News & Updates

Another example of how existing services models are not sustainable with skyrocketing costs of service delivery and historically low reimbursement rates, regardless of who the provider is, public, private, hospital-based, etc.

Community leaders need to be educated on the true cost of EMS service delivery, the cost differences based on service levels and provider types (public, private, 3^rd service governmental, hospital-based, etc.), decide what service level the community really wants based on the levels of investment needed for each level, and begin to fund EMS delivery the way other essential public services are funded.

Click here to view a recent webinar hosted by the Academy of International Mobile Healthcare Integration discussing costs and funding models based on service delivery levels.

This may be the latest, but it WILL NOT be the last!

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AMR to discontinue service in Youngstown

by: Jennifer Rodriguez, Megan Lee

Sep 14, 2022

https://www.wkbn.com/news/local-news/amr-to-discontinue-service-in-youngstown/

YOUNGSTOWN, Ohio (WKBN) – American Medical Response (AMR) sent a letter to the City of Youngstown Wednesday notifying the city that it will be discontinuing service in Youngstown.

According to the letter sent to the city, AMR will not renew its agreement with the city, and the current agreement will end on December 31, at 11:59 p.m.

The letter states AMR has been serving the city for over 30 years without any cost to the city or taxpayers. It also states that the company is not being reimbursed for medical calls.

“We have discussed throughout the last three years, the subsidy is needed to overcome inadequate Medicaid reimbursement which makes up a significant portion of our services and which is below our costs,” it stated.

It goes on to state, “The current Ohio Medicaid base rate for a basic life support emergency transport is $120 and has not been re-based by the state in years. When we treat and transport Medicaid patients, we are reimbursed far below the cost of providing service — approximately 42% of our cost. More than half our transports, or 54%, are Medicaid recipients.”

In April, Youngstown City Council voted down a $625,000 subsidy to “ensure continued EMS and ambulance services” for the city. All council members voted no except Third Ward Councilwoman Samantha Turner.

At that time, Fourth Ward Councilman Mike Ray said the door was not completely shut, but there were some details that needed to be worked out first.

We don’t know if that’s still the amount to keep AMR in place. When asked if the city should reconsider the vote, Turner said, “We should. If they’ll take it.”

Today, we asked several council members their thoughts on the notice and AMR stating they need more money.

“We asked admin months and months ago to go out for an RFP to see who else may be interested with that much money on the line, it’s only responsible of us to do that but the admin hasn’t done it, surprise, surprise,” said Fifth Ward Councilwoman Lauren McNally. “They are the largest EMS service in the country and I feel they are bullying us into a money grab since we have ARP money right now.”

“They are the largest ambulance company in the country, I feel like they are extorting us because we have some extra money now. I’m not sure what’s going to happen. My ultimate feeling is, have their services improved, what are they willing to give in return? Are they adding trucks, are we going to get better response terms, are the citizens of Youngstown going to be served any better because of the extra money? If not, what’s the point of payment? We can’t get or continue to get mediocre or bad service,” Oliver said.

“What we see in front of us doesn’t make sense to pass at this point, so we definitely wanna continue the conversation,” Ray said.

In January, AMR Regional Director Ed Powers used a computer presentation to explain the problems, saying while an average ambulance run costs about $300, Medicaid only reimburses the company $130 – a gap of 48%.

“Medicaid currently covers about 48% of our expense. We need another 52% just to break even,” Powers said.

“During that three years, we’ve explored all kinds of different models, trying to create a sustainable model. I mean, we knew five years ago that the model wasn’t sustainable,” he said.

Youngstown Law Director Jeff Limbian said the letter from AMR was not unexpected.

“The City of Youngstown, under Mayor Brown’s direction, has been to negotiate with AMR for many months now. Some members of City Council would like a more expansive analysis to see if there are other ambulance companies available to come into the city,” he said. “There is currently a request for proposals to determine if there are other interested ambulance entities. If that process does not produce an additional option, we anticipate that discussions will continue with AMR.”

According to Powers, AMR gave the city a 115-day notice to find new services. And if services aren’t found…

“Oh, it would mean a holy disaster to be perfectly blunt. We don’t anticipate that’ll happen. Mayor Brown is going to move heaven and earth to make sure that the citizens are protected. There will be ambulance service one way or another,” Limbian said.

Powers says the company hopes that the administration in Youngstown sits down with AMR to discuss any future plans or negotiations because he says AMR has invested a lot in the City of Youngstown.

“We actually hire residents off the street that are non-medical providers. We train them to be a medical provider and then give them jobs to work on our ambulances, and then they’re paying taxes to the City of Youngstown. So they’re… everybody here is invested in the City of Youngstown and nobody wants to leave,” Powers said.

Limbian hopes AMR will want to go back to the drawing board if the administration is unsuccessful in finding an alternative company.

“You know, it was a hard lesson for us to learn, to come to that realization, but now that we do understand that there just isn’t the money for them to make in the town the size of Youngstown with the volume that we have. So their requests are reasonable,” Limbian said.

The Youngstown Fire Department recently stopped using its fire trucks for emergency medical calls after it was determined what they were doing was illegal. The fire department needs what is known as “standing orders” from a hospital and is working to get them.

The Youngstown Professional Fire Fighters IAFF Local 312 responded to AMR’s announcement calling on city leaders to talk about the future of pre-hospital care for the city:

“Now is the time to address the inequalities that have plagued Youngstown for years. We are witnessing firsthand the ramifications of putting profits over patients. The citizens of Youngstown deserve access to basic infrastructure like public safety, which includes a sustainable, professional EMS system. The Youngstown Professional Fire Fighters urge the city leaders to finally recognize our abilities to help our citizens and negotiate the implementation of a first-class pre-hospital system.”

This action, while not unique as many providers have left certain communities, this is an interesting decision in a high-profile community to cease a certain service within the community. 

The wage pressures due to regulatory issues in California (fast food worker wages up to $22/hr.), the overall worker shortage, and the desire to seek generally higher reimbursement for emergency services, may all be factors that led to this action. 

This might be a bellwether for other providers dropping select services in some communities.  For example, like many physicians have, ambulance providers could elect to not provide non-emergency transfer services to Medicaid patients, while continuing to provide services for other commercially insured patients.

Imaging what would happen to a region’s healthcare system if all ambulance providers simply took the stand on low Medicaid reimbursement and said ‘no’ to any Medicaid, non-emergency transfer?  Or told the hospitals if they want the Medicaid patient transported, the hospital will have to pay, perhaps in advance, for the transfer?

If no provider was willing to provide non-emergency services for say Medicaid patients, does then the 911 safety net provider become the ONLY option?  Meaning, publicly funded agencies may then HAVE to provide the service if there is no one else?  What would that do to the availability of the 911 safety net system?

That might align incentives in states with ridiculously low ambulance Medicaid rates that have not changed in decades, to increase the ambulance rates.  Imaging the hospital association joining the state’s ambulance association to advocate for higher ambulance reimbursement rates.

Perhaps this same action could be taken for patients insured by commercial insurers who have a pattern on choosing to make surprise payments (payment less than perhaps a state required % of UCR, or % of Medicare), placing their members at risk for a high balance due to the surprise payment?  “I’m sorry, but ‘XXXX’ insurer is on our blacklist for surprise underpayments, and we do not want to put the patient at risk for a large out of pocket expense, so we are NOT going to provide the scheduled transfer”.  That, too, might send a very strong message to ‘XXXX’ insurance?

To some, it may seem harsh to deny non-emergency medical services to patients based on their who their payer is but hasn’t the U.S. healthcare system been doing that forever!?

AMR Letter Exiting NEM LA.jpg

Despite the intimation in the headline, the news report provides commentary on a federal report that reveals a small number of providers are likely responsible for the majority of potentially fraudulent telehealth billing, not unlike other aspects of the healthcare delivery system.

Reports like these will be crucial as MedPAC, HHS, Congress and states consider making payment flexibilities enacted as part of the PHE, permanent. The availability of telehealth has helped EMS provide enhanced services to prevent avoidable ER visits.

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'Guardrails' needed? Telehealth fraud cost Medicare $128M in first year of COVID pandemic, feds say

Ken Alltucker

USA TODAY

September 11, 2022

https://www.usatoday.com/story/news/health/2022/09/11/covid-telehealth-fraud-medicare-hhs/8013711001/

Key Points:

• During the first year of the COVID pandemic, 1,714 doctors and health providers billed Medicare nearly $128 million in “high risk” claims, according to a new report from federal investigators.
• Telehealth industry officials caution against creating “inappropriate barriers” to care, saying the report shows only a small number of providers engage in potential fraud or wasteful billing.
• More than 28 million seniors and disabled residents on Medicare accessed telehealth in the first year of the pandemic, an 88-fold increase from the previous year.

The federal government eased telehealth requirements at the beginning of the COVID-19 pandemic so more Americans could get remote care with fewer obstacles.

A report by government investigators last week found that more-permissive remote care has come at a price. During the first year of the pandemic, 1,714 doctors and health providers billed Medicare nearly $128 million in “high risk” claims, according to the Department of Health and Human Services Office of Inspector General.

Investigators said less than 1% of the 742,000 Medicare-certified doctors and other providers of telehealth services submitted roughly a half million problematic claims. Yet the billings are concerning enough that government investigators urged the Biden administration to tighten oversight to ensure millions of Americans can access remote care while safeguarding taxpayer dollars.

“We're really looking at practices that indicate a high probability of fraud, waste or abuse,” said Andrew VanLandingham, the HHS inspector general’s senior counselor for policy. 

The report comes less than two months after the inspector general's office alerted medical professionals about rising telemedicine fraud by companies that often pay kickbacks to doctors, labs and others to generate orders paid by Medicare and other federal health programs. Also in July, the Justice Department announced 36 people were charged for over $1 billion in health fraud involving telemedicine providers. Some were part of a telemarketing network that lured thousands of elderly or disabled patients to get unnecessary genetic testing or orders for medical equipment.

Medicare fraud, telehealth access and 'inappropriate barriers'

The latest inspector general report doesn’t address whether doctors or other providers intended to commit fraud, VanLandingham said, but the analysis suggests a high likelihood of billing abuses.

The report informs the Centers for Medicare and Medicaid Services, Congress and other stakeholders of potential ways a small percentage of providers are exploiting Medicare and suggests strategies to tighten oversight during the third year of the pandemic. 

The report also comes as Congress must decide whether to permanently extend pandemic-era telehealth rules that accelerated the use of remote care.

Telehealth industry officials say the report shows only a small number of health providers engage in potential fraud or wasteful billing. The officials also say decision-makers must evaluate the importance of convenient access for millions of Americans who get appropriate care.

“We want to make sure that in addressing concerns about fraud – as minute as that fraud might be – you're not erecting really harsh and inappropriate barriers,” said Kyle Zebley, the American Telemedicine Association’s senior vice president of public policy.

Before 2020, Medicare largely restricted telehealth to people who accessed medical care via video and audio connections set up in rural clinics. Amid the pandemic, Medicare allowed recipients in cities and suburbs to get care remotely, often from their home, via a phone call or a video chat. Medicare also more than doubled the types of services eligible for reimbursement

Medicare wanted to make it easier for people to get care without the risk of COVID-19 exposure during a visit to a clinic or hospital.

During the first year of the pandemic, more than 28 million seniors and disabled residents on Medicare accessed telehealth, an 88-fold increase from the previous year. Another inspector general report, also released last week, showed the expanded telehealth services reached more people in underserved populations and lower-income families eligible for Medicare and Medicaid.

The report did not identify doctors or hospitals that submitted claims investigators considered likely fraud, waste or abuse. However, examples included unnamed doctors who charged extra fees, billed the highest and most expensive level of care every time and submitted bills every day of the year.

Under Medicare’s fee-for-service billing, doctors are paid for the number of tests, procedures or other services they perform. And when patients require a higher level of care, reimbursement is more lucrative.

The report broadly recommended Medicare review the more than 1,700 doctors and providers suspected of abusive billing practices. Medicare also should crack down on a billing practice that allows lower-level providers such as physician assistants or nurse practitioners to bill Medicare using the name of a supervising physician. Billing using a supervisor's name existed before the pandemic, but VanLandingham said investigators are concerned such practices in telehealth could result in more subpar care.

"For oversight purposes, it's really critical for us to understand who was seeing that patient and where the physician was because that's how we can really ensure that that beneficiary is getting good quality care," VanLandingham said.

A 'facility fee,' double billing and other prolific charges

The report found hundreds of doctors inappropriately charged a "facility fee" while also billing for a telehealth visit.

Medicare allows a hospital or clinic to charge a facility fee when they host a patient who gets care from a remote provider – for example, a rural hospital that lacks a roster of specialists might connect a patient with a remote specialist located in a big city. However, a doctor who provides remote care isn't allowed to also collect a facility fee. Nearly two dozen doctors were prolific double billers, collecting a facility fee and a telehealth visit more than 1,000 times over the year, the report said.

Fiscal watchdog groups said the inspector general report points out potential problems Congress and Medicare must fix before extending the pandemic telehealth policies beyond the end of the public health emergency, now set to expire in mid-October, though it will likely be extended to mid-January. Congress passed a bill to stretch the relaxed telehealth policies five months beyond the public health emergency. Legislation pending in the Senate would continue the policies through 2024.

Josh Gordon is director of Health Policy for the Committee for a Responsible Federal Budget, a nonpartisan research group. His group released a report in April calling for safeguards to avoid unnecessary use, incentives, fraud and abuse. 

"If you set things up with the right incentives and the right guardrails from the beginning, it's a lot easier to get a handle on these programs over the long term," Gordon said. "If you wait, have it become very popular, very expensive, then it becomes much harder to go back and install guardrails or change the incentives."

AIMHI benchmarking reports perform a fundamental service to EMS leaders and local policy makers by demonstrating the clinical, operational, and economic outcomes of High Performance/High Value EMS (HPHVEMS), systems. These reports also demonstrate the innovation and system design changes that occur in these systems to meet the current challenges in EMS delivery and sustainability.

AIMHI’s goal in releasing this information is to ensure the progress and growth of the HPHVEMS model and expand the reputation and efficiency of EMS nationally and internationally.

AIMHI will be releasing quarterly reports on the member EMS systems that will highlight the demographic, clinical, operational, and financial outcome statistics of the nation’s highest performing EMS systems.  The data contained in these reports will demonstrates excellent clinical outcomes and proficiency, outstanding operational effectiveness, and exceptional financial efficiency.

This is the report you want to read if you want to know how your urban or suburban EMS system compares to these systems on key measures such as response times, cardiac arrest survival, cost per unit hour, cost and revenue per transport, and reliance on local tax subsidy.

Data contained in this quarter’s report includes:

• System delivery changes that have occurred in member service areas
• Medical First Responder (MFR) utilization
• Light and siren use by member agencies
• Accreditations by agency
• Service area information (population, size, response and transport volume)
• Response time goals and performance

Additional benchmarking reports will be released quarterly, to keep the information current, relevant and digestible.

Click here to download the Quarter 1 Benchmark Report

This is important information for all ambulance providers participating in GEMT programs.

Very specific communication by CMS and the CMCS reminding states that GEMT providers should only include costs directly related to GROUND EMERGENCY MEDICAL TRANSPORT services in their cost reports (i.e.: ‘Medicaid covered services’), and NOT costs that unrelated to covered services (E.g.: costs related to medical first response).

Here's the CMS Memo:

CMS Memo on Cost Allocation for GEMT - 8-17-22.pdf

This is stated in this part of the attached memo:

“Costs such as fire and rescue personnel and equipment are generally not directly or indirectly related to Medicaid covered services. As such, cost identification methodologies that inappropriately allocate costs associated with fire and rescue personnel and equipment to the Medicaid program potentially would be unallowable under the federal cost allocation requirements. For example, if state or local law requires that both a fire truck and an ambulance be dispatched to emergency scenes to transport a potential patient, even though the ambulance will be the only vehicle that participates in the transport of the Medicaid beneficiaries to a facility for treatment, only costs incurred in the provision of a Medicaid-covered service may be allocated to Medicaid.”

System changes like these are happening in many communities across the country.  

Transformative, patient-centric EMS systems are working with their medical directors and the community to analyze their patient outcome data and using evidence-based emergency medical dispatch systems to determine which types of calls truly need an immediate response, and which can receive a delayed response. 

This ‘Right Call/Right Resource’ helps preserve life-saving resources for the EMS responses they are needed and makes responses safer for the EMS personnel, and the public.

Among the more notable innovations, Mecklenburg County (NC) EMS (MEDIC) implemented a change last fall, extending the response time goal for low-acuity 911 calls to 30 minutes.  And, in March 2022, Colorado Springs, started a new program to not even dispatch fire engines or ambulances to low-acuity 911 calls anymore, they are sending EMTs in “medically outfitted SUVs” instead.

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Milwaukee private ambulance response times; new policy

The city doubled the amount of time allowed for private ambulances to respond to lower acuity calls. The old policy allowed 30 minutes to respond. It’s now a full hour.

By Cassidy Williams

August 28, 2022

https://www.fox6now.com/news/milwaukee-private-ambulance-response-times-new-policy

MILWAUKEE - If you need an ambulance in the city of Milwaukee, you could wait up to an hour. FOX6 News discovered a new policy that doubles the time allowed for private ambulances to respond to less serious calls.

FOX6 News first started asking questions when viewer Mike Reed reached out about his experience. On June 13, Reed called 911 for a friend who was going in and out of consciousness. FOX6 News filed a public request for the audio of that call. In it, you can hear Reed telling the dispatcher, "I just got here. The guy is on the floor, screaming. He lives by himself."

Reed says he was transferred to different agencies multiple times and had to wait on hold. In the end, he waited more than a half-hour for an ambulance to arrive.

"I could have probably put him on a coaster wagon and walked him to the hospital faster than the ambulance got there," said Reed.

While Reed waited, he dialed 911 and asked for a supervisor. FOX6 News requested the audio of that phone call, too.

You hear Reed tell the dispatcher, "This is just way over the top," to which she replies, "I'm sorry that you were transferred back and forth. Currently, yes. You're right. There are some flaws in the system."

FOX6 News asked Milwaukee Fire Department Assistant Chief Joshua Parish if he believed there were any flaws in the system.  Parish responded, "I would say a better way to categorize that is that it's a complex system."

How the 911 system works

Parish describes the system like this: When you dial 911, a dispatcher first makes sure your call went to the right place. That could involve some transfers, as cell towers do not always send calls to the correct agency.

Once the call is in the right place, the dispatcher starts asking questions. How the caller answers determines how the call is categorized and what happens next.

"We have over a thousand different call types," said Parish.

If a medical call is considered non-life-threatening, it’s called a "lower acuity" call. The Milwaukee Fire Department will then dispatch a private ambulance that responds without lights and sirens for safety reasons. It means they are dealing with the same things on the road as everyone else.

Bell Ambulance Director of Operations Chris Anderson took FOX6 News on a ride and explained some of the things that can slow them down.

"Well, trains are a big one. Draw bridges downtown," said Anderson.

Bell Ambulance is Milwaukee’s largest ambulance provider, although, these days, there isn’t much competition.

"The city of Milwaukee is 100 square miles, and we have, currently, just two ambulance companies covering that very large area of the city," said Parish.

Anderson says Bell is, on average, responding to twice as many calls per day compared to just a few years ago when there were four ambulance providers.

They are doing double the work with the same number of EMTs.

"We've pretty well maintained that number," said Anderson. "We've been having a hard time expanding that number."

Because of these challenges, the city made a change. On June 7, a new policy went into effect.

The city doubled the amount of time allowed for private ambulances to respond to lower acuity calls. The old policy allowed 30 minutes to respond. It’s now a full hour.

"I'm sure it's quite frustrating being the person waiting for the ambulance, but we have to do what we can," said Anderson. "We have to use the resources that we can in a system that keeps getting busier. We have to make changes."

Anderson says during the first two months of the policy, Bell responded to 2,600 lower acuity calls. The average response time was 16 minutes 33 seconds, but Bell did have to use the full hour on three occasions.

"Our goal is to treat those calls the same as every other call, which generally means 15 minutes or less," Anderson said.

Mike Reed's call

So what happened with Reed’s call?

The Milwaukee Fire Department dispatched a Curtis Ambulance, the city’s other ambulance provider.

MFD says Reed’s call was considered lower acuity, so his half-hour wait time was within the 60 minutes allowed.

Curtis did not respond to FOX6’s request for an interview, but we do know it was a busy day for first responders. Around the same time Reed was calling, two adults and a child fell into a drainage ditch after heavy rain.

"It's a very large city, and the things that happen in different parts of the city can affect different parts of the city," said Parish.

Reed thinks something needs to change.

"I just don’t want to see anyone else have to go through something like that," Reed said.

Anderson says Bell has been working closely with the Milwaukee Fire Department on solutions.

"It's been really collaborative, and it's been really great to see. I really enjoy working with those guys," said Anderson.

Anderson says things are improving, but the city simply needs more EMTs.

"I think we are in a good place. I think we could get to great," said Anderson.

Bell has hired a full-time trainer. September will be the first time they offer two concurrent EMT training classes.

This is very typical of what’s happening in many communities across the country, regardless of provider type… 

And, not surprisingly, people are not dying in the streets. 

Using effective emergency medical dispatch (EMD), low-acuity calls can be safely identified with appropriate response time expectations for the caller and community….

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Less serious 911 calls put on standby due to Durham EMS staffing shortages

August 2, 2022

By Monica Casey, WRAL Durham reporter

https://www.wral.com/less-serious-911-calls-put-on-standby-due-to-durham-ems-staffing-shortages/20400639/

DURHAM, N.C. — Less serious 911 calls in Durham are being put on standby, as Emergency Medical Services deals with a higher call volume and short staffing.

Just after midnight on Sunday, scanners captured this: No units available, and right now it's holding chest pain. Alpha response.

That low priority call was held for just over 13 minutes, until a unit was available, according to Durham EMS Chief Mark Lockhart.

Having no crews to respond - and leaving a less serious call on standby - is becoming more common.

"I can't say that it actually happens daily, but it is an almost near daily event," said Lockhart.

He says the issue is a combination of increased call volume, almost 9.5% over Fiscal Year 2021, and short staffing.

Out of 165 total positions, EMS currently has 22 vacancies: 5 are for EMT positions, and 17 are for paramedics.

Lockhart is hoping the profession will attract those with a desire to serve others.

"There are very few jobs I think where you can come in each and every day, and have the contact that we do with people, some of them experiencing perhaps their worst day, but at the end of the day go home knowing that you've made a difference," he said.

He believes the county's new thriving wage initiative will help with recruitment and retention.

"It looks like the average increase is 18%," he said.

Durham EMS also has to wait with patients when bringing them to a local hospital. That can take up to 30 minutes, delaying things even more.

Lockhart says low priority calls can be held from 10 to 30 minutes, but they try not to keep anyone waiting longer than that.

This is something we’ve really needed to address in our profession for a long time, with sadly little progress. 

During one of the great Pinnacle EMS sessions last week, an EMS chief from a major urban fire agency explained why they switched away from dual-role FF/Medics to flex-staff daytime ambulances in his department. 

He said that when they recruited for FF/Medics, the applicants all looked like the rest of the sworn department members, who did not look like the rest of the community. 

When they opened of the flex staffing to non-sworn personnel, the applicants looked more like the rest of the community.

It’s THAT kind of thinking, along with EMS agencies offering training scholarships for paid training and employment post-graduation, that may start to bend the diversity curve in our profession!

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From low pay to workplace culture, obstacles litter the path to diversity in EMS

By Akila Muthukumar

Aug. 1, 2022

https://www.statnews.com/2022/08/01/obstacles-litter-path-to-ems-diversity/

A single mother, Tashina Hosey quit her job at a Pittsburgh post office when she was assigned to work a seventh consecutive day just as her second daughter was about to be born. Desperate to find her next paycheck, she stumbled upon a free 10-week emergency medical technician course.

Called Freedom House 2.0, the program trains people like Hosey – unemployed, single parents, low income – following in the footsteps of the original Freedom House, a pioneering Pittsburgh ambulance service staffed by predominantly disadvantaged Black residents that was at the vanguard of efforts to modernize the delivery of pre-hospital care in America in the 1960s and 1970s.

Emergency medical services have since become predominantly white, as well as mostly male, in Pittsburgh and nationally. Programs like Freedom House 2.0 have sprouted across the nation in an effort to diversify EMS. As of 2000, less than 5% of certified EMS professionals were African Americans, and that proportion remained until 2017. As of 2019, it had increased slightly: non-Hispanic Black people accounted for 8% of EMTs and 5% of paramedics.

When the race of EMS crews doesn’t match the population they serve, studies show inequities in care proliferate – strokes are overlooked in Black women, and Black children are less likely to receive pain medications for long bone fractures. There are even differences in hospital transport destinations for Black and Hispanic patients in comparison with their white counterparts.

“A lot of those health inequities: stroke recognition delays, trauma care delays, and pain control differences, start to go away when you have a workforce that looks similar to your patient population,” said Ben Weston, medical director of the Milwaukee County Office of Emergency Management.

Yet the diversity efforts face big challenges. EMS is notorious for low pay, long hours, limited career-advancement potential, and high turnover; many services are staffed by volunteers looking for experience before going into firefighting, police work, or medicine. Gallows humor and bullying disguised as banter are part of the culture in many EMS workplaces, and in a 2021 survey, 61% of female EMS workers said sexual misconduct was a major issue in the industry.

During her 10 weeks in the Freedom House 2.0 program, Hosey woke up at 6 a.m. in her apartment on a street with nothing but a Rite Aid and “heavy, heavy, heavy drug activity.” She’d pack diaper bags, bottles, and leftover dinner for lunch before waking her children up from the bed she shared with them.

“They call it a two-bedroom but I’m gonna say it was one and a half because the other one was not possibly big enough to be a bedroom,” she said.

Battling heavy traffic in her white 2014 Chevy Malibu, she’d drop her kids off at daycare before driving to the Hill District to learn about injuries, medications, and triage skills from 8 a.m. to 4:30 p.m. five days a week. After retracing her morning commute, she’d finish errands and sometimes only begin studying at 11 p.m. Still, she loved ride-alongs and began to think being an EMT “is something I can do.”

Upon graduation, however, Hosey did not take the EMT licensing exam, even with the program covering all fees and offering a $250 stipend. In fact, of the 30 graduates from the first four cohorts of Freedom House 2.0, only one is an EMT. Of the 22 who are employed, 10 are patient care technicians, five are medical assistants, three entered other allied health fields, and three became community health workers, including Hosey.

“They were starting out at maybe $14 [hourly pay],” Hosey said. “With me being a single mom with two children and a car and rent and all types of bills, it just didn’t seem like something that would be beneficial to me. They do 12-hour days … it would have never worked.”

Instead, she helps other single mothers move out of mice-infested homes and navigate the intricacies of obtaining housing subsidies. The regular hours, remote-work option when her kids are sick, and increase in pay allowed her to purchase a 2,474-square-foot, three-bedroom home with a basement and attic – luxuries she never imagined having before Freedom House.

Before Freedom House, police officers and morticians used to transport patients, but the death of the Pennsylvania governor from a heart attack en-route to the hospital in 1966 cast a spotlight on avoidable deaths. In Pittsburgh, Freedom House saw an opportunity to improve care for its neighborhood while providing training and jobs for its poor, unemployed Black residents.

After completing a 32-week, 300-hour course, 25 paramedics previously deemed “unemployable,” most of them Black men, were assigned to two ambulances. They were pioneers of CPR, intubation, and IV administration in the field and helped pave the way for national standards for pre-hospital emergency care.

But within a few years, the city’s EMS crews became almost entirely white.

“EMS started in Pittsburgh on the backs of African American men and women from the Hill District,” said Sylvia Owusu-Ansah, the diversity and inclusion director of the National Association of EMS Physicians. “A new regime came in the early ‘70s that basically, through the acts of racism, eliminated probably the most elite, astute paramedics that were there at the time.”

The city terminated funding of the Freedom House service and built a new paramedic force from scratch. Driven by police officers eager to maintain control of ambulances, the Freedom House crews were split up, despite the city originally agreeing not to do so. Those with criminal backgrounds were fired or reassigned non-medical work, and tests on material they had not been taught were used to dismiss others. Their replacements were all white, and white employees with less experience began to take on leadership roles. By the late ‘90s, Pittsburgh’s paramedic program was 98% white.

Owusu-Ansah said the picture nationally is similar. EMS is clearly “very much an old boys club,” especially in EMS-fire services, she said. “I’m pretty much on the national committee of every EMS organization that exists out there, and over 90% of the time, I’m one of the few women, I’m the only person of color, and I’m the youngest person.”

Because EMS in most places is a part of the fire or police agency, it has a similar culture and draws recruits from the same pool of applicants. “There’s a lot of fraternity involved in the way of ‘my uncle did this’ or ‘my grandfather did this,’” Owusu-Ansah said.

Much like Hosey, Douglas Randell – now division chief of EMS in Plainfield, Ind. – was married with a young kid trying to “make ends meet” when he joined an EMT program through a scholarship for disadvantaged students.

“When you have the exposure of something generation after generation, it almost becomes an expectation that you follow the path,” he said. “For Blacks, especially in urban areas, we didn’t have that exposure.”

There is also a widespread perception that EMS is a part of law enforcement, and that deters Black applicants and others from communities that have long been victims of police violence. Meg Marino, director of New Orleans EMS, turned on her Zoom camera mid-interview to show how her uniform and badge look like a police uniform. Even small visual cues like wearing a pride pin or Black Lives Matter shirt can increase patient trust in EMS providers, she said.

While the paramilitary structure of EMS promotes organization and high performance, it comes with deep-seated cultural values such as not questioning authority and “toughing it out” that may also make the job less appealing.

“We can do all the recruitment in the world” but it is meaningless without changes to workplace culture,” said Jordan Rudman, a former EMT who is now an emergency medicine resident physician at Beth Israel Deaconess Medical Center in Boston. Referring to the hierarchical structure of EMS agencies and cases of sexual assault, he said, “It’s pretty hard for me with a straight face to say: come work here. It’s gonna be great.”

Hosey saw first-hand the difference a diverse workforce, and its absence, can make in the way patients are treated on ambulances in low-income neighborhoods in Pittsburgh. Once on a ride along, Hosey remembers the team visited a mental health facility that was “almost like a jail.”

“The guy we picked up was a Black guy and you can tell that he was suffering from some type of mental illness,” she said. “But they [the EMTs] chose not to listen to him. It was just like ‘shut up’ and ‘you don’t know what you’re talking about,’” she said.

“I wasn’t an EMT at the time so I couldn’t pinpoint what the issue was, but I was vocal about the way that they chose to talk to him,” she said, adding that the EMTs were receptive and apologetic.

Diversity can improve communication with patients, whose accounts are often as useful to ambulance crews as clinical examinations. A bilingual EMT can be invaluable, especially since translators are not practical given the need for speedy treatment.

Even without perfect provider-patient racial concordance, a more diverse workforce can indirectly benefit patients. Randell says conversations he has with white providers in the station – about barber shops, soul food, and his favorite TV shows – makes them a bit more comfortable with treating patients who don’t look like them.

“When we go into a house and it is predominantly Black, I am the lead person because I know the environment,” Randell said. When someone asks for albuterol for their asthma in a poor neighborhood, he says he has “a level of compassion” and is willing to believe they couldn’t afford to get it filled while someone without his background might think the patient is just abusing the system.

Alongside Freedom House 2.0, EMS agencies across the country – in New Orleans, Chicago, Milwaukee, Durham, N.C. – are implementing efforts to diversify their workforces, but it can be slow-going and providers of color feel the extra work of promoting diversity frequently falls on them.

With a million-person county, 125,000 EMS encounters per year, and 14 fire-EMS stations, Milwaukee’s service is one of the largest in the United States. In early 2020, it found that race and ethnicity status of patients was recorded less than 50% of the time, which made it difficult to study inequities in care. “The data was garbage,” said Weston, the county emergency management medical director. After making it a required field in the patient care records system, he said, the agency was able to identify and show providers specific disparities in patient care.

“It’s not just data from other systems, but showing that right here in Milwaukee County, our system also has disparities in how we care for patients,” Weston said. Rather than making blanket statements about improving patient care, this focuses the conversation on how to improve care for patients from disadvantaged racial and ethnic groups. The issue is framed at the population-level so providers don’t feel like their medical competence is being called into question, nor that they are being attacked for bias.

Joshua Parish, assistant chief of EMS in the Milwaukee Fire Department, said traditional recruitment efforts involve highlighting the job – the fires and trucks – at career fairs, which attracted people who were willing to commit immediately.

Now, when speaking with someone from an underrepresented group, he tries to “anchor our recruiting messaging in what my target audience already understands.” He asks people what they like in their current job, what differentiates a job from a career, and how money factors into their family’s current situation. He gives them time to think about the decision.

He’s hyper-intentional about visual images: a feminine silhouette or a child wearing a hijab on flyers, websites, and photos can serve as psychological cues for inclusivity “without having to say ‘we’re inclusive,’” he said. Younger firefighters – who have dreadlocks and cornrows and get their hair done – are serving as a recruiting tool for the next generation to enter into this space, he says.

EMS certification is equivalent to an associate’s degree, and Parish said learning so much content quickly can be a barrier to entering the profession. For non-university-educated students unfamiliar with anatomy, or without any exposure to Latin, making sense of medical prefixes is not easy. Parish worked on making the EMT curriculum more accessible to under-resourced students by finding ways to teach basic numeracy and health literacy.

“This is so much harder than I thought it would be,” he said. “I was sitting in some high school classrooms and I realized that that’s where the deficit was.” The training program started teaching students structured note-taking and implemented academic probation for those with less than a B average, which led to students seeking additional help; though labor intensive for the leaders, it was beneficial to push students.

Now, the firefighters he is recruiting and promoting are the most diverse the department has ever seen; over 50% of new hires in the last five years have been women and people of color, but it will take time for that diversity to be reflected in leadership.

“[People] who just got promoted today, that’s because I hired them seven years ago,” Parish said. “They’re going to be my cultural trendsetters. So it’s my job, when they want to do something out of the norm and they get crap from our old guys to go, ‘No, that’s cool. Let them roll.’”

Workers are evaluated using objective metrics like the speed and accuracy of taking patient vital signs, Parish said, as opposed to an officer “telling you that you did a bad job because they think you did.” He said he assigns the “old guys” to work alongside colleagues from different backgrounds — say, a younger woman of color. After a while, he added, the older workers will accept that “people who look like her and sound like her can be EMTs.”

In New Orleans, EMS Director Marino said her agency has blinded hiring decisions and promotion reviews in an attempt to overcome unconscious bias or overt instances of candidates being excluded because of an “ethnic name” on a resume.

She said she’s not deterred by pushback from some veteran employees. The old guys’ pejorative whispers about the “diversity agenda,” she predicted, will be phased out by a workforce that wants to include maternity pants for pregnant providers, ask questions about pronouns for trans patients, and make diversity a core part of their agenda.

This is a significant problem in many communities!

MedStar has several processes in place to prioritize 911 calls to help assure our emergent calls get the fastest response time.

Thankfully, our hospitals do a fantastic job NOT holding MedStar crews!

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Sunburn, a UTI and insomnia are some of the calls Douglas EMS gets, causing big delays for real emergencies

Some things people called Douglas County 911 for this week include a sunburn, UTI, and insomnia.

By: Dawn White

Published: July 31, 2022

https://www.11alive.com/article/news/local/douglas-county-ems-911-calls-delays/85-610697fe-6392-4068-b53a-abb30ddc8cfc

DOUGLASVILLE, Ga. — Emergency services throughout metro Atlanta are being stretched thin and making it harder to respond to those who need help right away.

Douglas County reports that its ambulances are having to wait at area hospitals for at least 30 minutes more than 500 times in both May and June. They report two reasons are behind this and are asking for people's help to improve public safety.

Responding to emergencies is where Douglas County EMT and firefighter Jordan Reid wants to be.

“We do love to be out there serving the community. It is frustrating to be stuck at the hospital and stuck not being able to serve the emergency calls that are coming in," Reid said.

Douglas County ambulances have responded this week to a variety of non-emergency calls.

“We had a young lady who was a newer parent whose baby would not go to sleep at about 3 o’clock in the morning, and she just couldn’t put the baby down," Reid said. "She didn’t know what to do, so she called the ambulance.”

“We’ve had everything from a sunburn to I can’t sleep to a UTI," Douglas County EMS Chief Stacie Farmer said.

Farmer said the problem isn't just responding to those non-emergency calls but also ambulances waiting at hospitals due to high call volumes.

“To turn that patient over is sometimes taking one, two, three hours," Farmer said. "A couple of days ago, [it took] five hours. The highest we’ve had is eight.”

Douglas County posted a public service announcement this week asking people only to call 911 for emergencies.

"We’re asking them to evaluate whether this is a true emergency or if there are avenues that are more appropriate," Farmer said.

Those avenues include telemedicine and urgent care, Farmer explained.

“If you have a situation that’s non-emergency that you’re using an ambulance for, that ambulance is not available for the other citizens in Douglas County," Reid said.

This isn’t just a problem in Douglas County. It’s a regional problem. DeKalb and Cobb counties said they're experiencing similar issues. Fire and rescue services in Clayton and Gwinnett counties said they'd get back to us, but we didn't get information on if they're seeing these problems by the time this story aired.

Boswell Fire Department ending emergency ambulance service Sept. 30

July 29, 2022

By David Hurst

dhurst@tribdem.com

https://www.tribdem.com/news/local_news/boswell-fire-department-ending-emergency-ambulance-service-sept-30/article_da7415d8-0ea2-11ed-a9b0-0b1268a6c2c9.html

BOSWELL, Pa. – Saddled by escalating costs, Boswell Fire Department is cutting its emergency ambulance service Sept. 30.

Fire department officials announced the move with a “heavy heart” Thursday, saying ambulance costs racked up a $150,000 budget deficit over the past two years alone.

That’s a massive sum for a department that operated on a $321,000 budget last year, including equipment, payroll, fuel and other costs, board member and financial secretary Jonathan Adams said.

“This isn’t something anyone wanted to do. But it was getting to a point our entire fire department’s reserves were down to months and weeks (of funds remaining),” Adams told The Tribune-Democrat in a telephone interview Thursday.

He said the division operated on a $121,000 deficit in 2021.

The fear is that if the department didn’t do something, volunteer fire service itself would be threatened, he said.

“Make no mistake, while the thought of not having a professionally staffed ambulance in our community full-time concerns us, the fear of not having a fire department in our community concerns us far greater. Without a “course correction” from our current financial state and trajectory, the possibility of completely shutting down both ambulance AND fire-rescue operations could be a very real scenario,” the department wrote on Facebook in a post to the community.

By announcing the move early, department officials are hoping to give nearby agencies time to research the idea of adding the Boswell area to their coverage zones.

The department’s ambulance division has a roster of 25 employees, including paramedics and EMTs who mostly cover shifts on a part-time basis in addition to handling calls for other departments, Adams said.

Boswell also serves parts of Jenner and Quemahoning townships.

Regardless of what happens, rest assured that an ambulance will be dispatched Oct. 1 – and beyond – through Somerset County 911 even after Boswell’s lights go dark, Somerset County Emergency Management Agency Director Joel Landis said.

It may mean an ambulance is traveling further to serve the Boswell area.

“But we have a system in place to send out ambulances when a call comes in from Boswell. It already works that way now when Boswell’s department is already out on another call,” Landis said, noting the next closest available would step in for that particular call.

“We’re saddened to see us lose another emergency medical service in the county,” he said, “but I can completely understand with the state of things the way they are. In today’s economy, it must be a challenge for every service to continue operating.”

Landis said the decision should serve as a reminder across the region that communities need to “gather around” the emergency medical service providers that serve the area and support them in any way they can.

“We’ve got to support them to keep them running,” he said, “so that we don’t lose any more.”