Paramedics can make more money bagging groceries

Ambulance service state of emergency

EMTs/Paramedics attending to emergency call in O.B.
  • EMTs/Paramedics attending to emergency call in O.B.

In October 2015, American Medical Response acquired Rural Metro, one of the largest emergency (ambulance) providers in the nation. In October of 2017, the medical response company renegotiated with the City of San Diego a rate increase for the cost of transportation. According to one emergency medical technician willing to speak anonymously, “To say it’s a mess in an understatement.”

“The city fire department has been sending two engines/trucks to all medical calls that don’t have a medic unit assigned.”

“The city fire department has been sending two engines/trucks to all medical calls that don’t have a medic unit assigned.”

The mess referred to is a lack of available ambulances, overworked employees, and long delays in transporting victims to the hospital, while also creating a shortage of fire engines and emergency personnel in some areas.

“We are playing Russian roulette with our citizens,” Todd Barry told me. “I just wanted to bring this to light. It needs to be heard and [American Medical Response] needs to be held accountable.”

Barry has been a firefighter for 30 years, 15 of those years out of the Ocean Beach station, and a paramedic 10 of those years.

Data separated by San Diego County ambulance-response zones indicates that the average offload time for San Diego County in total is 28 minutes

Data separated by San Diego County ambulance-response zones indicates that the average offload time for San Diego County in total is 28 minutes

“To make up for the shortage [of ambulances], the city fire department has been sending two engines/trucks to all medical calls that don’t have a medic unit assigned,” he explained in early January. “The impact is huge for the fire department, and for the citizens of San Diego…. [American Medical Response] ambulances use fire stations to do crew changes, but once their shift starts you never see them back at the station; they run non-stop…many of their paramedics are overworked, doing 12-hour shifts running from call-to-call. The last thing you want is tired and overworked paramedics transporting you to the hospital…. I have no idea why this is happening or know when it will stop. One call is too many not to have an ambulance available.”

In December of 2016, NBC 7 San Diego investigated “level zero” — when no ambulances are available for 911 emergency calls — and noted that American Medical Response missed the city-mandated response times in six of the eight medical-response zones in San Diego for the month of October (2016). The company was fined $291,000.

From January 1, 2017, through June 30, 2017, AMR/Rural Metro accrued non-compliance penalties in the amount of $75,500.

On January 22, 2018, an ambulance driver in Indiana was killed after falling asleep and crashing. “It’s just a matter of time before it happens here,” Barry says.

I spoke to multiple American Medical Response employees. Employee One, explained the situation: “We have multiple ambulances shut down — at least 20. It’s gotten to the point where they’ve actually cut multiple ambulances out of the system, leaving us very short staffed. I think we are 31 or 32 medics short…. Add to that, call volume is up — 911 calls have increased significantly and it’s having a domino effect on everyone.... We’ve had patients on the gurney sitting in front of the hospital for up to four or five hours because hospitals don’t have any beds to move them to.”

(Employee One noted that life-threatening injuries “are pushed forward” and don’t have to wait on gurneys.)

This wait time is officially referred to as “off load” time. According to the San Diego County Transfer of Care report, dated December 2017, data separated by San Diego County ambulance-response zones indicates that the average offload time for San Diego County in total is 28 minutes, with 53.6 percent of patients offloaded in under 30 minutes. American Medical Response has an average offload time of 35 minutes.

“[American Medical Response] can’t even get people to apply for jobs anymore. Paramedic pay starts at about $14 an hour; they can make more money bagging groceries at Costco…. There are two shifts, 12 hours and 24 hours…. It’s to the point where we start our shift and may not see the station [for breaks], rarely sleep, have no chance to even eat…. We get no breaks and literally run from one call to the other.”

Employee One took an informal survey among coworkers and found that out of the 200 responses received, only 12 of them said they have not worked while sick or injured. “We have crew members working sick, working hurt…working 36, 48, 60, and 72 straight hours with little breaks. We have 20 paramedic units they don’t have staffing for. Response time for us should be 12 minutes, but if you were to call 911, it could take 25 to 30 minutes to get to you — if you’re having a stroke or cardiac issue, or you were hurt significantly where time is critical, you may not make it to the hospital....

“Everyone that I know is starting to look for jobs elsewhere. They keep pushing the crews, who are at their wits’ end…. I’ve been doing this for 21 years and have never seen it this bad. For a municipal system, it’s so backward at times we can’t even get supplies…. I actually carry a cache of hidden supplies so I can take care of my patients; they run out of oxygen almost weekly.”

Another emergency medical technician, Employee Two, told me: “I wouldn’t want to call 911 with this system, I love my job…been with Rural since 2012, but even working 80 hours a week, I still wasn’t earning enough, so I cut back my hours and got a second job. Like I said, I love being an EMT, but with the hours and pay, it’s not attracting new hires.”

“The situation is beyond belief,” another ten-year veteran (Employee Three) told me. “The [emergency medical] system in San Diego is so broken.... I can literally pick and choose what shifts I want to work because they are so understaffed…. Last weekend [January 28th] there was only one ambulance available — almost every weekend is like that…units are pulled from North County to cover calls in downtown San Diego.”

In December 2017, attorneys from Pope, Berger, Williams & Reynolds began meeting with emergency medical technicians to represent them in a lawsuit that’s been filed in the U.S. District Court (Southern District of California). Plaintiffs contend that emergency medical technicians working for Rural Metro Ambulance et al. (including American Medical Response) were not given ten-minute rest periods, as required by law, because “they were not relieved of all duties at any time during their shift.” It is alleged “that ambulance-crew members were on call during their entire shifts and that they were required to keep their pagers and radios on at all times and to comply with 60- or 120-second ‘out-the-chute’ times upon receiving a service call.”

A hearing is scheduled in federal court on March 16 to determine whether the case will be classified as a class-action matter.

“This is the worst I’ve seen it in five years,” Employee Three added. “There are less ambulances on the street than there were five years ago. It’s mind-boggling what’s going on, and the citizens of San Diego should be informed of this…. On a side note, we just had a second EMT have to be treated for irregular heartbeat because of drinking energy drinks just to function at work.”

On February 2nd, a fourth emergency medical technician messaged me: “It is horrible today. We are responding from Scripps La Jolla to the airport and another unit was responding from Rancho Bernardo to the Border…. Don’t get hurt or sick right now, it’ll take a long time to get an ambulance…. A lot of us are afraid to talk about it because we love our jobs and don’t want to be fired.”

Asked for comment, Madeleine D. Baudoin, American Medical Response’s government and public affairs manager responded, “We are working diligently to recruit more employees and bolster our ability to add staff. So far this year, we have hired 21 caretakers into the City of San Diego system, including eight new paramedics and 13 EMTs with more to follow.”

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"Paramedic pay starts at about $14 an hour," but the excuse AMR used to renegotiate the contract is that they had "implemented the City's Living Wage"?! This is what happens when the city doesn't foster competition and instead awards a monopoly based on campaign kickbacks rather than service provided. Upper management is making a killing (literally) overcharging patients and underpaying employees, and it's time to announce this deal DOA.

I wonder if the ace parking mafia has a few fingers in the amr business ?

"Paramedics can make more money bagging groceries"

But they don't. They don't want to bag groceries, they want to be paramedics. So do hundreds or thousands of others. There is no shortage of people willing to take the training and the job, hence wages are low. Maybe if 95% of them said eff this, there'd be a shortage and wages would go up.

I get it... they're "heroes". They should make a lot more. But who should pay? "Not me!", right? "I already pay too much for insurance and prescriptions and doctor visits!"

The problem is when you equate the training and responsibility of a grocery bagger to a paramedic. If you want minimum wage level experience and performance, then that's what you'll get. However, if you consider the provision of EMS as an "essential service," like police and fire, then you need to make it part of that same public service model that is provided by governmental agencies, such as the FD, or as a "third service" (EMS) by the local government. Do you want someone at your door in less than 10 minutes after dialing 911? Do you want someone who can properly asses your condition and treat it while you are being transported to the appropriate hospital? Or do you want someone who feels as though they have chosen a career that gives requires a high level of critical thinking and decision making, yet doesn't provide enough to pay a decent living, so they look for opportunity elsewhere?

Your statement about "if 95% of them said eff this" is true because they should...but if they did go on strike, what would you say to them then? That they "abandoned" the people they chose to serve? That they were being "greedy"? That there is "no shortage of people willing to take the training and they job"?

The problem is the for profit contracting system. City (Fire Department) Paramedics make decent wages and benefits and provide service at no profit. Cities contract to AMR and their ilk to provide all or part of the paramedic services to "save money". The only way contract ambulance service providers can make any money is to cut corners and reduce wages/benefits. The money to pay the top company management has to come from somewhere and they always come from out of the employees pocket.

One of the basics of capitalism: buy low and sell high.

Haaahaa...yes, and when it comes to city/county government..."just give it to the lowest bidder..."

Nothing new....this is the way it has been since the 1980s when the privatization of EMS became a "cost cutting" method of providing services. The only way around it is to place EMS transport back into the control of the FD and operate a two-tier EMS system with BLS ambulances staffed by EMTs and have the medic on the engine accompany the patient only when necessary. That would allow EMTs to work for the FD and make a decent wage/benefits, and provide a career ladder where they could eventually become a medic/FF and transfer to an engine or some other assignment within the FD. Or provide a one tier system where the medics are placed on the ambulance and would not tie up the engine for most calls. Either way, you have to stop using a private ambulance service to provide what most people consider to be an essential service (Police, Fire, EMS). The city could charge for transport to recoup some of the cost to provide the service, and you would no longer have a private entity to deal with.

I worked as an EMT for 7 years while I worked on my RN degree from 1988-1995 for Hartson Ambulance, before it was acquired by AMR. Trust me, the only people getting paid a decent wage are the fat cats in the head office. It was a fun job at times. In fact, for the most part, I loved it. But they did work the crews like dogs. However, most crews were idealistic, and the EMTs I worked with all dreamed of being firefighter/paramedics, which is the only way to make a decent living wage in EMS. I went in the other direction and became an RN. Being a provider in the medical field is a completely thankless job. The only thing one gets out of it is what they put in. I can tell you the vast majority of calls we ran were non-emergency calls, such as hospital transfers, and bogus 911 calls from street people who were trying to scam drug prescriptions from hospital ERs, and scoring a gurney and a meal for the day. Or they used ambulances as free taxi services to get from neighborhood to the next. I don't mean to make it sound like all the calls were of this nature. But the 911 EMS system, and the Medicaid benefit are abused on a daily basis around the country, which is just a couple of reasons the system is so messed up. I could go on for hours documenting some of the nonsense I had to put up with, but the bottom line for me is, if you choose to do this job, find a way to make it work, or quit and go something else.

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