COVID-19 is pushing Fla. ambulance service to its limits and beyond
Fla. counties are launching new ambulances, using fire rescue vehicles to transport patients amidst, high volumes, hospital bypasses
Tampa Bay Times
TAMPA, Fla. — Spencer Wynn pulled the F-150 out of the Crisis Center parking lot and headed south on Interstate 275 through the heart of Tampa during the fourth wave of the COVID-19 pandemic.
His phone buzzed, and he calmly fielded questions from TransCare ambulance crews. Sometimes the 19- and 20-year-old emergency medical technicians make the 27-year-old supervisor feel old.
One crew was transporting a senior with a weak pulse and asked him how to proceed with her do-not-resuscitate order. Another reported their ambulance’s air conditioning was out.
The radio crackled constantly last Wednesday: Hemorrhage on Armenia, 22-year-old male; 61-year-old female with chest pain at the HART bus terminal; 72-year-old male with trouble breathing on Hillsborough at Nebraska Ave.
Wynn’s phone buzzed again. “St. Joe’s, crit-care bypass,” a voice said on speaker.
St. Joseph’s Hospital was not accepting any more ambulances with critical patients. Too many to deal with already. Please go elsewhere.
Hospitals have always been able to go on and off bypass, Wynn said, “but it wasn’t every day, and it wasn’t multiple hospitals. Now it is.”
Across Tampa Bay, emergency medical services — the call centers, fire departments and private ambulance contractors who treat and transport those who call 911 — are facing unprecedented call volumes of all types and making adjustments to cope as COVID-19 tips the system to its limits.
Wynn pulled up to St. Joseph’s and saw seven ambulances parked. Yes, that’s busy, but this was the new normal and far from the worst he’d seen, which was 18 ambulances. Another TransCare employee described seeing more than 20 outside a Tampa hospital recently, overflowing into the parking lot, with technicians and paramedics just waiting around.
“Those no-parking signs right here?,” Wynn said, pointing. “We do park there.”
911 calls overwhelm as ambulances wait
Officials in Hillsborough and Pasco counties said that handing off patients from an ambulance to a hospital is taking longer than ever due to already-busy hospitals now packed with COVID-19 patients and a shortage of nurses.
And while technicians and paramedics wait around, sometimes for two hours or longer, more 911 calls are coming in that they can’t get to. That could mean longer waits for people with emergencies where minutes count.
“Trauma, cardiac, stroke — the old mantra in medicine is time is muscle, time is brain,” said Dr. Charlie Sand, chairperson for Hillsborough’s Emergency Medical Planning Council, and director of Hillsborough Community College’s emergency medical training program. “With delays, people are potentially losing parts of their hearts, losing parts of their brain, losing limbs.”
One ambulance crew in Pinellas County described arriving at a hospital with a patient on a “sepsis alert,” a life-threatening condition that normally would get them seen right away. They stood in a hallway waiting with the patient for nearly 90 minutes.
This isn’t all due to COVID. Hillsborough County Fire Rescue Section Chief Jeremy Fischler called the call volume “unprecedented,” but said Hillsborough was already busy. The 911 call numbers have been rising for years due to an influx of new residents.
The county’s emergency medical services and hospitals have struggled to keep pace, he said, and there was little slack in the system for a pandemic.
“COVID is now exacerbating a problem that existed beforehand,” he said, “and maybe exposing it somewhat.”
Fischler recommends that people get the COVID-19 vaccine, “not necessarily to prevent getting the virus,” but to prevent the need for hospital care and to help take pressure off the system.
When a truck crashed through a Tampa Waffle House on Aug. 8 injuring five people, Wynn said things got so backed up there were no TransCare or Tampa Fire Rescue units available within the city limits for at least an hour. When that happens, the city calls on fire departments from neighboring jurisdictions to help.
In Pasco County, Fire Chief Scott Cassin said he’s concerned about how his system could handle a “mass-casualty event,” such as a larger accident or serious hurricane.
“If there’s a major incident,” he said, “that could be the call that tips the whole system.
“We’d handled the population increase fairly well, but you throw in COVID-19, and even if it’s just a 10 percent bump in call volume, it’s just enough that it puts everybody over the edge.”
Cassin said 911 calls are up 32 percent in Pasco County year-over-year. They’d expected a 10 percent increase. Last week, he went on social media to plead with residents to get vaccinated and to please not call 911 unless it’s a life-or-death emergency.
People are taking ambulances to the hospital for matters that could be handled by primary care doctors or urgent care clinics, he said. That includes people calling who have COVID-19, but aren’t experiencing an emergency.
Ambulance crews told the Tampa Bay Times they’ve transported COVID patients who were very sick, but others who had mild symptoms. Paramedics advise such patients that they may not need an ambulance, but they never deny anyone a ride to the hospital.
Some believe that going to the hospital in an ambulance jumps them to the front of the emergency room line.
“It definitely does not,” Cassin said, and less serious patients who arrive by ambulance are the ones who wind up waiting for hours.
The worst he has seen in Pasco was an ambulance waiting for seven and a half hours.
EMS scrambling for solutions
Pasco’s 911 call center now has an employee solely dedicated to monitoring hospitals and directing ambulances to the best option, though patients can still insist on going to the hospital they want.
Hillsborough has a new website that crews use to monitor which hospitals are on bypass, because it’s become so common. The county launched four new Fire Rescue ambulances last week to help with the load. And to meet staffing needs, they’re sending training officers and fire inspectors with paramedic certifications out on 911 calls.
Derrik Ryan, a fire captain and president of the Hillsborough firefighters union, said the county needs about 10 more Fire Rescue ambulances in operation.
Pinellas County has resorted to using Fire Rescue vehicles to take patients to the hospital.
Unlike other local counties, Pinellas County Fire Rescue rarely transports patients. But if the county’s ambulance contractor, Sunstar, gets overwhelmed, a rare emergency protocol known as Condition 3 Medical or “3M” is triggered.
Since late July, the county has gone into 3M nearly every day, with Fire Rescue transporting dozens of patients.
If the situation in Pinellas triggers an even more dire Condition 2M, as happened for several hours last week, it can fundamentally change the way paramedics work.
Historically, ambulance crews have stayed and cared for patients until they are off the ambulance stretcher and into a hospital bed, no matter how long that takes. They discuss a patient’s status with a nurse or doctor face-to-face.
But during 2M, ambulance crews that have waited 15 minutes with a patient who is stable are supposed to drop them into a waiting room, a wheelchair or an ER stretcher, and get back on the road. Instead of a conversation, they tag the patient with a written report and verbally explain the situation on a recorded radio channel before leaving.
On Aug. 5, Craig Hare, director of EMS and Fire Administration for Pinellas County, sent a letter to hospital administrators explaining the protocol. He noted the 131 bed delays that ambulances experienced the day prior, most of them lasting one to three hours.
“The delays are now tying up all ambulances and rescue units to dangerously low levels ... ,” he wrote. “EMS cannot allow all of our resources to be tied up at hospitals ... This affects our ability to respond to fires, rescue incidents and life-threatening emergencies.”
Hare also reminded them: “Leaving a patient at a hospital is not patient abandonment per the (Emergency Medical Treatment and Labor Act.)”
Ambulances in Pasco County are taking similar measures, leaving patients who aren’t severely ill in the ER waiting room with the walk-in patients.
Such unprecedented measures, said Dr. Sand, are being discussed nationwide in the emergency medical community.
Tough job of first-responders gets tougher
The job of first-responders is always fast-paced and high-stress, but current conditions are making it even more taxing, with fewer moments to catch a breath.
“I had a battalion chief tell me last week that our guys are eating dinner at 2 a.m. because they’ve been out all day,” said Ryan, the firefighter union president. “They’re not complaining — that’s part of the job — but it goes to show you our workforce is extremely stressed right now.”
In Pinellas, Sunstar ambulance employees have been required to work an extra shift each week for nearly a year to keep enough ambulances on the street. That is at least 108 hours every two weeks, though shifts can run longer if crews are held over to help with the next shift.
Employee turnover is always high at private ambulance companies, as many move on to jobs as firefighters or go to nursing school. But Sunstar field employees told the Times they’ve seen more colleagues than usual leave this year, burned out.
The company recently approved raises for all field employees and increased starting pay. Emergency medical technicians start at $39,491 with less than a year experience, and $43,439 with five years. For paramedics, it’s $50,428 and $55,461, respectively.
TransCare said the closure of local emergency medical technician schools at community colleges earlier in the pandemic had hampered staffing, and they are still catching up.
Wynn, the TransCare supervisor, started as a technician with the company. He likes the job despite the stress. He grew up playing baseball and found a similar camaraderie working on ambulances. The fast pace suits him.
The company will have to find a replacement for him soon, though. He’s finishing paramedic school at night and plans to join the fire department.
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