KNOXVILLE, Tenn. — In late October, Knox County experts proposed giving American Medical Response the chance to continue serving as the area's EMS provider. However, that same group recommended changing the contract to boost the county's overall EMS system.
On Thursday the Knox County Commission, members from the mayor's office and representatives from the Knox County Health Department met to discuss the proposed new contract for ambulance services. Some of the people attending the workshop meeting said they were concerned about high response times in the area.
"I have two teenage boys. And the thought of a priority one call taking 20 minutes is very alarming," said Knox County Commissioner Kim Frazier.
Larsen Jay, a county commissioner, brought up financial concerns facing AMR's parent company — Global Medical Response. He said he isn't entirely confident the company can live up to Knox County's needs.
"I have grave concerns about where they are financially as a company, where their parent company is selling off different pieces, and how that might affect our service here. So, we're taking a leap of faith," he said.
Some leaders also said AMR is just one part of many growing concerns with Knox County's overall medial system. Jay said they wanted hospitals and first responders to join in on the discussion about how the system can be improved, instead of solely focusing on ambulance services in the area.
"This is a larger picture — the hospitals have to come to the table with the ambulance providers, with the fire departments, with Rural Metro and decide how are they going to get better," said Jay.
Leaders have debated and fretted about ambulance service in the county for months now amid concerns that there aren't enough crews to respond to demand, which has sharply risen in recent years, and crews are today often tied up at hospitals waiting to drop off their patients before they can go back in the field.
As county leaders looked for ways to improve the EMS system, a consultant prepared a report about Knox County's needs and demands on ambulance services. Fitch and Associates presented its findings this fall to the Knox County Commission.
It offered five major findings:
- The current county contract system is no longer feasible without subsidies or adjustments to performance expectations. Expenses have risen while revenues have decreased for AMR, the current vendor.
- Response times are equal when comparing suburban or city-center calls versus rural calls for service. Suburban and rural communities have extended response times. "In reviewing response time statistics and data, we recommend realigning response zones to provide equitable response across all areas of the County," Fitch recommended.
- Current wait times for ambulances to drop off patients at hospitals are excessive. They're what are called "wall times." Current times prevent any EMS contractor from being successful, according to Fitch.
- There is a lack of effective and transparent controls in the EMS system for monitoring operational and clinical performance. Fitch recommends Knox County require the vendor to have a software program that automates the process of measuring both clinical and operational performance.
- The so-called "Mission District" along Broadway north of downtown is the source of multiple, needless calls for service. WBIR reported on the topic this week. Also, many calls for service from the Mission District come from people who cannot pay. "Even though resources are limited in this district, it's advisable to assess the area for supplementary resources like alternative response units, mobile clinics, or other healthcare programs to help reduce the demand and burden on the healthcare system as a whole. It will take a multi-faceted and multi-disciplinary approach to reduce the EMS contractor burden. Furthermore, this will require the EMS Contractor, County and City officials, with many other healthcare and non-for-profit partners to support," the Fitch report said.
The Knox County Commission will bring up the new contract again during a Nov. 20 meeting. If they will then vote on whether to approve the contract on Nov. 27.