The Spokesman-Review, Spokane, Wash.
Facing an increase in call volume and shortage of staff, the city of Spokane’s ambulance service will now be allowed to give patients a ride without a paramedic on board.
The city amended its contract last week with American Medical Response, the private company that provides ambulance transportation to patients within city borders, to be able to respond to low-level calls without a paramedic.
The change is meant to reserve paramedics, who are more highly trained than emergency medical technicians, for emergencies that require more intensive care.
“It takes that load off those paramedic units and increases their availability without sacrificing patient care,” Spokane Fire Chief Brian Schaeffer told The Spokesman-Review.
It’s a reflection of the strain on all ends of the health care system caused by the COVID-19 pandemic, which has filled hospital emergency rooms, forced emergency responders into quarantine and isolation, and led to more ambulance calls.
In the city of Spokane, the Spokane Fire Department responds to emergency medical calls, but it relies on American Medical Response to provide ambulance transportation.
Under its original contract with the city, AMR provided only advanced life support service, meaning a state-certified paramedic would always be along for the ride.
Now, the company will be allowed to offer basic life support service for less severe emergencies, which are known in emergency responder parlance as “alpha” calls.
Spokane is hardly the first to implement such a two-tiered system. King County Emergency Medical Services already operates this way, sending basic life support crews to calls like those for a broken leg, while reserving paramedics for emergencies like a heart attack.
Still, it’s an adjustment for Spokane. The move was necessary because emergency calls are increasing while there aren’t enough paramedics to maintain the city’s usual level of service, according to Schaeffer.
“A steep rise in infections locally has led to oversaturated hospitals and radically increased call volume for ambulance teams,” Nicole Lee, a spokesperson for AMR, wrote in an email .
Hospital emergency rooms are frequently overburdened, often forcing ambulances to wait before offloading patients and returning to service.
“Ambulance crews encounter such wait times multiple times every day. Ambulances held at local emergency rooms cannot respond to other 911 calls,” Lee wrote.
The COVID-19 pandemic has not spared first responders. In a single week last month, the company had seven employees out due to COVID-19, and several of their coworkers in quarantine due to potential exposure, according to Spokane Fire Department leaders.
Hiring paramedics is a challenge, with agencies across the country competing with one another and offering incentives like sign-on bonuses.
If AMR hires a paramedic from out of state, it takes time for them to become certified in Washington. Emergency Medical Technicians, however, are easier to hire because their requirements are less stringent.
For now, fire department and ambulance service leaders believe the city can make this adjustment without patients noticing much of a difference.
“In fact, the provisions adopted by the City of Spokane will help to ensure those with conditions necessitating an advanced level of care could receive such on a timelier manner,” Lee wrote. “By allowing for use of Basic Life Support units to respond to minor medical need issues, we are increasing the availability of the Advanced Life Support resources.”
There is the possibility that a basic life support ambulance responds to a call that is believed to be of lower-urgency, only to realize at the scene that a paramedic is needed. This would increase response times.
“That is always a concern, but an outlier,” Schaeffer said.
But in order to keep paramedics available for acute emergencies, Schaeffer noted, changes have to be made to the system.
“We’re going to continue to send them to those emergencies, but we’re not going to oversend,” Schaeffer said.
Editor’s note: This story was changed on Oct. 12 to delete a reference to “Alpha” calls. The story incorrectly stated that American Medical Response ambulances in the city of Spokane are sent to Alpha calls, the lowest level of emergency. They are not.
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