The largest private ambulance companies serving Clark County have been repeatedly late to high-priority emergencies this year, blaming slow response times on staffing issues as county officials mull taking action to address what one called a “fairly catastrophic failure.”
Ambulance delays have strained the resources of the Clark County Fire Department, officials say, and resulted in nearly a half-million dollars in penalties against American Medical Response and MedicWest Ambulance over a recent four-month period.
The issue was thrust front and center on Oct. 5, when county lawmakers decided that they would explore taking some territory away from the two ambulance operators, which are both owned by Colorado-based Global Medical Response, and potentially giving more to a third, smaller ambulance franchisee.
“If I have a family member or friend or any constituent who’s in need of (ambulance) service, and the response is not going to meet the required contractual obligation, it worries me for them,” said Commissioner Jim Gibson.
90 percent target
Under 10-year franchise contracts signed with the county in 2016, AMR and MedicWest must meet specific response times. For the most moderate to most serious emergencies, described as priority 1 calls, ambulances are considered on time if they arrive on scene in less than 12 minutes after being dispatched.
At a minimum, 90 percent of total monthly calls must be completed on time. Operators are evaluated monthly in each of their coverage areas. Both AMR and MedicWest cover two zones, handling roughly 83 percent of all calls among the three companies that serve the unincorporated county. The third operator, Community Ambulance, is responsible for the remaining volume.
Between April and July, AMR reached the on-time standard for priority 1 calls just once out of eight possible times, according to county-provided figures. For MedicWest, the target was hit three out of eight times.
The roughest month over the period was July for both operators, county figures show. AMR performed at 85 percent in its two zones. MedicWest hit 85 percent in one of its zones and just 82 percent in another.
Community Ambulance exceeded the target every time during the same period.
“Ninety percent should not be the goal,” Commissioner Michael Naft said. “Ninety percent is the low bar.”
Naft started the discussion this month not to “besmirch any one operator,” he said, but to raise alarm that the problem remains unsolved.
“To me, this is a fairly catastrophic failure,” Naft said.
Delays have occurred more frequently in the southwest Las Vegas valley, which falls within his and Commissioner Justin Jones’s districts.
Michael Johnson, regional director for AMR and MedicWest, insisted to the commission that the issue is one of understaffing and not underperformance, claiming that the operators have never missed a response or received a complaint about a patient’s outcome.
Amid an unprecedented staffing crunch, he said, the ambulance companies have taken steps to improve their pipeline of paramedics and were “very close” to solving the issue.
AMR and MedicWest are collectively down 40 paramedics needed to regularly meet on-time standards, according to Johnson, who said that 20 interns are in the final phase of their training and should be ready to come fully aboard within the next month or so.
But Johnson also said that hiring staff with unique skills comes with challenges: It requires a minimum yearlong training, there is a lack of education or training institutions in Southern Nevada and private companies often lose employees who are recruited by public agencies, including the county’s fire department.
“The bottom line is that the system demand continues to rise,” he said. “If we’re not effective at increasing the supply, we fall behind.”
Municipalities in Southern Nevada have franchise agreements with ambulance companies, too.
MedicWest is the sole operator in North Las Vegas. It missed its monthly 90 percent target twice in each of the two zones it covers from August 2020 to July, city spokesman Patrick Walker said.
Community Ambulance primarily provides nonemergency services to the city of Henderson and did not miss the monthly on-time benchmark over the same period, according to city spokeswoman Kathleen Richards.
AMR, MedicWest and Community Ambulance also serve the city of Las Vegas, along with a fourth operator. The city did not provide requested performance data by deadline.
Pandemic made issue worse
On Oct. 1, the American Ambulance Association and the National Association of Emergency Medical Technicians sent a letter to Congress, warning lawmakers that the “nation’s EMS system is facing a crippling workforce shortage” that has been building for more than a decade.
The pandemic exacerbated the shortage, with ambulance crews feeling burned out, and clinical and in-person trainings being halted for long periods of time, the trade groups wrote.
To address staffing woes, Johnson said that AMR and MedicWest have expanded recruitment across the country and the number of classes they offer, instituted mandatory minimum staffing and awarded bonuses and other incentives to employees for working additional hours.
Still, uncertainties remain, he said, including whether new federally mandated vaccine requirements for emergency medical services workers would lead to a significant drop-off of paramedics.
While the issue persists, county lawmakers have asked their staff to assess the ability of Community Ambulance to cover more territory if officials decide to remove at least portions of existing zones from AMR and MedicWest to provide relief to the two companies.
It is a recourse available to the county under the franchise agreements whenever an operator misses the 90 percent target in any four months during a year.
Burden to pocketbooks
In the meantime, the county’s fire department is feeling the strain. The department transports patients to area hospitals 250 times a year on average but it has already reached more than 411 transports for this year as of Oct. 5, according to Clark County Deputy Fire Chief Jen Wyatt.
Wyatt said she has instructed fire crews to keep watch for when private ambulances will be late or delayed and to then immediately call for one of the county’s rescue trucks in order to not hold up a patient’s transportation.
“(I) can tell you in the 20 years that I’ve been with the fire department, that I’ve never seen it like this,” she told the commission.
The county’s franchise agreements provide for costly late fees. From August 2020 to July, AMR and MedicWest were fined about $356,000 and $348,000, respectively, according to county figures. Community Ambulance, which handles less than 17 percent of franchisee calls, was fined roughly $13,000 over the same period.
The fees account for $10,000 penalties levied every month that an ambulance operator misses the 90 percent target. There are additional charges of $100 to $500 as well for each instance when an operator is excessively late to an emergency scene.
“I mean $100 is nothing; a person’s life is priceless,” Naft said. “So how do we solve this?”
Contact Shea Johnson at sjohnson @reviewjournal.com or 702-383-0272. Follow @Shea_LVRJ on Twitter.