Rapid Response: EMS providers bear burden when leadership fails

What happened: The TransCare ambulance company, which is one of the major participants in New York City, 911 EMS system filed for bankruptcy on Wednesday.

The result is the immediate loss of 27 ambulances responsible for 81 daily shifts in the city. The liquidation is also resulting in the end of ambulance service in several communities surrounding NYC as well as Maryland.

The FDNY, aware of TransCare's financial problems, had a contingency plan ready and is immediately putting additional ambulances into service. FDNY is also calling on other hospital and third-party EMS providers to increase their ambulance staffing to fill the void created by TransCare.

Why it's significant: New York City is the largest EMS operation in the United States. Each day, FDNY, private agencies and hospital-based EMS services respond to 4,000 911 calls. The sudden loss of a major response and transport agency is likely to have significant impacts throughout the system.

The short-term loss of TransCare will be felt by FDNY EMS and other agency providers who will be asked to work more overtime and respond to more calls. Dispatchers may struggle to find ambulances available to respond to calls. It's also reasonable that patients will experience increased response times. With thousands of calls per day, we can be certain that a few patients with time sensitive, life-threatening problems will have potentially longer wait for needed care.

Meanwhile, 225 miles south, AMR is recruiting paramedics to respond to 911 calls assigned to them during peak demand times by D.C. Fire and EMS. This long-promised service improvement comes on the heels of the very public resignation and testimony of DCFEMS medical director Jullette Saussy.

Top takeaways: D.C. and NYC, as well as a Kentucky agency that announced layoffs this week, remind us that the delivery of EMS is tenuously balanced on a razor's edge between survival and failure. Many agencies, public and private, are under significant financial and operational stress. Here are my top three takeaways for EMTs and paramedics:

1. Your safety is number one.
Think of safety as more encompassing than physical safety at a 911 call. Your financial safety is critically important to your survival. Every EMS provider needs an emergency fund of at least $1,000 in case of sudden job loss. It's even better to have savings for three to six months of expenses.

2. FDNY needs to escalate operational changes.
The department is going to begin using SUVs to respond to calls during peak-demand times ahead of ambulances. In addition, FDNY is planning to staff additional ambulances with EMTs. Those service changes need to happen sooner rather than later.

As a department, 75 percent of responses are for medical incidents, but like many communities the high-volume of EMS responses is not reflected in proportional funding. Though not likely to change fast, FDNY needs to better allocate resources to its medical mission.

3. Opportunities abound in EMS.
If you are willing to relocate, there are a lot of opportunities. AMR is recruiting in D.C. and the ink was barely dry on the FDNY contingency plan order when AMR invited displaced TransCare medics to visit its job page.

EMS transitions are never easy. Our thoughts are with the former employees of Transcare and the communities they serve. ...

Posted by American Medical Response on Thursday, February 25, 2016

What's next: In the short-term, we can expect local media to be sniffing for sensational stories of people waiting for ambulances and emergencies that could have been responded to quicker.

I also suspect that politicians, officials and agency leaders will point fingers at one another, shifting the blame and shrugging responsibility, while the field providers on the streets get hammered with more calls, mandated overtime and the ire of an impatient public.

Further reading:

TransCare declares liquidation to New York City and Maryland assets

Increase ambulance service for less money

An open letter to the leaders of DC Fire and EMS

DC Fire and EMS: The shame of EMS

DC fire Lt. facing neglect charges skips disciplinary hearing

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