FORT WAYNE, Ind. (WANE) — A nearly year-long staffing crisis is one of the reasons Three Rivers Ambulance Authority (TRAA) officials say the ambulance service has fallen out of compliance.
Since August 2020, the ambulance service has been out of compliance because of long response times. A cause of the long response times is the shortage of TRAA staff.
TRAA paramedics and EMTs who have spoken with WANE 15 describe the situation as “life or death.” Several say they respond to 10-22 calls during a 12-hour shift. During that shift, the medical professionals say they barely have time to eat, use the restroom or catch a breath.
During a July Fort Wayne City Council meeting, TRAA officials were called to speak on the state of the ambulance service. During the meeting, several council members pushed for a change calling for relief for TRAA paramedics and reduced response times.
However, during the meeting, there were several questions that were brought up but never answered. WANE 15 reached out to TRAA for answers and here is what WANE found.
Questions and Answers
How many runs do TRAA ambulances make daily? What type of runs are they? Is there a type of run that is most common?
TRAA ambulances responded to roughly 120 requests for service per day from January 1st – July 31st of this year. Of those 120 requests for service, approximately 69% originated through the 911 system, 13% are required medical transports to and from medical facilities, and 18% are urgent responses (Priority Six) with very low patient acuity of mixed types. Regarding TRAA responses by priority per day, the most common type of runs are non-life-threatening emergency (Priority 2) requests through 911, followed by life-threatening emergencies.
How many ambulances does TRAA have making runs in a 24-hour period?
TRAA uses a dynamic demand scheduling process whereby the number of active ambulances by day and by hour is based on anticipated volume as determined by thorough analysis of demand over time. In the Fort Wayne system, the number of active units increases through the late morning into the afternoon as demand generally peaks near early evening, and then resources typically decrease overnight as requests for service reduce. Pre-COVID, the average units in the early morning were six (6) ambulances building to an average of twelve (12) during peak hours. In June 2021, the average range of active ambulances was 5 to 9 units. Inconsistent demand trends and staffing shortages have made it difficult to maintain required resources recently not only at TRAA, but across the nation in the EMS industry.
How many times has another ambulance service been called to help TRAA? If so which services are most often called?
TRAA operations requests for mutual aid (i.e., requesting support from surrounding services) from January – June 2021 comprised approximately 2% of its total requests for emergency response through the 911 System. Of the total requests for mutual aid in this time period, roughly 36% of the requests were canceled by TRAA prior to the mutual aid arriving as TRAA ambulances became available. This resulted in less than 1% of calls in the City of Fort Wayne being transported by mutual aid.
Most Mutual Aid requests are made to Southwest Allen County Fire Protection District, New Haven Adams Township Fire/EMS, and Washington Civil Township. TRAA also provides Mutual Aid to the surrounding outside communities, typically at levels greater than our requests for mutual aid into Fort Wayne.
What should the run time for a call be in compliance?
We’ve heard several times over the past few weeks a dispatcher comes over the scanner and says ‘TRAA level 0′ Does that mean there are no TRAA ambulances available?
The use of the language of “Level 0” is established and recognized industry verbiage which acknowledges that, at the moment, all ambulances are currently engaged in work. Ambulances often become quickly available even in a Level 0 status due to a call finishing at a hospital, or a call being cancelled, which allows those ambulances to then respond on a timely basis. In cases where they do not, mutual aid is a standard practice in all ambulance services.
How is the tiered system going?
It is important to understand that until now, by contract, we were not allowed to incorporate a tiered approach into the Fort Wayne system. Now that we are able to utilize Basic Life Support (BLS) ambulances, there will not be as much strain on the system. Our ALS ambulances, which are staffed by two paramedics, will continue to take the trips requiring that higher level of expertise and equipment, however since many of the calls can be safely handled by a BLS unit, we can better utilize the staffing available to meet the demand with the tiered system.
The tiered system implementation began being phased in on August 2nd. The Collective Bargaining Agreement with our employee group requires that we allow for formal shift bid to BLS ambulances. We also must provide training approved by the TRAA Medical Director for the current and newly hired employees prior to making a full transition to this new structure. While we are currently placing BLS ambulances into the system when staffing configuration allows, we anticipate the first dedicated and scheduled BLS shift ambulances to be on the streets in early September.
This is a fundamental change to the system and we are pleased that our employees are embracing and supporting the addition of the Basic Life Support service.
Looking at the LifeCare Eligibility Map on TRAA’s website, what is the average time currently for an ambulance to get to some of the outmost townships?
TRAA does not receive frequent calls from the LifeCare membership in the outer townships and when we do it is typically through a request from a neighboring agency for mutual aid. Therefore, we do not have this information readily available.
Patient Care EMS Solutions is the corporate company behind the Three Rivers Ambulance Authority. According to their website, the company is the “leading provider of ground-based 911 ambulance services and other critical healthcare logistics solutions which has forged solid reputations in communities both large and small.”
Along with Fort Wayne, the company also has emergency ambulance services in Florida, Texas, New York, Mississippi and South Dakota.
WANE 15 reached out to the company to hear its response to TRAA falling out of compliance.
We are clearly experiencing compliance issues in TRAA as well as some of our other operations due to staff shortages. The factors driving the compliance challenges are not unique to TRAA or PatientCare EMS, as our industry, along with much of the healthcare sector, is struggling with staffing levels. Even before the pandemic, staff turnover was a sizable issue in the EMS industry across the country and since the beginning of the pandemic, the shortage of qualified staff has continued to worsen. We are working diligently to implement solutions and staff our operation with a workforce that will allow us to continue to serve the City of Fort Wayne at the highest level. We are also working with the Three Rivers Ambulance Authority to develop alternative approaches to delivering service that will improve our response times. It is our strong desire to provide the best in care to the citizens and visitors of Fort Wayne and across the country in our other operations. We will continue to strive to do that. If you would like additional perspective on the issues facing the EMS industry nationally, we would recommend reaching out the American Ambulance Association (AAA).Cyndy Stone, Patient Care EMS Solutions
TRAA officials are expected back in front of the city council in August or September to an update discuss their progress.