Across the nation, municipalities and private transport services have struggled to keep their ambulances staffed with Emergency Medical Technicians (EMT’s).
1819 News recently spoke to three fire chiefs in the Birmingham area to get their perspective on how this national issue is impacting their departments. Though interviewed separately, each chief shared a similar analysis of the problem, as well as their skepticism over finding short-term solutions.
Chief Gene Coleman, of the Center Point Fire Department, made it clear how dire the situation is.
“In terms of response times, we’re at a critical point now,” said Coleman. “It’s a state and national issue as far as the number of people coming into our profession is down and the demand continues to climb. It’s a serious issue.”
Coleman said the attractiveness of the job is also impacting the availability of needed EMTs. Industry leaders estimate there is a 30% shortage in EMTs throughout the state.
“There are not many people coming out of the paramedic schools,” Coleman said. “When I came out the class size used to be 40 people, now we’re graduating five or six per semester.”
According to Chief Buddy Wilks of the Cahaba Valley Fire Department, the extensive training required as well as the comparatively low pay, has made it challenging to recruit quality candidates.
“The issue we have is the training these guys are having to go through takes so long to accomplish and the money that they’re making is not commensurate with the work they’re putting in, so there isn’t a draw,” said Wilks.
According to the U.S. Bureau of Labor Statistics, the EMT field is expected to grow by 11% between 2020 & 2030, compared to an 8% national growth average for the same period. Additionally, the bureau reports the median annual pay for EMT jobs nationally is $36,650 per year, with 261,300 jobs. In Alabama, the annual median pay is $30,770, with 4,070 jobs.
With transport reimbursements beings capped, it makes it more challenging to pay EMT’s at rates that are consistent with the educational commitment and the challenge of the work. In Alabama, transport providers are reimbursed around $170 from Medicaid after transporting a Medicaid patient, according to Regional Paramedical Services, which handles many counties around central Alabama.
“We did a study in the states surrounding us,” RPS Director of Operations Eric Pendley told CBS 42. “Mississippi is at $385, Georgia and Tennessee are close to $400.”
Pendley said an ambulance company in Alabama can lose anywhere from $150 to $200 on each transport at Alabama reimbursement rates.
According to Chief Tim Love, of the Alabaster Fire Department, the private ambulance services are particularly affected by the reimbursement caps.
“Alabama has one of the lowest reimbursement rates in the nation on transport fees,” said Love. “It makes it really, really tough for them [private ambulance services] to be able to pay more, recruit higher, and still make a profit.”
Beyond staffing, all three chiefs said the biggest challenge facing ambulance services are the bottlenecks that occur in the emergency departments of hospitals, many of which are backed up to capacity.
“Where we’re getting hit is our trucks are getting stuck at the hospitals,” said Wilks.
“We’ve got to come up with a way to relieve the ambulances from being held up at the hospital,” said Love. “We have good days and bad days, but even on good days, the service level is not adequate.”
Wilks also explained how even though hospitals may stop accepting patients, they are still bound to deliver a patient if the patient insists.
“An issue we do have is hospitals can go on ‘diversion,’ meaning they can’t accept any more patients,” Wilks said. “Under state law, if the patient still says they want to go there, we have to take them.”
While staffing issues and bottlenecks at the hospitals are the dominant problems, departments are also facing the same price increases and supply chain delays as average consumers.
“We recently took delivery of a fire truck, which cost just under half a million dollars,” Coleman said. “If we were to replace that same apparatus today, it would cost $585,000. Same with ambulances. Last year, we purchased an ambulance for $170,000, today that unit would be $220,000.”
So, what are some ideas that could improve the situation?
“Of the things I wish we could get, one would be a non-transport protocol,” Wilks said. “Where we can say no. Is there a way where we could come up with a protocol where we can go in, consult with an ER physician where they can say, ‘No, you don’t need to go to the ER?’”
“There is going to have to be some changes in how we intake ambulance patients,” said Love. “Some better triage, the hospitals themselves are going to have to take on part of that load. We’ve thrown several ideas out there.”
Love said among other things, he would like to see organizations help pay for the education of first responders in order to get more young professionals involved.
“Notoriously, the state of Alabama hasn’t really put anything in to help with EMS or fire for that matter,” said Love. “The Alabama Department of Health, which manages EMS rules, tells us what we can and can’t do, but there is no education funding. There is no real collaboration between them and the hospitals on what is going to take place. Who tells the hospitals, ‘You have to find a way to get that patient off the cot so the ambulance can get back into service’?”
As the state’s population continues to grow and demand for emergency services continues to increase, more and more Alabamians may be asking the same question.
Post Script - Chief Coleman asked 1819 News to share the following message as a public service:
“The message I have any time I talk to people is prevention. Last year we had 96 fire fatalities in Alabama… Please encourage folks, install and test their smoke detectors. I ask that you let people know that smoke detectors save lives. We will come and install them. We make house calls at no cost.
“Car seat installations, encouraging folks to wear seat belts, call 911 if you’re having chest pains… Those things that can prevent the loss of life and emergencies are better investments than spending money in order to respond to these tragedies.”
1819 News will continue to follow this story. If you have experienced any significant delays in requesting ambulance service and would like to share your story, please e-mail the author at [email protected].