Wake County (NC) EMS Battles Steep Rise in Calls, Staffing Shortages

Wake County EMS
Photo/Wake County EMS

Julian Shen-Berro

The News & Observer (Raleigh, N.C.)

(MCT)

Wake County EMS is experiencing an unprecedented growth in calls that is making some 911 callers in non-emergency situations wait longer for service.

The agency received over 11,000 calls in August, or about 360 calls per day, Jose Cabañas, the director of Wake County Emergency Medical Services, told county officials last month.

By the end of 2021, the county could receive 120,628 calls, the most in at least a decade and over 10% more than last year.

When a person calls 911, a dispatcher may send out different agencies depending on the situation. That could mean firefighters, police or sheriff’s deputies, paramedics and emergency medical technicians, or a combination.

From the JEMS Archives

EMS workers help respond to broken limbs, heart attacks, strokes and other medical conditions around the county.

Brian Brooks, spokesman for Wake County EMS, said increased calls are making some non-emergency callers wait longer.

When the system is under stress, a shift commander determines which calls need immediate response.

“We won’t send people to non-emergency calls when we’re low on resources,” he said. “We’re saving those units for emergency calls.”

Some callers can wait as long as two hours, he said.

“It’s a lot more complex than saying someone called with a sore throat, or someone called with abdominal pain,” Brooks explained. “It’s a difference between a 70-year-old complaining about abdominal pain versus a 25-year-old.”

Certain calls are never held, like those reporting shortness of breath, chest pain, stroke symptoms, a shooting or stabbing, or falling unconscious, he said.

But responding to more calls, with less urgent calls backing up, takes a toll on EMS staff, he said.

“Mentally, it’s draining,” Brooks said. “It’s very difficult for you to come to work for 12 hours and run 10 calls. It’s not something that anybody would want to do.”

Why calls are rising

Cabañas told the Wake County commissioners that several factors are driving the increase in calls.

“First, we’ve had more economic activity in the summer, given the (COVID) restrictions lifted in May,” he said. “More desire for people to be out in the community, which unfortunately sometimes requires EMS services.”

Also, many people delayed medical care at the height of the pandemic in 2020. “There were people who just flat out refused to go to the hospital because they were scared of catching COVID,” Brooks said. “Their situation obviously has gotten a whole lot worse.”

But in the majority of cases, he said, long waits for primary-care appointments are turning people to EMS.

“For somebody who is not feeling well, they’re not going to sit around for three months to see a doctor,” he said. “So they use the emergency room for that.”

“There’s a myth that if we take you to the hospital, you go directly to the ER, to the back,” Brooks explained. “It’s a myth. We put people in the waiting room all the time.”

Wake EMS is considering several ways of reducing the agency’s call load, including a potential nurse phone line that would take over calls and provide medical guidance in non-emergency situations.

Staffing shortages Wake EMS

Nationwide staffing shortages have contributed to challenges locally.

Nationally, nearly a third of EMS workers left their job in 2020 after less than a year, NBC News reported. Of those, 11% left within the first three months, the outlet said.

As of September, Wake EMS had 41 vacancies and another 49 virtual vacancies, meaning an employee who is on a long leave and unable to work, according to county data.

Those figures were down from the 68 vacancies and 58 virtual vacancies in August, but still up from the 29 vacancies and 31 virtual vacancies Wake EMS had at the start of the year

There are 495 total employees at Wake EMS, the county said last month.

Despite recruiting efforts and successful high school training programs, the county has seen fewer applicants, officials said.

And the pandemic has caused staffing shortages across many fields of medical care, Cabañas added

“What is unique and new is the fact that we’re now seeing active competition from non-EMS employers for EMS clinicians, to try to fill some of the gaps in other areas of the health care system,” he said.

Brooks said while staffing is low at the moment, Wake EMS had seen worse shortages in past years.

“Being short staffed in EMS kind of goes hand-in-hand,” he said. “People are starting to realize that things need to change, systems need to change, our processes need to change — because there’s no way that anybody can sustain what we’re going through right now long term.”

What this means for Wake County

The average time it took for an EMS unit to reach the scene of an emergency call has increased by roughly 90 seconds this year, or from 8 1/2 minutes at the start of the year to 10 minutes last month.

For non-emergency calls, that time rose from roughly 10 minutes in January to just over 12 minutes in September.

Nationwide, the standard for EMS response times is 11 minutes and 59 seconds, said Brooks.

But Brooks said Wake County focuses on outcomes, not how long it takes to reach the scene.

“If you’re having a heart attack, how long did it take us to get you to the correct hospital and up to the lab, versus how long it took us to get to your house,” he said. “That’s what we look at: Not necessarily the response time itself, but the time that it takes us to get you whatever intervention you need.”

Brooks said all first responders in Wake County, including police officers, sheriff’s deputies and firefighters, have been trained to the EMT level.

“They can stop you from bleeding and start CPR if you need CPR,” he said. “If you’re having an allergic reaction, the fire department is capable of giving you epinephrine, which is what’s going to save your life.”

Brooks said response times were far more important years ago, before all first responders had that training.

Now, it’s rarer that calls need an immediate ambulance on scene, except in cases of trauma like shootings, he said.

The average time it took for any first responders to arrive on the scene for emergency calls changed only slightly between January and September, remaining roughly 6 minutes.

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