Can NEMT Companies Rescue the EMS System?

By Michael Shabkie, NEMTAC Founder

Emergency Medical Service (EMS) providers and local hospital systems nationwide are under tremendous stress due to severe staffing shortages and the ongoing pandemic. These challenges are the final moment of truth for an industry that has struggled with recruitment and retention of qualified first responders for decades.

In Massachusetts, the staffing shortages have crippled EMS systems statewide. The lack of ambulances has delayed the response to life-threatening 911 calls, as detailed in Boston’s NBC10 Investigators report, Delayed: Ambulance Response Times Suffer From EMS Worker Shortage. One worrisome data point noted is that there are 30% fewer ambulances on the road today than before the outbreak.

In Austin, Texas, the City Council directed the City Manager to develop a comprehensive Public Safety Vacancy Staffing plan due to the extended response times for all public safety agencies.

“Filling vacant positions that taxpayers fund should be an absolute priority of any municipal government,” said Councilor Mackenzie Kelly. “One of the core components of ensuring services are provided also is ensuring we have well-trained and well-rested public safety employees.”

Councilor Mackenzie Kelly
Councilor Mackenzie Kelly

Additionally, disaster response organizations are recruiting overworked EMS providers in Texas. These providers can earn 2-3 times more per hour staffing vaccination and testing sites, further draining the pool of available EMTs and Paramedics to staff fire trucks, ambulances and community paramedic programs.

Hospital Bed Delays Are Impacting Ambulance Availability

An alarming industry report by Page, Wolfberg & Wirth, Ambulances held hostage: Can the hospital make you stay?, reported that EMS personnel throughout the country are involuntarily held at hospital emergency departments due to a lack of available hospital beds.

For over a decade, ambulance diversion and delays have been a concern in many EMS systems. A California Hospital Association study involving 200 cities illustrated the impact of ambulance delays in the emergency department. During the reporting period, the time for handing off ambulance patients had doubled and resulted in a loss of nearly 5 million hours of EMS system productivity.

Although EMS systems have made tremendous strides to accommodate the increasing patient volume, problems like overcrowded emergency departments and lack of bed space persist.

As one EMS professional stated, “we are working a multi-casualty incident with limited resources every day.”

Inefficiency in Action: EMS Services in 2022

Finally, to exacerbate the current crisis, 911 systems still send the most expensive equipment (a fully staffed fire engine) and the costliest transportation model (a paramedic ambulance) to 911 calls. The ambulance is then used to transport the patient to the most expensive receiving facility (the Emergency Department). This inefficient combination of resources dramatically contributes to the ongoing personnel shortage.

As all these factors make clear, EMS systems nationwide are at their breaking point.

Integrating Alternative Transportation Resources into the EMS System

The Annals of Emergency Dispatch & Response estimated that as many as 56% of all Emergency Department visits could be avoided, with a potential savings of $38 billion to the healthcare system. These avoidable visits are almost all non-urgent cases. Simply stated, the way EMS providers respond to requests for ambulance transportation needs to undergo a complete overhaul.

Leading EMS systems and their local hospitals will never achieve a system that can handle the increasing patient volume without incorporating Non-Emergency Medical Transportation (NEMT) providers as an on-scene resource. Any other effort to improve bed capacity is merely a band-aid covering up the underlying wound.

As we know, patients calling 911 expect a rapid response from highly trained individuals to treat their ailments. The industry has done a terrific job in promoting the concept of immediate 911 access to the highest level of care. But unfortunately, public education on the “appropriate use” of the 911 system has not been our strong point.

Untapped Resources: NEMT Providers

Many innovative EMS systems are exploring alternative destinations protocols that ensure when a person calls 911, they receive the appropriate level of response, be treated appropriately, and then transported to the correct facility.

EMS leadership and their medical directors should also consider alternative “mode of” protocols that integrate the use of qualified NEMT resources within their communities. For example, local companies have fleets that can accommodate ambulatory, wheelchair passengers and those needing a stretcher for transportation to appointments.

If integrated into the EMS system, the resources could transport low acuity patients not requiring any level of medical care. In addition, transportation to their physician’s office, behavioral health clinics, Urgent Care facilities, or social service organizations located throughout their communities would now be possible.

Introducing NEMT transportation providers as alternative transportation modalities would provide immediate relief to be entire EMS system. Alternative transportation protocols that match the patient’s needs are both cost-effective and clinically sound.

The Medical Priority Dispatch System™ (MPDS®) establishes a universal standard for emergency dispatchers taking EMS calls. Utilizing this established standard to send the appropriate transportation resource will ensure callers receive the right level of care for their situation.

The concept of delivering an alternative to what is considered a “standard of care” can make EMS professionals and healthcare regulators a little nervous. However, it is clear that the current model of “you call, we haul” is inefficient, increases risk, and does not match the level of services required.

EMS providers throughout the U.S. have a strong history of providing selfless service to our communities. Now more than ever, we should become reflective, roll up our sleeves and evaluate how the 911 system delivers that service. By integrating local NEMT providers into the existing service model, the NEMT industry will serve as a desperately needed force multiplier to the 911 system.

Although the challenges faced may feel like the “perfect storm,” not all storms come to disrupt; some come to clear the path. Integrating NEMT providers into the 911 system is not an overnight solution, but with innovative strategies and responsible changes, our communities and the patients we serve will benefit enormously.

(Special thanks to Peter Hicks, President of Health & Safety Associates for his contribution to this article.)

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