The Buffalo News
BUFFALO, N.Y. — Buffalo Common Council members concerned about the response times of American Medical Response ambulances have gotten the attention of the emergency medical services provider.
In a letter to Council members this week, AMR Regional Director Timothy Frost outlined the company’s commitment to Buffalo, its investment in the city and the factors that can influence slower response times, such as staffing challenges, ambulance waiting times at local emergency rooms and too many calls for non-emergency needs.
Still, Frost said AMR Western New York’s response times “remain within industry standards.” From July 1, 2023, to June 30, 2024, Frost wrote, the average response time of an AMR ambulance to a life-threatening emergency in Buffalo was 9 minutes and 21 seconds. Meanwhile, the average response time to a non-life-threatening emergency in the city was 10 minutes.
In a follow-up interview with The Buffalo News, Frost acknowledged that there are some issues with delayed responses in the city, particularly for less medically critical calls.
“There’s not resources available for everything all of the time in that expedited, quick format,” Frost said, “and what I would actually double down and say is not all emergencies are created equal. There is a vast difference between a cardiac arrest and a stubbed toe, and I use the two extremes to kind of really emphasize the point that a majority, or a great deal, of what comes into the 911 system are not those true emergencies in which time matters.”
Every day in the city, there are about 40 “low acuity calls, many of which would be more suitable for an alternate transport solution such as Lyft or Uber,” Frost wrote in his letter to Council members. Those calls strain the system, Frost said, and redirect resources away from major medical emergencies.
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Frost’s letter, dated Monday, was in response to one sent July 18 by Fillmore District Council Member Mitchell P. Nowakowski to AMR. In his letter, Nowakowski noted some people in his district who have experienced a serious medical emergency have had to wait more than a hour for an AMR ambulance, if one arrived at all. In light of those concerns, Nowakowski requested detailed information from AMR on its average response times, as well as any shortages in staffing or vehicles that could be contributing to the delays.
The topic gained more traction through a resolution introduced on July 30 by Council President Christopher P. Scanlon. The resolution, which was approved by the Council that day, asked the Buffalo Fire Department and the Department of Finance and Administration to produce a report on the feasibility, fiscal impact and potential long-term cost savings for establishing an ambulance service within the fire department.
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In a statement Tuesday, Nowakowski said he has reviewed AMR’s response letter and the company’s “initial reaction to delays, response times and worker shortages.” He said he wants to better understand the underlying issues on worker recruitment and looks forward to examining that further.
The next chapter of this story will likely unfold Sept. 10, when AMR will present information at the Council’s Finance Committee meeting.
“I appreciate the beginning of dialogue regarding this matter,” Nowakowski said. “It’s a starting point of discussion for September’s committee meeting. ... I know the Council is eager to speak on how we can get the best service for the residents of the City of Buffalo.”
A complicated problem
The health care system is intricately connected, and just one issue in just one part can lead to problems in many other areas.
That applies to the world of emergency management services, too.
AMR responds to an average of 144 calls a day in the city, with about 40 of those – or more than one-quarter – low enough in urgency or priority that an alternative mode of transportation could be faster.
AMR, in partnership with the Buffalo Fire Department and the Erie County Health Department, responds to EMS calls based on a Medical Priority Dispatch System, with calls prioritized by severity of illness by the county Health Department’s Medical Emergency Radio System.
Frost explained that if an ambulance was on its way to a house for a stubbed toe, it could get rerouted if a more serious call came in for, say, respiratory distress if it’s nearby, or if the entire fleet is busy or tied up.
There are also challenges once the ambulance arrives at a local Emergency Department.
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When AMR delivers a patient to an emergency room, the ambulance waits an average of 46 minutes to transition the patient into the hospital’s care. If a hospital backup is particularly bad, an ambulance crew may have to wait more than four hours to offload a patient. At one point during the Covid-19 pandemic, Frost explained that one local hospital had a triage wait time of more than eight hours.
“We haven’t seen anything quite that bad in quite some time,” he said. “However, we still see some days where we are sitting for three to four-plus hours. And an hour-plus is more of a regular than it is an outlier.”
In his letter to Buffalo lawmakers, Frost explained that if those waiting times could be shortened to 30 minutes per patient, AMR could add about 75 ambulance hours a day back to local patients.
And just like the local hospitals, AMR and other EMS providers also are grappling with staffing challenges in what can be a high-turnover field.
In his letter, Frost said that the number of certified EMS providers in New York State is now less than 65,000, a drop from 80,000 just five years ago.
Frost said AMR has about 350 EMTs, paramedics, dispatchers and support staff serving Erie and Niagara counties, but the company “obviously needs more.”
“All of these things play together, creating this imperfect scenario in which we work within the confines of the system to try to meet the needs of, first, the most serious or the most critically ill,” he said.
An expired contract
AMR has been providing ambulance services in Buffalo since 2016 when AMR purchased Rural Metro Ambulance Co., which had won a five-year contract from Buffalo in 2015.
The company’s services agreement with the city expired Sept. 30, 2020, which adds another layer of complication to this situation.
Frost’s letter said AMR proposed a short-term extension to work toward a new agreement, but it received no response. Nowakowski’s letter, meanwhile, said the city’s contract with AMR was extended until March 31, 2021.
In August 2021, when Buffalo sought requests for proposals for providing ambulance service to the city, it wanted bidders to be able to have an ambulance on the scene of the highest priority medical emergency calls within nine minutes 90% of the time.
AMR submitted a response to the city on Oct. 1, 2021, and was awarded the contract, according to Frost’s letter. At the fire commissioner’s request, Frost said, AMR then drafted an agreement to start negotiations and sent it to the city on Oct. 15, 2021.
Since then, Frost said, AMR has not received any revisions or questions about the draft and there have not been any “substantive negotiations.”
“We have been, and continue to be, eager to discuss our shared vision for emergency medical services delivery in the City of Buffalo,” Frost wrote in his letter.
Those conversations might get rolling at the Finance Committee meeting on Sept. 10 . Nowakowski said he will be requesting that the fire commissioner attend the meeting and respond to AMR’s statement that the company received no response to its drafted agreement.
Without a contract, Frost said AMR and the city still communicate regularly, “but we’re not necessarily hitting at all cylinders on all people who need to be spoken to.”
Despite that, Frost said AMR has invested in its operations in the city. Since 2021, he wrote in his letter, AMR has invested more than $5.2 million to improve services in the city. That included replacing its fleet of 26 city ambulances with new Ford Transit ambulances, which was completed in 2023, and investing in its Earn While You Learn EMT Academy, which started in Buffalo in 2018 and last year created 65 new certified full-time EMTs.
“That is also kind of where we were trying to get to in our letter is to say, we’re not just sitting here doing nothing, going, ‘Woe is us,’ “ Frost said. “We are investing.”
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