Cleave firefighting duties from emergency medical duties.

    No more (very expensive!) firefighters who are also paramedics at every call. No more 25-ton fire trucks arriving beside ambulances for routine medical mishaps. No more fire trucks and their (constant-staffing as per union contract) four-man crews accompanying those ambulances to the hospital and waiting (“wall time”) until the patient is taken by the E.R. before returning to service.

    In Placentia’s proposed revolutionary setup (which is really only revolutionary in Orange and Los Angeles counties),

    firefighters would do the firefighting and a private ambulance company would do the emergency medical/paramedic/lifesaving.

    To the old guard in that room that night, this was Armageddon. The crack that could bring down the entire dam. It had to be stopped.

    “A Placentia Police Department officer, God forbid, gets shot on these streets — I tell you right now they’ll be the first ones, as they’re bleeding out, wishing OCFA was en route, not a new fire department with volunteers,” Frank Lima of the International Association of Fire Fighters told the city council. “This dangerous decision is going to put somebody standing in front of a church at a funeral and you will own it. This vote’s going to follow you and we’ll make sure of that.”

    And so it went. For hours. “Your consultants are selling you snake oil. You can’t get more with less. Your consultants — I’m going to tell you right to your face,” snarled Brian Rice, president of California Professional Firefighters, searching the audience for them. “If one member, whether they’re OCFA or one of these volunteers, gets injured, I’m going to come back and I’m going to sue your ass for everything you’ve got.”

    We recall thinking that Placentia was, indeed, a bit crazy at the time. Providing services regionally is, at least theoretically, the more efficient way to go.

    But these are fire services we’re talking about. Unions and management have agreed to staff up to handle extreme scenarios, despite their rarity, resulting in some crazy costs.

    To wit: A Los Angeles city firefighter made more than $500,000 in overtime alone last year. An Alameda County firefighter made more than $400,000 in overtime alone. An Orange County Fire Authority firefighter made more than $290,000 in overtime alone. Surely, there has to be a better way.

    Understand that little Placentia – population of approximately 52,000 – has teetered on the brink of bankruptcy. Its OCFA bill jumped a stunning 47% over a decade, for zero extra personnel or services. Its general fund budget increased only 12% over that time, and its police department budget was sliced 9% to help make way for the increased costs.

    Craig Green was a city councilmember that fateful night. He gazed out the giant picture windows of the trendy Golden State Coffee Roasters in the heart of Old Town and grinned. “No dead bodies in the streets,” he said.

    Four years later, the results of Placentia’s “half-baked,” “dangerous,” “reckless” experiment are in. And they may be the old guard’s worst nightmare.

    Costly and outdated

    City Administrator Damien Arrula was the rudder that kept the ship steady through stormy waters. Young, energetic, plain-spoken and well-versed in economic development and management analytics, he fought back at the fear-mongering and intimidation. He laid out painstakingly detailed, data-driven analyses of the city’s actual emergency needs and how they could be met with improved safety for less money.

    ”‘Unproven,’ ‘untested,’ ‘half-baked’ — these claims are false, absolutely false,” Arrula told the city councilmembers.

    In fact, 56 out of California’s 58 counties already provide 911 advanced life support with private paramedic services providers. That includes nearby Riverside, San Bernardino, Ventura and San Diego counties.

    “This is not only the primary model in California, but throughout most of the U.S.,” he said. “Only two counties in California do not currently use private 911 ALS paramedic services – Orange and Los Angeles.”

    The city’s consultants did an enlightening “workload analysis” examining OCFA data. They found that:

    • Placentia averaged 7.1 emergency medical calls per day, and 2 calls for other emergencies, for a total of 9.1 calls.
    • That means nearly 80% of those 911 calls — 4 out of 5  — were for medical, not fire.
    • Only 0.8% of calls were for structure fires, and only 8 of those had losses exceeding $20,000.
    • 90% of calls were handled with one engine.
    • The average call duration was 23.2 minutes, with 6 to 8 minutes of response time.
    • The actual workload of an on-duty firefighter was 3.9 hours per 24-hour work period.

    And despite all the chatter about how deadly a “volunteer” fire department would be, Arrula said Placentia’s new Fire and Life Safety Department would be a professional operation with professional firefighters and reserves who could help in a pinch. It would have two trucks in the city, just as OCFA did, each staffed with three rather than four firefighters. It would have two Lynch EMS ambulances carrying four trained and licensed paramedics on duty 24/7, an increase in lifesaving personnel.

    OCFA’s service and firefighters are great, the city council concluded. But its model is costly and outdated. Despite intimidation and outright threats — mutual aid might be withheld by surrounding fire departments during a big emergency — the council decided that a local department controlled directly by the city would better meet its residents’ needs. Its goals were to reduce response time, improve fire prevention and improve quality of emergency medical care.

    Four years down the road, the numbers speak for themselves. According to Placentia:

    • Under OCFA, the response time for fire calls was 9 minutes and 30 seconds.
    • Under Placentia’s new fire department, that shrank to 6 minutes and 21 seconds.
    • Under OCFA, the response time for emergency medical calls was 9 minutes and 30 seconds.
    • Under Lynch EMS, that shrank to 4 minutes and 48 seconds.
    • Among cardiac arrest patients in Placentia, Lynch paramedics were able to restore a pulse 58.8% of the time in 2021-22 and 54.2% of the time in 2022-23 — more than twice the national averages.

    On the fiscal front, this improved performance has saved the city more than $1 million each year over what it would have paid OCFA — savings that’s expected to average out to $3 million a year over the next decade as OCFA costs continue to rise. That’s real money over the long haul: more than $30 million saved by 2032, and close to $60 million saved by 2038, according to Placentia’s projections.

    And overtime? The firefighter with the most overtime pay in Placentia earned just shy of $51,000 in OT — a fraction of what the top OT earners rake in at other agencies.

    “It’s been an amazing few years,” an almost-astonished Walt Lynch of Lynch EMS told the city council earlier this month. “If you asked me back then if I’d be sharing this with you today, I’m not sure I would have said yes.”

    Councilmember Rhonda Shader was mayor that night back in 2019, retaining poise in the onslaught of threats. “The nimbleness of this model, it’s turning out to be more than we hoped for,” she said.

    Arrula was vindicated. “This is really amazing work when you talk about fundamentally saving lives,” he said. “Really unprecedented.”

    Change

    So what do all the purveyors of doom have to say about all this?

    We reached out to several unions and union reps who had warned of death and destruction. No one was chatty on the record, but there was suspicion about the veracity of Placentia’s data.

    Predictions that Placentia would be so weak it would need constant backup from surrounding agencies? The 2021 data showed 128 mutual aid calls into Placentia under the new department, versus 806 under OCFA in 2019. (It responded to 104 mutual aid calls in 2021 versus 457 in 2019; Placentia is now called upon less by its neighbors. A snub?)

    In an emailed statement, OCFA said this:

    “The OCFA recognizes that there are a few jurisdictions in the state that utilize non-fire-based EMS delivery systems due to their budgetary constraints. OCFA is fortunate and proud that our leadership supports a robust and proven Fire & EMS system that puts two firefighter/paramedics (along with two additional firefighters) to the side of our patients with speed, efficiency, competence, and care.”

    The takeaway here is that there are other, more economical and efficient ways to deliver emergency services, but that the forces working against change are enormous. The old guard tried hard to thwart Placentia, asking surrounding cities not to enter into mutual aid agreements to help in emergencies, asking other agencies not to bid on Placentia’s fire and life safety contracts, threatening the city with lawsuits.

    But change arrived nonetheless in Placentia, and it’s coming for everyone else.

    “The DNA of fire departments is to respond to EVERYTHING and help EVERY TIME,” says a white paper called “21st Century Fire and Rescue,” co-chaired by retired Anaheim Fire Chief Randy Bruegman.

    “While fires may be diminishing due to better engineering, codes and enforcement along with an increased focus on community risk reduction activities, calls for service are up for every department. These calls are for help, and the calls received today are much broader in scope. The services required often fall outside the traditional scope of fire and emergency services.”

    Bruegman sees real opportunity here to deploy resources differently and more effectively, as has been done in Anaheim: sending nurse practitioners or behavioral health workers or community paramedics when that makes sense, rather than running four people on a 50,000-pound fire apparatus to everything.

    “We need to look at what our statistics and data are telling us: Our demand for fire and rescue calls have gone down over the last 30 years, but call volume has skyrocketed,” he said. “It’s about how we address those calls in the most efficient and effective manner.”

    As technology improves, precision will increase: Soon our wearable fitness devices will be able to transmit medical information to dispatch centers. Cars will alert first responders to traffic accidents. Smart buildings will send data instantaneously on emergencies.

    “That’s going to change the way we do business in the future,” said Bruegman, president and founder of the Leadership Crucible Foundation. “There’s going to be a need for fire suppression, response and rescue for many, many years to come, maybe forever, but I think it will become a small component of our overall system.”

    Many folks in Placentia agree. According to its most recent audit, the city that once teetered on the bankruptcy abyss had a 17% cushion for its general fund (for you numbers types, that’s a $7.2 million unassigned fund balance, compared to expenses of $42.1 million).

    Back in 2012, that fund balance was in negative territory.

    Green, the former city councilman who was on the dais when the decision was made back in 2019, had served on the OCFA board of directors and has great respect for the agency. “But Placentia doesn’t need helicopters. Placentia doesn’t need bulldozers,” he said. “We wanted our city to be fiscally sustainable, and now it is. We wanted to do this — and lo and behold, it works.”





  • 30 Oct 2023 3:37 PM | Matt Zavadsky (Administrator)

    Cayuga County (NY) official: AMR ambulance exit requires 'immediate solution'

    Oct 29, 2023

    By David Wilcox

    https://auburnpub.com/news/local/cayuga-county-official-amr-ambulance-exit-requires-immediate-solution/article_1dbfed12-71cb-11ee-98d7-1b2f8ef7d8d2.html

    Cayuga County is looking for "an immediate solution" after being told by American Medical Response last week that it will cease ambulance services in the area at the end of the year.

    Riley Shurtleff, the county's director of emergency services, told The Citizen on Monday that the medical transportation provider responds to about 3,000 emergency and nonemergency calls annually.

    To begin figuring out how to fill that void, Shurtleff has asked AMR to provide the county more detailed call response data. The provider operates one 24-hour rig and one 12-hour daytime rig from its Auburn station, he explained. Sometimes it responds with a full rig and sometimes with advanced life support intercept services for smaller providers, riding in their ambulances to the hospital.

    That data will help the county "determine a path forward," Shurtleff said, in partnership with Auburn City Ambulance and the handful of other ambulance providers that will be left in the area.

    "Those are conversations that will have to happen with agency chiefs and leaders in the very near future," he said. "We need to find an immediate solution in order to handle the call volume."

    AMR, a subsidiary of Global Medical Response, confirmed in a statement to The Citizen on Monday that its Auburn operations will close effective Dec. 31. The private provider has served Cayuga County for more than 40 years. All local employees will be offered positions at its Syracuse operations, and AMR said it is "committed to a successful transition of services as determined by the county."

    AMR said its decision to leave the county was made due to "stagnant reimbursement rates, rising costs of apparatus and medical supplies and the cost of a qualified workforce in a post-pandemic society."

    Emergency medical services providers nationwide face similar problems, Shurtleff said. The fact New York state does not classify EMS as essential — meaning that municipalities don't have to provide them like fire and police services — exacerbates those problems, in his opinion. But he hopes that will change with a bill introduced to the state Senate in 2021 that would classify EMS as essential.

    "There's potential for a reworked system out of this," he said, "but truly Cayuga County is seeing the local effect of health care and EMS systems struggling at a national scale."

    What didn't play a role in AMR's decision, Shurtleff continued, was Auburn's creation of a municipal ambulance service in 2021.

    Lon Fricano, who served as director of operations for the city service's predecessor, TLC Emergency Medical Services, said in a letter to the editor in The Citizen this week that the change "destabilized" local ambulance service and led to AMR's decision. He also accused the city service of "traveling to distant facilities while you may be waiting for an ambulance and AMR was being underutilized."

    According to data received from the city of Auburn through a Freedom of Information Law request by The Citizen, however, city ambulance hospital-to-hospital transports have decreased since the creation of the new service. TLC averaged 70.7 transports a month in the 10 months of 2021 prior to the change, while Auburn City Ambulance has averaged 55.2 transports a month since.

    Shurtleff said he thought the city's service "worked well" with AMR.

    "I would actually say there were a number of times when AMR was covered by the city, and the city was covered by AMR," he said. "You can't predict when people have heart attacks."

    The city service, and other ambulance providers in Cayuga County, now have a little more than two months to figure out how to work best together in the absence of AMR.

    "EMS is a unique animal," Shurtleff said. "These additional agencies will have to look at their own structures to see where they can pick it up to move forward and continue serving the public."


  • 26 Oct 2023 4:50 PM | Matt Zavadsky (Administrator)

    Update to the news report shared yesterday….

    ----------------

    Knox County recommends commission stick with AMR for ambulance service

    Tyler Whetstone

    October 26, 2023

    https://www.knoxnews.com/story/news/local/2023/10/26/knox-county-recommends-commission-stick-with-amr-for-ambulance-service/71304332007/

    The Knox County committee in charge of selecting an ambulance provider has decided to stick with its current provider, American Medical Response, despite wait times that have stretched to more than an hour for some patients and prompted Knoxville police and fire personnel to raise a public alarm about the problem.

    The decision was announced Oct. 26. The recommendation must go through the Knox County Commission for approval before the current contract expires in January.

    The county provided a copy of AMR's proposal after news broke of the committee's decision. As expected, the contract will require new subsidies to shorten wait times for patients in need of emergency care. AMR provided two options varying in cost from $2-$2.8 million annually, with a 3% annual increase built in.

    The process for rebidding the county’s emergency services contract coincided with skyrocketing delays for service, including for some reasons that are out of control AMR, including understaffed emergency medical service systems and hospitals. Emergency rooms are overwhelmed by people using them as primary care, forcing ambulances to wait with patients because AMR policy does not allow them to leave patients until a hospital has taken over care. At the same time, hospitals are struggling to attract and retain health care workers.

    These problems aren’t unique to East Tennessee, or to AMR. They're happening across the country as ambulance providers become the first option for residents who lack health insurance or a ride.

    A third party hired by Knox County to review the situation, Fitch & Associates, said the current expiring contract is "financially nonviable." A Fitch representative told commissioners Oct. 16 the county will likely have to subsidize any contract by paying $1.9-$3 million each year.

    "We all know that there have been some significant issues with healthcare and ambulance services – not only here but across the country," Knox County Mayor Glenn Jacobs said in a statement. "We put the current contract out to bid early because we realized, with 12 amendments already, it was becoming a hindrance to EMS services in the county. Though this new contract and its significant updates won’t immediately fix all the problems, we feel like it will be a big step forward.

    "We still have high wait times at understaffed hospitals, but the new contract should help alleviate some of the associated issues, and, as always, we remain committed to working with all our partners to continually improve emergency access in our community," he continued.

    How the committee selected the company

    The committee in charge of reviewing the proposals was made up of five members, which included Colin Ickes, director of Knoxville-Knox County Emergency Management Agency; Jay Garrison, procurement coordinator from the county; Jennifer Ranson, an emergency medicine physician; Kevin Parton, senior director of the Knox County Health Department; and Steven Hamby, emergency response coordinator for the health department and chairman of the Tennessee Emergency Medical Services Board.

    The committee scored each company on four segments: administration, operations, quality management and cost.

    The total possible score was 5,000. This is how they finished:

    • AMR: 4,761
    • Priority: 4,124
    • Falck: 4,060
    • AmeriPro: 3,655

    "Knox County ran a fair and focused process and we are thrilled to win the competitive process and be able to continue our long standing service to the citizens here," Brett Jovanovich, AMR's regional vice president of the southeast region, said in a statement.

    "The new and much different contract will help address many of the problems plaguing the EMS industry nationwide and we salute the county for taking a different approach."

    What’s next?

    The ambulance contract has historically been a contentious vote for the commission and there’s no guarantee AMR has the six votes required to approve the contract at November’s meeting.

    Regardless, commissioners’ hands are tied when it comes to suggestions or tweaks to the contract. Their only role in the process is to vote the committee's suggestion up or down. If they decide to reject it, the contract will require a rebid and the process starts over, which would take months.

    To complicate matters, AMR’s current contract is set to sunset at the end of January. Even if AMR retains the contract, the current one would presumably have to be extended. If AMR's bid is not approved, it will take time to get a new ambulance service up and running.

    Such confusion has precedent. In a heated ambulance contract debate in 2002, two Knox County Commission committees voted against awarding the contract to AMR, which won the rebidding process over Rural Metro, according to Knox News archives. Rural Metro had the contract the previous 17 years.

    Weeks later, County Executive Tommy Schumpert removed a final vote on the contract minutes before the commission could take it up after Rural Metro filed a complaint with the county about how the procurement process was handled.

    Schumpert originally supported AMR but later changed his tune, supporting Rural Metro instead. Months later, the commission approved a contract with Rural Metro. In the interim Rural Metro's original contract had to be extended so the county could continue receiving ambulance services.

    AMR bought out Rural Metro in a 2015 deal worth over $500 million.


  • 26 Oct 2023 4:49 PM | Matt Zavadsky (Administrator)

    Special thanks to JP Peterson at MEDIC in Charlotte, NC for agreeing to share their experiences with this reporter…

    --------------------------

    Knox County's struggling ambulance service will change. What will that look like?

    Tyler Whetstone

    October 25, 2023

    https://www.knoxnews.com/story/news/local/2023/10/25/knox-county-struggling-ambulance-service-will-change-under-new-contract/71204237007/

    Knox County doesn’t pay a dime for the private ambulances that serve sick and injured people, but lengthening response times have leaders rethinking whether they need to spend public money to fix the problem fast.

    The only solution could require an annual investment of a few million in tax dollars, and that decision is looming. Knox County commissioners will decide in November on a new emergency services contract.

    The stakes are high, especially for the injured or sick waiting for help to arrive.

    County leaders might have to get creative to ensure reliable ambulance service, especially in an American health care system where too many patients rely on emergency rooms for care that should be provided in clinics, and hospitals operate with razor-thin staffing and under tremendous pressure to generate income.

    A consultant hired to review the local situation, Fitch & Associates, said the soon-to-expire contract with American Medical Response is "financially nonviable." A Fitch representative told commissioners Oct. 16 the county likely will have to subsidize any contract by paying $1.9 million to $3 million each year.

    With ambulance response times in Knox County often topping 17 minutes for the most serious calls such as trauma, heart attack and stroke, patients and health care professionals are sounding the alarm.

    So, too, are Knoxville firefighters and cops who are often first to arrive when a person is in distress but limited by law and training in what care and transport they can provide. This month, Knoxville police spokesperson Scott Erland described the situation to Knox News in no uncertain terms.

    “The harsh truth is that, in the current state of ambulance services in Knox County, there’s no guarantee an ambulance will show up quickly or at all," Erland said, "leaving residents who need urgent care in a situation where they potentially have to find their own way to the hospital.”

    In order to understand the county's options, Knox News analyzed ambulance service in two counties grappling with similar challenges: Hamilton County, home to Chattanooga, and Mecklenburg County, North Carolina, home to Charlotte. Both operate their own EMS systems, but there are insights to bring to Knox County's problems.

    Here’s a look at where we are and where the county can go from here.

    Knox County increased allowable response times

    Knox County’s ambulance service is provided by American Medical Response, or AMR. The contract originally set response time goals of 10 minutes or fewer on any call 90% of the time.

    But as market conditions changed, the contract was adjusted to give AMR 17 minutes to arrive for any call.

    Even with the extension, ambulances are unlikely to come that quickly, especially once you leave the Knoxville city limits.

    In 2022, outlying areas, including Corryton, Farragut, Mascot, Powell and Strawberry Plains, had a response time more than 17 minutes on priority one calls (which are the most life-threatening situations) 90% of the time. Knoxville was the only place with call times of less than 17 minutes 90% of the time ‒ and it barely hit that mark.

    Outside of Knoxville, ambulances arrived in other places on average between 18.5 to 26 minutes after a call for help came in, according to data provided in the Fitch review.

    Proposal for zoned response would reduce response times - at a cost

    Ambulances are required to serve the entire county, but Fitch proposed splitting the county up in zones centered on the city, on North and East Knox County and on West Knox County and Farragut.

    Dividing Knox County into three zones, one covering the city of Knoxville and two covering the rest of the county outside city limits, could reduce response times. Those who live outside the city, however, still could wait up to 20 minutes for even the most serious medical emergencies.

    In that zone structure, the county could implement a system designed to provide emergency medical services response times under 10 minutes for 90% of calls from Knoxville residents, and under 20 minutes for 90% of county residents outside city limits.

    This proposal is expected to cost upwards of $3 million and would be more expensive if responses were reduced further. For example, a 10-minute urban, 15-minute rural response time would require more EMS resources and would be more expensive.

    Learning from Hamilton County

    Hamilton County is a slightly smaller mirror of Knox County, both in population and its urban/rural divide. The county has run its own EMS system since 1988 and offers a few ideas to emulate.

    The county’s average response time is 10 minutes, EMS director John Miller told Knox News. Like Knox County, Hamilton County deals with extended "wall times," the insider term for how long ambulance crews have to wait at a hospital before the patient they brought is admitted.

    Recently, Hamilton County has pushed back on emergency room wait times with an offload policy that allows them to simply leave patients inside an emergency waiting room. The policy is included in their agreement with local hospitals.

    “It’s not the hospitals’ fault, but we can’t have five trucks waiting two hours,” deputy director Wade Batson said. “(Hospitals) don’t like it, but at the end of the day, something has got to give.”

    AMR sometimes does this now, but staffers are more likely to group a few patients together at an ER with a single employee watching them.

    Hamilton County's costs track with Knox County's expected bill

    The Hamilton County-run ambulance system costs about what Knox County will likely end up paying. Hamilton County budgeted $17.9 million for EMS for the 2023 fiscal year but softened the financial hit by using $15.7 million in expected revenues from ambulance service, paid mostly by patients' insurers. The direct cost to taxpayers is $2.2 million.

    But those are the annual costs to operate a system that already exists. Starting one up means buying ambulances and hiring more skilled staffers.

    New ambulances, for instance, take at least 18 months to arrive after they're ordered and cost more than $300,000 apiece, according to the Fitch review.

    Charlotte metro wait times have gotten longer … and leaders brag about it

    Earlier this year, leaders in Mecklenburg County, North Carolina, turned their EMS system on its head. The county’s EMS system serves more than 1 million people, more than double Knox County's population.

    The door to change was already opening as costs started to outpace revenues. Mecklenburg EMS Agency executive director John “JP” Peterson told Knox News the COVID-19 pandemic blew open the doors of possibilities for rethinking ambulance service.

    In April, the county switched to a system that relies heavily on triage dispatch to determine the severity of the patient's medical condition. If the condition is potentially life-threatening, an ambulance is expected to arrive in less than 11 minutes.

    In less-severe cases, responders are given a cushion. The scaled system goes from 11 minutes to 15 to 30 and finally, for those who need assistance but not right away – think about sprained ankles – EMS has up to one hour to arrive.

    Peterson said the county previously dispatched ambulances for potentially life-threatening emergencies about 75% of the time, but those cases turned out to truly be life-threatening just 5% of the time. About 35% of patients didn’t need to go to the hospital at all.

    “The public sometimes doesn’t realize that everyone who calls 911 isn’t experiencing a life-threatening (event). … We have to pivot and do a combination of readjusting our system response (and) educating the public,” Peterson said.

    This type of dispatch depends on a near-perfect triage system, where trained professionals can take calls and quickly work through a sometimes lengthy set of questions to determine whether a person needs immediate assistance.

    In the months since Mecklenburg County implemented the new system, dispatchers have classified 30,000 calls as low priority. That means an ambulance crew has up to an hour to respond.

    Of those calls, less than 1% needed a quicker transport, Peterson said, and there have been no deaths or averse outcomes from the new policy.

    Knox County will likely copy the triage system in some way. In its proposal for Knox County, Fitch & Associates suggested some sort of tiered response system based on the severity of call.

    Peterson says the new policy is a bright spot amid constantly increasing EMS costs, though there’s admittedly a very long way to go.

    “If all of this is successful, then in the future, maybe 5 to 10 years from now, hopefully we will need less resources to do the work," he said.

    "But that’s pipe dream, down-the-road thinking.”

    What can you stand? What can you pay?

    Matt Zavadsky is an EMS expert for the Center for Public Safety Management and the chief transformation officer at MedStar Mobile Healthcare, which operates the EMS service in Fort Worth, Texas.

    In Fort Worth, emergency crews responded to 450,000 911 calls over a 3-year period and just over 2% of calls required lifesaving care. The rest of callers, he said, don't need an ambulance within the nine minutes he defined as an immediate response.

    The choice for how the system should be shaped is entirely up to the community and what it’s willing to accept, Zavadsky told Knox News.

    Will we demand 9-minute response times? Are 20-minute response times OK?

    The fewer the minutes it takes an ambulance to arrive, the more money it costs taxpayers.

    You end up settling on “what your heart can withstand, and your wallet can bear,” he said.

    So many factors have led to a broken system

    Everyone from experts in the field to county officials running the process agrees the system is messed up regardless of what model is used.

    The challenges include many out of the hands of public officials, such as an increasing reliance by patients on emergency rooms for primary care best provided in clinics.

    Zavadsky, the Fort Worth official, has seen firsthand that EMS costs have skyrocketed “50-70%” since 2020, much of it in additional personnel costs. Employees have received a 58% increase in wages in the past 18 months, he said.

    “The primary driver in that is personnel. When COVID happened, EMTs making $17-20 an hour figured, 'Maybe this isn’t worth risking my life for,'” he said. “Then you had the nursing shortage and hospitals' desire to hire EMTs and paramedics to work there for half of what they pay (nurses).”


  • 13 Oct 2023 1:10 PM | Matt Zavadsky (Administrator)

    Kudos to the folks in California for coming together on this effective legislation designed to protect patients and providers from surprise underpayments by insurers…

    Very similar to the recently enacted Texas legislation that requires insurers to pay billed charges, as long as the local government has published their rates.

    Another example of state legislation that the GAPBAC should consider to national replication… 

    Salient language below…

    ------------------

    https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202320240AB716

    SEC. 2. Section 1371.56 is added to the Health and Safety Code, to read:

    1371.56. (a) (1) Unless otherwise required by this chapter, a health care service plan contract issued, amended, or renewed on or after January 1, 2024, shall require an enrollee who receives covered services from a noncontracting ground ambulance provider to pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting ground ambulance provider. This amount shall be referred to as the “in-network cost-sharing amount.”

    (d) (1) Unless otherwise agreed to by the noncontracting ground ambulance provider and the health care service plan, the plan shall directly reimburse a noncontracting ground ambulance provider for ground ambulance services the difference between the in-network cost-sharing amount and an amount described, as follows:

    (A) If there is a rate established or approved by a local government, at the rate established or approved by the governing body of the local government having jurisdiction for that area or subarea, including an exclusive operating area pursuant to Section 1797.85.

    (B) If the local government having jurisdiction where the service was provided does not have an established or approved rate for that service, the amount established by Section 1300.71 (a)(3)(B) of Title 28 of the California Code of Regulations.


  • 12 Oct 2023 1:07 PM | Matt Zavadsky (Administrator)

    Hopefully, the GAPBAC is watching developments like this!? 

    Seems IDR for surprise underpayments may not be an ideal solution…

    -----------------------------

    Surprise billing arbitration is still a mess

    Maya Goldman

    October 12, 2023

    https://www.axios.com/2023/10/12/surprise-billing-arbitration-is-still-a-mess


    Nearly two years after a surprise medical bill ban took effect, the process for settling billing disputes between insurers and providers is still mired in litigation and many cases remain unresolved.

     

    Why it matters: Uncertainty around how providers get paid for disputed out-of-network services isn't likely to ease as multiple challenges to the Biden administration arbitration rules continue to work through the courts.

     

    Driving the news: The Centers for Medicare and Medicaid Services last week reopened its portal for providers to submit new claims for unpaid out-of-network services to arbitration for the first time since early August.

     

    Federal officials also said last week that they don't have plans to release new guidance on how insurers should calculate a key benchmark used to determine payment for a disputed bill. Officials will exercise enforcement discretion over calculations for at least six months.

     

    A federal district court tossed out portions of the regulations for calculating that benchmark in August, but the Biden administration said it plans to appeal.

     

    Catch up quick: The No Surprises Act has protected consumers against unexpected medical bills since the beginning of 2022. But figuring out how insurers should actually pay out-of-network claims has proven to be a major headache.

     

    The Texas Medical Association has filed four lawsuits against the administration over different aspects of the law and its corresponding regulations.

     

    By the numbers: Between April 15, 2022, and March 31, 2023, while the claims resolution process was underway, federal arbitrators sided with providers in about 71% of disputed claims that were resolved, according to a government update published earlier this year.

     

    Claims went to arbitration nearly 14 times more than officials expected in the first year of the process. However, a survey produced by insurers this summer found that providers accepted the insurers' initial payment offer in 88% of disputes.

     

    Still, radiologists, anesthesiologists and emergency department physicians — some of the specialties most frequently involved — are "very concerned about this delay in full enforcement" of the arbitration rules, five trade organizations said in a joint statement this week.

     

    Enforcement of insurers' compliance with surprise bill payment to providers is already lacking, and the latest federal guidance gives payers more leeway, the provider groups said.

     

    Providers face "a bumpy and expensive road ahead," Jeffrey Davis, health policy director at McDermott+Consulting, wrote.

     

    The other side: Insurers are frustrated, too. Continued lawsuits have eroded the structure around the No Surprises Act, said Adam Beck, a senior vice president at health insurance trade group AHIP.

     

    "We, from the outset, said that an arbitration-based system is going to be costly, it's going to be cumbersome and it could end up increasing health care costs," he said. "And unfortunately, that's what we're seeing."

     

    That said, many of insurers' challenges with the arbitration process could be solved with technical updates, Beck added.

    "It's not grand policymaking. Sometimes it's just adding a new drop-down menu," he said.

     

    What we're watching: There's a good chance that some litigation over the No Surprises Act makes it all the way to the Supreme Court, Beck said.

     

    In the meantime, the Biden administration's appeals over Texas court decisions on their arbitration rules will continue. Several individual court challenges over specific arbitration cases have popped up as well, noted Matthew Fiedler, senior fellow at the Brookings Schaeffer Initiative on Health Policy.

     

    And while patients remain insulated from most surprise medical bills under federal law, these squabbles could have trickle-down effects.

     

    The prices ultimately paid to providers after arbitration could drive up premiums, Fiedler said. The ever-changing rules being challenged in court could also lead to some incorrect cost-sharing for patients, according to Davis.


  • 9 Oct 2023 7:43 AM | Matt Zavadsky (Administrator)

    An excellent insight into one of the primary drivers of ED delays and boarders in the ED.

    At the recent American College of Emergency Physicians (ACEP) Summit on ED Boarding, the inability to discharge inpatients was a major driver highlighted. This is exacerbated by the paltry economic model for post-discharge providers, including ambulance service.

    As an example of how economics and payment reform drive this process, I recently received a phone call from the Executive Director of one of the largest Medicaid MCOs in the DFW metroplex. He said he had 5 inpatients waiting for ambulance trips in Dallas (not MedStar’s service area), and he could not get any agency to transfer the patients out. He went on to explain that the cost of the inpatient facility care was significantly higher than if the patients were to be transferred to the post-discharge facilities. We discussed the low Medicaid reimbursement, and EMS shortages due to the staffing and economic crisis as the likely reason he could not find a provider and suggested that it may be in his economic interest to offer a higher reimbursement for the services to facilitate the ambulance transfers – which he said he could and would do.

    Not also the opinion that payment reform could help patients get the right care, in the right setting, avoiding preventable hospital visits. The EMS profession has been promoting that change for years, since currently, we are ONLY reimbursed for services by Medicare and most commercial insurers who follow the Medicare rules, if we transport a 911 patient to the ED. A perfect example of how payment policy drives clinical practice.

    --------------------  

    Opinion: Discharge delays are another sign of a broken healthcare system

    Chris Van Gorder

    October 04, 2023

    https://www.modernhealthcare.com/opinion/scripps-health-ceo-chris-van-gorder-discharge-delays-broken-healthcare-system

    August marked a milestone for Scripps Health and one of our patients. After two years and three months at Scripps Mercy Hospital San Diego, the patient was finally able to leave. The patient didn’t need to be in an acute-care hospital for that long; there was just nowhere else for him to go. With a severe behavioral health diagnosis and a county mental health conservatorship, he required transfer to a specific, locked level of care. But there was no space available. So he stayed.

    His situation is not unique. Another patient has been at one of our hospitals for more than a year and a half waiting for a county bed. During that time, he has exhibited disruptive behavior, including multiple episodes of hitting and throwing objects at staff members.

    We have a number of patients who have been in our hospitals for more than 500 days. Our longest-term patient has been here for 2 1/2 years. He is on a five-year wait list for a state psychiatric hospital, but open beds for transfers are extremely rare, with priority given to state criminal patients over those being boarded at hospitals.

    If we cannot move patients out of beds when they are ready to leave, we cannot take in more patients. It’s as simple as that. So we face bottlenecks—acute-care beds occupied with patients we cannot discharge even though they are ready to leave, which backs up patients in the emergency department. That, in turn, backs up ambulances waiting to offload patients.

    This problem exists at hospitals across the country. A survey conducted over a three-month period last year by the Healthcare Association of New York State found that the 52 responding hospitals accrued 60,000 avoidable bed days at an estimated cost of $169 million. A report by the University of California Davis Medical Center said it racked up more than 7,800 ABDs in 2019 at a total cost of $20.4 million. According to an Advisory Board 2019 report, 71% of hospitals have at least 500 avoidable bed days per 1,000 cases.

    At Scripps Health, we record more than 33,000 avoidable beds days annually. That’s up from about 11,000 three years ago. Our daily average jumped from 30 in 2019 to 91 in 2023. Over that period, the annual costs we absorb have skyrocketed, from $16.7 million to $59 million.

    This is a state and national policy failure—one of many involving regulations and unfunded mandates focused on hospitals. The real problems that need to be addressed are chronic and intentional underfunding and a focus on fixing parts of the system rather than the broader issues threatening hospitals. Piecemeal legislation and policymaking won’t get the job done.

    At the urging of the American Hospital Association and hospitals across the country, Congress considered proposals in December 2022 to compensate hospitals for some of their avoidable bed day costs through a temporary Medicare payment adjustment, but to date, none of those proposals have advanced.

    Several reasons account for why these patients have nowhere to go. In San Diego, we have just over 800 inpatient behavioral health beds, but we need more than 1,600. Many step-down healthcare providers might have beds, but are struggling with staffing shortages. And many facilities won’t take patients with Medi-Cal (Medicaid in California) or Medicare if there are better-paying patients, or they will only designate some beds for them.

    California hospitals have not received an increase in Medi-Cal base rate reimbursements in 10 years. But while facilities downstream from hospitals can pick and choose which patients they take because the Emergency Medical Treatment and Labor Act does not apply to them, hospital emergency departments don’t have a choice. So the patients stay.

    Increasing government reimbursement to cover the cost of care at hospitals, as well as at other providers such as home health, skilled-nursing and behavioral health organizations, would give patients a better chance of being accepted elsewhere when they no longer need to be in an acute-care hospital. Or maybe they would receive the proper level of care in the first place, keeping them out of hospitals altogether.

    Avoidable bed days are another sign of a broken healthcare system. Hospitals should not be stand-ins for nursing homes or specialized residential treatment facilities. Hospitals are the most expensive setting for these patients. And they’re not the right medical setting.

    This is an untenable problem that must be fixed, but that won’t happen until more people are focused on solving it at all levels: local, state and national.


  • 4 Oct 2023 4:18 PM | Matt Zavadsky (Administrator)

    Outstanding program that many communities/agencies are implementing, or at least investigating…  Kudos to the ATCEMS Team for this initiative!

    MedStar just entered into an agreement with a commercial payer that reimburses us for this type of alternate response, without sending an ambulance, including patient navigation through our 911 center… It uses CPT codes vs. typical HCPCS ambulance codes, for the alternate response reimbursements.

    Key quotes from the news report –

    • ‘Selena Xie, president of the union that represents EMS workers in Austin, says 90% of 911 EMS calls are not medical emergencies, but are resource needs. So this program gets people the help they need, while freeing up ambulances for the higher needs calls, like heart attacks and other life-threatening situations.’
    • ‘Over the summer, Council Member Alison Alter pushed to have more money for paramedics included in the budget so the program can run 24/7. “This is really important if we want to grow as a city,” Alter said. The city can respond to calls for help "without having to add a million [fire and EMS] stations as we grow.”’
    • ‘When someone calls 911 and they don't necessarily need an ambulance or to go to the emergency room — they have an infected wound or a minor injury requiring stitches, for instance — this team of paramedics responds with alternative solutions. The goal is usually to keep the person at home.’

    --------------------------------

    A 911 call for help doesn't always require an ambulance. But these paramedics respond.

    KUT 90.5 | By Luz Moreno-Lozano

    October 2, 2023

    https://www.kut.org/austin/2023-10-02/a-911-call-for-help-doesnt-always-require-an-ambulance-but-these-paramedics-respond

    Capt. Doug Schulz looks just like any other paramedic in Austin. He wears a navy blue uniform with his name pressed on the right corner of his chest. He carries a medical bag with equipment and sky blue gloves.

    But his job is different — and it's not just that he responds to calls for help in an SUV instead of an ambulance. It's that he has the ability to meet people where they are.

    Schulz is part of a team of paramedics referred to as the Collaborative Care Communication Center, or C4, a program that began with the COVID-19 pandemic.

    The team aims to respond to calls for help that do not require an ambulance or trip to the emergency room, reducing the strain on hospitals and the health care system.

    “Back in March [2020], I got a call from one of our chiefs,” Schulz said. “He said, 'You are going to screen COVID calls that come in on 911, and we are going to try to deal with them without overloading the system or the ambulances.'”

    But that was just for COVID-related calls. As the pandemic dwindled, Schulz said the team realized they were really good at this, responding to calls that weren't necessarily emergencies.

    “We eventually thought: Why don't we do it for these other low-acuity calls,” he said, referring to calls for help that wouldn't be considered emergencies. “That is what birthed the [program].”

    What is C4?

    The Collaborative Care Communication Center is sort of like a telehealth line, Gabe Webber, a commander with C4, said.

    “Maybe that is an oversimplification,” he said. “But it is our way of trying to find alternative dispositions for low-acuity health care needs.”

    When someone calls 911 and they don't necessarily need an ambulance or to go to the emergency room — they have an infected wound or a minor injury requiring stitches, for instance — this team of paramedics responds with alternative solutions. The goal is usually to keep the person at home.

    The program often caters to people who are either low-income or vulnerable and have no other resources. Many are dealing with chronic health issues.

    Michael Minasi

    The goal of the C4 team is to treat a person where they are and not bring them to the emergency room.

    “Usually they don't have a relationship with a primary care provider,” Webber said. “They have no place else to turn, so disproportionately they’ll access 911.”

    That creates a cycle, he said. They get into an ambulance, are seen by a doctor at the hospital, and told to follow up, but they don’t because they don’t have the ability to do so. That's where C4 comes in.

    “We try to break that endless cycle,” Webber said, “and try to connect them with an appropriate resource.”

    That then not only creates a better outcome for the patient, but is also a cost savings. Operating an ambulance and going to the hospital are expensive, Webber said.

    Selena Xie, president of the union that represents EMS workers in Austin, says 90% of 911 EMS calls are not medical emergencies, but are resource needs. For example, she said, if someone calls 911 who has trouble getting around, a paramedic can respond to help and also provide a referral for services. So this program gets people the help they need, while freeing up ambulances for the higher needs calls, like heart attacks and other life-threatening situations.

    “It is a keystone of what we are trying to do,” Xie said. “We do have limited ambulance resources, and we are covering the entire county and city.”

    Using best judgment

    Schulz said the team is given a rough set of guidelines when responding to calls. “'Make good decisions' was basically the direction we were given,” he said. “Like, 'Use your best judgment.'”

    Schulz said the paramedics try to keep people home or where they're most comfortable rather than taking them in an ambulance to the hospital. But that's not always possible.

    Earlier this month, Schulz responded to a call from a 56-year-old man with a spinal disease. The man had been discharged from the hospital just two days before and had promised to give himself medicine through an IV. But all of the sudden, he couldn’t get out of bed and was unable to get this medicine from the refrigerator.

    Living alone with his cat, he called 911 for help.

    Schulz did his best to try to keep the man home, but because he had missed several doses of medicine and was unable to move, a trip to the hospital was really the best option.

    “He even agreed,” Schulz said. “He was right there. If he called 24 hours ago that would’ve been way different because we would’ve gotten a dose in. … We tried.”

    Expanding the program

    Schulz and his fellow team of paramedics respond to many calls for help. But they can only answer a call within the hours they are available — usually from 9 a.m. to 9 p.m. The overnight hours are left unfilled, when paramedics say lots of calls happen, especially mental health calls.

    Over the summer, Council Member Alison Alter pushed to have more money for paramedics included in the budget so the program can run 24/7.

    “This is really important if we want to grow as a city,” Alter said. The city can respond to calls for help "without having to add a million [fire and EMS] stations as we grow.”

    Webber said expansion is important for consistency.

    “People do call 24 hours a day … the system never sleeps,” he said. “But during the day, certain calls are diverted [to C4].

    During the nighttime, those kinds of calls have to be handled in the traditional manner, and that creates confusion for paramedics in the field.”

    While consistency is important, Webber said, fewer resources are available at night, like walk-in clinics and other social services.

    “But we could potentially verify the stability of the caller and provide medical advice or maybe a temporary solution overnight, and then set up followup the next day,” Webber said. "Again, potentially keeping from sending that ambulance to that call."

    The goal is to have the program 24/7 by late next year. But Xie said there is more to be done.

    “It’s a good start,” she said. “And it's good to celebrate it, but we shouldn't feel like we’ve made it to the end zone yet.”


  • 20 Sep 2023 1:11 PM | Matt Zavadsky (Administrator)

    Yet another challenge that continues to pile on to the “EMS Misery Index”….

    --------------------

    Scripps News Investigates: The deadly toll of a US ambulance shortage

    Aging and damaged ambulances are making it tough for emergency departments around the country to provide reliable service.

    By Chris Conte and Daniel Lathrop

    Sep 20, 2023

    https://scrippsnews.com/stories/scripps-news-investigates-the-deadly-toll-of-a-us-ambulance-shortage/

    Jennifer Cowan didn’t used to worry about breaking down. 

    When she became an EMT in Clay County, Tennessee nearly 20 years ago, she knew she could depend on the ambulance she drove to make it to any emergency call that came in.  

    But now, a nationwide shortage of ambulance chassis is leaving Cowan and other EMTs constantly worried about breaking down on the way to an emergency — or with a patient in back, when seconds often can mean the difference between life or death. 

    “I’ve broken down running an emergency with a patient in the back before. [You’re] worried about not being able to get someone’s child or grandma to the hospital because you don’t have an ambulance to get them there,” Cowan said. 

    She’s not alone. 

    Scripps News Investigates found local emergency medical services departments across the country that have been waiting years for replacements and repairs of aging and damaged ambulances.  

    “It’s always in the shop for something. We’ve been ready to buy a new ambulance for years,” Cowan said of her ambulance as she navigated the country roads in the rural part of the state. 

    How we got here

    The paint is peeling on some of Clay County’s ambulances. Maintenance and repair bills are piling up. 

    Nationally, the problem began in 2020 when the COVID-19 pandemic ground global trade to a halt, preventing automakers from getting enough of the microchips that are critical to making modern cars, trucks — and ambulances.

    Ambulances are made by a small number of specialized companies, which build them on top of bare chassis — the engine and frame of a truck — purchased from companies like Ford Motor Company and General Motors. 

    Vehicles using the components of those chassis continued rolling off the assembly lines during the pandemic, but in lower numbers than usual. 

    As the backlog grew, EMTs said they had more and more trouble with their aging vehicles. 

    In fact, in 2021 there were a reported 13,540 mechanical failures that prevented ambulances from responding, and in 2022 that figure climbed to 14,905, according to U.S. Department of Transportation data. That’s a 10% increase. 

    And, critics charge, automakers simply did not prioritize chassis for them over passenger trucks and other products analysts say are more lucrative than bare chassis. 

    “Our customers are in dire demand for ambulances. The fact that we know a lot of our customers are running ambulances way past their life expectancy, the reliability of products on the road is very concerning,” said Randy Smith, president of Iowa-based Life Line Emergency Vehicles. 

    Among the critics is American Ambulance Association president Randy Strozyk, who represents public and private ambulance service providers. 

    He’s frustrated that automakers and public officials haven’t heeded emergency responders’ repeated warnings.  

    “You would think we wouldn’t have had to jump up and down. This should have been an easy decision to make,” Stroyzk said. 

    Clay County’s aging fleet

    Clay County ordered a new ambulance in March 2022. But it still hasn’t arrived, and EMS director Andy Hall’s not optimistic. 

    “We are looking at our next ambulances five years down the road,” Hall explained. 

    Hall’s agency has four ambulances to cover a county that encompasses an area of 259 square miles.  

    The newest is a 2019 model, purchased and delivered before the pandemic. 

    The oldest is a 2010 with more than 235,000 miles on it — so many miles Hall had to get special permission from the state of Tennessee to keep using it. 

    And in Clay County, the situation is compounded by a larger issue in rural health care. Back in 2018, the county’s only hospital shut down, leaving this county of 7,555 people without an emergency room.  “We are their hospital, we’re their ER until we can get them to a facility,” Cowan said 

    In fact, the closest ER is now 20 miles away.  A typical round-trip call for EMTs lasts around 90 minutes. 

    That increases the chance that the oldest vehicles in the fleet will be put into use — and increases the chance that the newer, more reliable units will be tied up when a call comes in. 

    The new normal

    Meanwhile, in 2022 representatives of the nation’s ambulance operators, fire chief, EMTs and firefighters sent a joint letter to Secretary of Transportation Pete Buttigieg that called the situation a “crisis” and asked that DOT push ambulance makers to prioritize them now and in the future. 

    But a spokesman for Buttigieg said DOT lacks jurisdiction — and that its role enforcing safety and environmental regulations actually prevents the agency from pushing for changes in “production decisions.” 

    At Buttigieg’s urging, a White House task force on supply chain issues did examine the chassis shortage.  

    Automakers told officials that the supply chain issues preventing chassis manufacture have been resolved, said U.S. Department of Commerce spokesman Charlie Andrews. 

    A representative of Ford, the leading provider of chassis to ambulance makers, echoed that. 

    “From our vantage point, Ford is not the current constraint in the ambulatory supply chain,” spokeswoman Catherine Hargett said. “Beginning last year, we allocated more chassis to ambulance converters to address a vehicle backlog created by pandemic-driven supply chain issues and demand.”  

    But ambulance makers, EMS workers and fire departments interviewed by Scripps News said they still are unable to place orders for chassis in the volume needed to reach pre-pandemic needs — much less account for a two-year backlog. 

    Before the pandemic, Life Line made about 250 vehicles per year. The company should reach 220 this year, Smith said.

    But that’s nowhere near what’s needed by those using ambulances day in and day out. 

    “I’m not saying I want a year’s worth of chassis in two weeks but they have the ability to do that,” Smith told Scripps News.  

    Meanwhile, the people who put their lives on the line said their concern is not just the current backlog — but what will happen when another pandemic or disaster disrupts global supply chains. 

    “We want priority. We should’ve been able to raise our hand once and this was recognized,” said Stroyzk, the head of the ambulance association. 

    Other EMS officials say they see long delays as a new normal that agencies need to simply plan for. 

    “They are coming through, it just takes some time,” said assistant EMS chief Dave Edgar of West Des Moines, Iowa. 

    But back in Clay County, Cowan and Hall said they’re just hoping their time comes soon. 

    “Our hands are tied, there’s nothing we can do,” Cowan said. “We can’t help people if we can’t get to people.” 


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