The Critical State of Ambulance Response

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By Doug Marrin, STN Reporter

Dexter Area Fire Department Chief Robert Smith recently gave a sobering assessment of the current state of medical emergency response in the area.

Speaking to the Dexter City Council at its December 13, 2021 meeting, Chief Smith responded to questions regarding the diminishing ability of ambulances to respond to medical emergencies. The queries were prompted by a Sun Times News article reporting on Chelsea Area Fire Authority Chief Robert Arbini’s comments to the Sylvan Township Board. Arbini explained how a critical staffing shortfall at Huron Valley Ambulance (HVA) dramatically affects medical emergency response.

See article: Chelsea Area Fire Authority is looking to address a pressing issue

In response to everyone who asked him if the same problem impacted the Dexter area, Chief Smith replied, “Absolutely, yes.”

To help put the situation in context, Chief Smith briefly explained the background of ambulance services. Unlike police and fire services, he pointed out that no state or federal law has ever mandated ambulance service as essential to a community. When the ambulance companies first appeared, their primary mission was to transfer patients from one medical facility to another. That history evolved into becoming more and more involved with the fire service for onsite medical treatment.

In Washtenaw County, ambulance services are primarily regulated by the Medical Control Authority (MCA). The MCA requires ambulances to be staffed with two paramedics for emergency response and transfer.

“Right now, because of that requirement, the ambulances are having trouble hiring people to staff,” said Chief Smith. He referred to the Sun Times News article stating a Vice President of HVA was reported to have said the company is currently short-staffed by around 300 positions.

Chief Smith stated there has been a move afoot across the country for the past decade to get away from private ambulance services and return to fire department EMS response. This would position EMS as an essential service provided by a government entity.

HVA currently responds by getting an ECHO Unit onto the scene quickly. This is one paramedic who can begin providing medical care, usually arriving at the same time as the fire department. A second ambulance then arrives with two paramedics, meeting the MCA patient transportation requirement. It’s the second transporting ambulance that has been problematic, explained the Chief.

“With the current shortage o personnel, they can’t put enough ambulances on the road,” said Smith. “We’re seeing response times from a transporting ambulance of ten to fifteen minutes. That’s a long time in the EMS world. We like to get people off the scene much faster than that. Our response time requirements as an essential service are four minutes. So, it’s really created a problem.”

Chief Smith went on to say that in some cases where the patient could not be stabilized until transportation arrived, the fire department has driven the ambulance with the paramedic in the back with the patient.

A provision in the MCA requirement of two paramedics does allow for emergency transport if the ambulance is going to be more than ten minutes out. As a result, Chief Smith reported that patients have been transported on fire trucks and in police cars. Staff cars have also been used.

“One fire department even called Uber to transport a patient, and that was in the City of Ann Arbor,” he said. “That’s how drastic the problem has gotten with the ambulance service in Washtenaw County.”

Fire departments are scrambling for solutions. CAFA has purchased two rescue squads, which will respond with the other vehicles. The fire department will be ready to transport if no ambulance shows up. “It gets around the requirements of MCA, but it's not a done deal. That’s still a huge fight,” says Smith.

Another idea being bandied about is allowing fire departments to use the unused HVA vehicles just sitting around. This involves a lot of red tape over who is qualified and licensed to operate these vehicles, provide emergency services, and how many of them need to be on board for a run.

“As far trying to get those ambulances in and working around the MCA requirements, we’re working with them,” says Chief Smith. “It’s not an easy fight right now.”

As to the root of the decimated staffing problem, Chief Smith points to funding, specifically training, wages, health benefits, and retirement benefits. It’s a problem that response services, public and private, have dealt with for years, but like many things, the pandemic has made it much worse.

“This problem is not going away,” said Chief Smith. “It’s just going to get worse and worse and worse. That’s really where we’re at.”

Photo: Doug Marrin

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