Ambulance 'response times' miss the big picture: health outcomes

No one would dream of requiring that every patient seen in emergency rooms across our state is treated within 12 minutes.

Such a stringent and arbitrary requirement would be dangerous to those most in need of urgent attention and unaffordable if not impossible to implement. A broken arm is bad, but a cardiac arrest, stroke or bleeding from a severe motor vehicle trauma takes precedent. So, emergency rooms “triage” patients to determine an order of response. And we all accept that. Even if we don’t like sitting in the ER a little longer. We get it.

Yet, in 2023, that is how we continue to measure Emergency Medical Services and ambulance responses: How quickly was the truck there?

“Response Times” are the loudest complaint, both locally and around the country — regardless of whether a private or public ambulance is responding. Everyone is, understandably, mad the ambulance isn’t right here, right now. And in many if not most instances, the ambulance providers agree — they want to be on scene sooner.

But that system is showing its fragility everywhere.

A national survey of ambulance providers by the National Association of EMTs found 65% reporting a significant decline in job applicants compared to 2019. Over half of the news stories in local media across the nation are about shortages of paramedics and EMTs. Emergency 911 call volume in many jurisdictions is on the upswing, while the number of paramedics and EMTs is falling.

Ambulance providers are conducting their own in-house certification courses just to keep up. On the Mississippi Gulf Coast, one ambulance provider is recruiting and training students in high schools, showing them a pathway into a healthcare field that has a high demand for workers throughout the nation.

But it’s not just a paramedic shortage that is straining ambulance response. Ambulances are just the last domino in a healthcare worker shortage chain.

The ambulance you are waiting on is more likely than not already at an emergency room, waiting to unload a patient at an understaffed hospital. That hospital can’t find enough nurses to hire to care for those and other patients, meaning EMTs can’t transfer the patient in the back of their ambulance.

“Ambulance response time” is just the most public face of a national healthcare provider shortage that stretches back into hospitals, clinics and even some 911 dispatch centers that can’t hire people to answer the telephones.

Further, compounding this, our EMS system was built around a hospital system that is rapidly evolving. As more complex procedures are performed at fewer and fewer hospitals in urban centers, ambulances and their teams in the most rural parts of the state spend more time on the road, taking patients to and from those advanced hospitals, and less time in their home county waiting to respond.

Nobody should be faulted for wanting an ambulance at their doorstep within seconds of when they call 911, especially those facing truly severe illness or accidents when minutes and seconds will make the difference. That should be the goal.

To achieve that shared goal, communities around the country are rethinking Emergency Medical Services.

For example, there is a tiered ambulance response system where basic lifesaving (BLS) ambulances are used for appropriate 911 calls in addition to advanced lifesaving (ALS) ambulances. These BLS calls are determined by a trained and certified emergency medical dispatcher (EMD). Not only does this get the appropriate level of care to the caller, but it also allows ALS ambulances to be available for lifesaving calls.

These complex health challenges won’t be fixed overnight. Nor will they be cured by simply demanding a faster response. In fact, it may make things worse, incentivizing trip volume and truck speed over triage. In fact, simply demanding all ambulances drive faster can actually put more people in the hospital due accidents.

Ambulances today are intensive care units on wheels. They are extraordinarily expensive, staffed by dedicated and well-trained first responders who consider their work a calling, much like police officers and our fire fighters who are being trained and equipped to be a part of the chain of survival.

Let’s leverage telemedicine, let’s reward EMS responders for treating non-urgent medical issues on the scene (in consultation with a physician) and when appropriate let’s refer patients to a clinic during normal hours. Let’s use this moment to build a new, coordinated EMS system that can triage 911 calls and ensure the patients who need the quickest response can get it.

Counties, cities, hospitals, paramedics, EMTs and ambulance providers — along with insurers and healthcare payors – should use this moment to work together to build systems that focus on good patient outcomes: systems that get patients the care they need, when and where they need it. We should not simply turn up the stopwatch on a model creates a race to push everyone into understaffed emergency rooms.