Short staffing of Kentucky ambulance services leads to deaths

Dwayne Oliver of Lee County ends a hospital run. (Photo by Ryan C. Hermens, Lexington Herald-Leader)

Kentuckians are dying because their local emergency medical services can't find enough employees to staff the ambulances.

That's the upshot of a detailed story by Bill Estep in the Lexington Herald-Leader, which begins with the story of a Magoffin County man who died while waiting for an ambulance that took 45 minutes to arrive.

Lifeguard Emergency Medical Services spokesman Terence Ramotar blamed the delay on a staff shortage. Estep reports, "That is a problem in many parts of Kentucky and the nation, and it’s causing longer response times for some calls, according to EMS officials."

The ambulance had to come from another county because Magoffin has only two and both were on runs. "It’s not unusual for a rural county in Kentucky to have two ambulances on duty but for both to be tied up, forcing dispatchers to call for an ambulance from another county under mutual-aid agreements, adding to the time needed to respond," Estep reports.

"Without measures to get more people to train as EMTs and paramedics and stay in the field, the EMS system in Kentucky 'is in danger of collapsing,' Keith Sanders, head of the ambulance service in Edmonson County, told Kentucky lawmakers at a committee hearing in August."

The services "have struggled to recruit and keep workers, especially paramedics. There are a number of reasons," Estep reports. "The job can involve long hours and high stress, and the coronavirus pandemic of the last 18 months has made that worse, raising worries among EMS workers about getting sick or carrying Covid-19 home to family members, and forcing some to quarantine after being exposed."

Also, Estep writes, "The pandemic reduced the number of training classes in 2020, meaning fewer people in the pipeline. It can take up to two years to become a paramedic. Many rural services can’t afford to pay as well as urban ambulance services or hospitals, making it harder to keep paramedics.

"Ambulance providers said another factor is that Medicaid and Medicare, two primary payment sources for ambulance services in much of rural Kentucky, pay less for many runs than it costs to treat and transport patients. That affects their ability to pay paramedics and emergency medical technicians. . . . The shortfall is being met by ambulance crew members working extra shifts, sometimes 80 hours or more a week and often at more than one service, according to directors around the state."

Estep's story focuses partly on the performance of Lifeguard, a subsidiary of Global Medical Response, the world's largest medical transport firm. It also operates in Floyd, Pike, Knott, Leslie and Harlan counties. "Prestonsburg Mayor Les Stapleton, a retired state police officer, said Lifeguard has good professional staffers, but hasn’t had ambulances readily available in Floyd County at times," Estep reports, quoting him: “I’ve got people that have literally died.”

State officials have dealt with staffing issues by "allowing people with less emergency medical training to drive ambulances and waiving the recertification fee for trained EMS workers who had allowed credentials to lapse," Estep reports. But Michael E. Poynter, director of the Kentucky Board of Emergency Medical Services, told him that the pay issue needs fixing.

"Sanders, the Edmonson County EMS director, said many ambulance services can only afford to start EMTs at $11 or $12 an hour — less than some restaurants are offering these days." He asked at the Aug. 26 legislative hearing, “Why would you spend a thousand dollars to take a class to make $11 an hour when you can go serve fast food and make $15?” Ramotar told Estep that Lifeguard starts EMTs at $10 to $11.44 an hour and paramedics at $16 to $17.44 an hour.

Another financial issue is low Medicare and Medicaid reimbursements. Sanders said the average cost of a run for his ambulance service in Edmonson County is $880, while the average reimbursement from Medicare and Medicaid is $386, and the difference comes from taxpayer dollars.