Like many industries, ambulance services are facing a nationwide worker shortage. Increased turnover among paramedics and emergency management technicians (EMTs) has resulted in longer wait times for emergency ambulance services, and Ann Arbor is no exception. To address this issue,
Huron Valley Ambulance (HVA) provided the Ann Arbor Fire Department (AAFD) with its own ambulance last month. AAFD will have use of the ambulance for six months.
The idea of providing certain fire departments with their own ambulances is not a new one. HVA currently offers similar "safety-net" programs in collaboration with the city of Plymouth, Huron Township, and Monroe Township.
“Actually, we've operated what we call a safety-net program for many, many years, starting in the early '90s with one of our more rural fire departments. We gave them a safety-net ambulance,” says Karl Rock, HVA vice president. “We decided that it might be a good option for the Ann Arbor Fire Department.”
The basic life support ambulance has emergency communications capability, oxygen (both in the ambulance and a portable oxygen tank), a stretcher, an automated external defibrillator, and medical supplies, including bandages, splints, back boards, cervical collars, airway management supplies, and a rescue pump for administering CPR. AAFD firefighters assigned to the ambulance can take patients directly to the hospital or, if they are far from a hospital and the patient is critical, meet up with an HVA ambulance equipped with advanced capabilities.
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Huron Valley Ambulance vice president Karl Rock.
“If you have a critically ill patient that, for example, ... was hit by a car, they can load the patient in the ambulance and rendezvous with us,” Rock says. “Then we can provide that advanced life support in between where the incident happened and the hospital.”
Ann Arbor firefighters are licensed EMTs who are trained to provide basic life support. Previously, when responding to a call for help with an emergent health crisis, AAFD would dispatch a fire truck or its light-rescue vehicle. However, neither of these are suitably equipped for transporting a sick or injured person to the hospital. During the six-month trial period, AAFD can send its ambulance to the scene when HVA has no units available.
“In [the first half of] calendar year 2022, we have had 125 instances of HVA having over a 10-minute response time,” says Mike Kennedy, AAFD fire chief. “This [ambulance] will allow firefighters to transport a patient when an HVA ambulance is not available. The level of care and ability to provide care remains the same with this ambulance. The improvement is the ability to transport a patient in a timely manner to a hospital.”
AAFD began tracking delays in ambulance response times in 2019. The number of delayed responses rose from 121 in 2020 to 209 in 2021. The longest delay in 2022 was 45 minutes. Firefighters normally assigned to the light-rescue vehicle will staff the AAFD ambulance.
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Ann Arbor Fire Department fire chief Mike Kennedy.
“During this trial, each transport will be tracked to enable the city to determine the impact to fire department operations,” Kennedy says. “This data will help us to evaluate the success of the six-month trial without incurring the cost of an ambulance. Our ultimate goal is to get patients the emergency care they need and eliminate current transport wait times.”
Another benefit of the AAFD ambulance is that the AAFD fire truck will be available to respond if a report of a fire comes in while AAFD is responding to a health issue. Kennedy explains that once a fire truck has been dispatched to help with a medical issue, it must remain on the scene.
“If fire responds and we make patient contact, we cannot leave that patient until they're either transported or that patient decides to refuse care. So, one of the consequences is we'll have fire crews tied up on patients for an extended period of time,” Kennedy says. “If there's a fire in the city, these crews are unable to respond. … It takes our crews out of service for our primary mission, which is fire control.”
HVA will pay AAFD $125 for each completed ambulance transport. This offsets AAFD’s additional costs for staffing the ambulance. If the city of Ann Arbor decides to keep an ambulance after the six-month trial period concludes, AAFD will have to purchase its own at a cost of $300,000. If independently licensed as a basic life support transport agency, the city would be able to bill its ambulance transports independently.
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Chris Roy and Danielle LaLonde with an HVA ambulance at Ann Arbor Fire Department Station 1.
Kennedy says the EMS system is “absolutely broken” due to worker shortages. While the loaned HVA ambulance is a good stop-gap measure as far as meeting Ann Arbor residents' needs, long-term strategies are needed for increasing the number of EMTs and paramedics. Currently, becoming a paramedic requires the same education as is needed for an associate’s degree in nursing.
“If somebody can make tens of thousands of dollars more a year and work in an ER or a hospital in a nice climate-controlled environment with regular hours versus go be a paramedic, there's not much of a decision point there,” Kennedy says. “Option A is to pay paramedics more. Option B is to look at eliminating things that are currently in the paramedic curriculum that are well beyond the scope of what paramedics are doing on a day-to-day basis.”
Meanwhile, HVA is looking to expand collaborations in all of the 14 counties it serves.
“We're willing to collaborate,” Rock says. “We're always looking to what else we can do to better serve the communities that we operate in. We will partner with fire departments or any other stakeholders in delivering the best care possible. That's ultimately everybody's goal — getting care to those that need it in a timely manner.”
Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.
All photos by Doug Coombe.