Photo: stockbusters / iStock / Getty Images
The problem with the ambulance might not be the ambulance.
In Rochester, City Hall and the first-responder community are looking for solutions to lingering problems of slow response time and unanswered calls by its contract ambulance provider, AMR. Social media tracks in real time firefighters and police officers caring for patients as they wait for an ambulance to show up, and as calls are eventually released to mutual aid, leaving the critically sick and injured to wait while a town or volunteer ambulance comes from across the county.
Adding to the foment was the mysterious decision of the city government to recently release – at 6:16 on a Saturday night – an analyst’s report on ambulance service which had been kept under wraps for 11 months.
Clearly, this is an issue coming to a head.
And my suggestion is straightforward: Have the Rochester Fire Department take over all emergency medical services in the city. Let them be RFD ambulances and let the people working in them be members of the Rochester Fire Department.
I say that because of my high regard for both the Rochester Fire Department and the medics who work for AMR. The RFD does things right, and medics – who get poverty wages and wreck their bodies – deserve the stability, respect and compensation working for the city would bring.
I hope that happens. It will accomplish much good.
But it won’t solve the problem.
Because the problem with ambulance availability and response in Rochester arises from issues outside the ambulance fleet. The problem isn’t the ambulances or their management, it’s the people and the hospitals – and maybe a little bit of state law.
Delayed ambulance response is a function of ambulance availability. The ambulance doesn’t come because there isn’t an ambulance that can come. And that’s not really because there are too few ambulances on the road; it’s because the ambulances are being delayed by the hospitals and misused by the public.
First, the public. Ambulances and emergency departments are used by many Rochester residents for primary health care, the way most people use their family doctor. Coughs, colds, aches – things that might necessitate a phone call or maybe a visit to the doctor’s office for most people – are instead a 911 call and a trip to the hospital. With Medicaid picking up the bill, or nobody paying the bill, there is no downside to the patient for misusing the system, and the problem keeps getting worse.
Many ambulance calls in Rochester don’t need to be ambulance calls, but they are. And that taxes the system, wasting crews and equipment, and making them unavailable when real emergencies arise.
And then, the hospitals. When an ambulance takes a patient to the emergency department, there must be a transfer of care, it’s not just a drop off. And the ambulance can’t leave – and return to service for new patients – until it is released by the hospital.
That can take a long time.
The emergency department is choked with patients – many of whom really shouldn’t be there – and it takes nurses and doctors time to get to new non-emergency patients coming in on ambulances. For all of that time, those ambulances are out of service and their communities are uncovered.
That’s why the lots outside emergency departments are choked with ambulances, and that’s why response times can be so long on urgent calls.
And none of that has to do with the ambulances themselves.
If every AMR ambulance was replaced with an RFD ambulance today, nothing would change, because the wasting of this precious EMS resource would continue just as it does today.
So what should be done?
First, try to change patient behavior. Try to make the community understand the ambulance is for real emergencies. Possibly even impose some kind of fee that actually has to be paid for non-emergency ambulance use. But don’t hold your breath. Neither of those things are apt to happen or work.
Second, create some sort of fast handoff situation at the emergency departments. Maybe ambulance crews could pass patients to hospital paramedics, who will maintain and treat patients until emergency department nurses and doctors are free, releasing the ambulances to return to duty.
And finally, adjust state law to allow ambulances to deliver patients to urgent cares and after hours. If a situation is relatively minor, and can be attended to by the staff of an urgent care facility, far better for all concerned if the patient goes there – instead of to an emergency department, as is mandatory now.
I believe those are the solutions.
Yes, I want the Rochester Fire Department to take over all EMS in the city. But fixing the problem will take more than that, because the AMR and its crews aren’t causing this problem.
The patients and the hospitals are.