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Copyright © 2019 Albuquerque Journal
“Level Zero” is the phrase at the heart of a legal fight between Albuquerque Fire and Rescue and privately owned Albuquerque Ambulance Service over the city’s proposed expansion of its authority to have AFR rescue units transport patients to the hospital.
In most cases, AFR rescue units stabilize patients on scene and Albuquerque Ambulance then takes them to the emergency room – allowing the Fire and Rescue units to return to service for new 911 calls.
When Albuquerque Ambulance has no units able to respond immediately to 911 calls, its dispatchers announce “Level Zero” over the radio.
The sharp uptick in “Level Zero,” the city says, shows the ambulance service doesn’t have enough staffed units deployed and translates into AFR rescue units spending too much time waiting at a scene for Albuquerque Ambulance to show up and transport a patient.
Albuquerque Ambulance, part of the Presbyterian Healthcare Services system, says the city’s concerns are overblown.
But no one disputes the system is under stress as 911 calls for nearly every type of medical emergency – ranging from overdoses to chest pain to shootings to “down and out” on a sidewalk – have increased. Last year, Albuquerque Fire and Rescue responded to more than 96,000 such calls.
The city, which contracts with Albuquerque Ambulance to provide transport services for most 911 medical calls, is asking the state Public Regulation Commission for a certificate that would allow Fire and Rescue to transport all emergency patients to local hospitals.
In its request for full transport authority from the PRC, which regulates ambulance services statewide, the city says that in 2012 Albuquerque Ambulance was at “Level Zero” 379 times. That number jumped to 2,472 in 2016 and 3,024 in 2018.
Albuquerque Ambulance is fighting the city’s request. It says the city is overstating the problem and that an announcement of “Level Zero” by its dispatchers can last for as little as a few seconds until an ambulance is available to respond to a call for service. The ambulance service admits it has had a chronic shortage of paramedics to staff ambulances but is upping salaries and has increased recruitment efforts.
Scott Kasper, who heads Albuquerque Ambulance Service, told the Journal that the company “transports nearly 99% of patients who require emergency medical services in the metro area. As such, we believe an additional certificate of authority for (city) emergency transport is unnecessary and remain committed to the cooperative emergency response that we already deliver alongside Albuquerque Fire Rescue (AFR).”
The city counters that even with its limited ambulance certificate, issued by the Public Regulation Commission, rescue services are being hamstrung by the Albuquerque Ambulance’s inability to respond to all calls in a timely manner.
“With a full authority certificate from the PRC, we can ensure no interruption of services,” said Deputy Chief Emily Jaramillo.
Under a contract to supply emergency transport, the city has set response times for the various levels of medical emergencies for Albuquerque Ambulance to meet. And in some cases the city has fined the ambulance service $20,000 a month for failing to meet those standards.
The PRC has scheduled three days of hearings on the city’s request beginning Nov. 12.
“Across the nation, the need for EMS has expanded and many municipalities rely on private ambulances to provide these services,” Jaramillo said. “When these private companies cannot meet the needs, it is up to the local jurisdiction to ensure medical services are still available.”
Two-tiered response protocol
For almost 50 years Albuquerque has had a system that calls for a two-tiered response when a medical emergency call comes into the 911 dispatch center.
The call is forwarded to an Albuquerque Fire and Rescue dispatcher who follows an approved protocol to question the caller to determine the “acuity” of the call. The most serious calls, including things like trauma and possible heart attacks, are considered priority one.
The city dispatcher then radios a call to both the nearest AFR rescue unit and Albuquerque Ambulance.
Depending on the seriousness of the call, Albuquerque Fire and Rescue can send a rescue unit with paramedics or an engine manned by emergency medical technicians (EMTs).
A rescue unit is always sent on priority one calls.
AFR rescue units and Albuquerque Ambulance vehicles are both equipped to transport patients, but engine units are not.
Under its contract with the city, Albuquerque Ambulance is supposed to respond within 10 minutes for a priority one call, 12 minutes or less for priority two, and up to 28 minutes for a priority three.
When a patient is determined by paramedics to be in “critical” condition, Albuquerque Fire and Rescue is required to transport the patient as quickly as possible regardless of whether the ambulance service is on the way.
City rescue units are also allowed to transport patients if Albuquerque Ambulance is delayed, if the patient is an on-duty city employee or a member of Albuquerque Fire and Rescue or immediate family.
Albuquerque Ambulance claims the city would dismantle this two-tiered system if granted full transport authority by the PRC.
The city says it wants to be able to transport when Albuquerque Ambulance can’t respond or is late responding to calls.
The ambulance company has had serious staffing problems according to its own testimony.
In the last year, Albuquerque Ambulance has had 45 unfilled but budgeted paramedic positions. Kasper said as a result of pay raises and out-of-state relocation bonuses that number has been reduced to 30 unfilled positions.
Kasper also said in testimony there are limits to the number of hours paramedics can work without suffering fatigue and impaired decision making.
Even in the bland Public Regulation Commission filings, it is apparent both sides are unhappy with each other.
City rescue officials say they can’t get answers from Albuquerque Ambulance to simple questions like how many units are available in the city to transport patients on a given day.
“AFR (Albuquerque Fire and Rescue) knows that AAS (Albuquerque Ambulance Service) does not have enough units deployed due to its chronic inadequate response times,” Albuquerque Fire and Rescue Battalion Chief Chris Ortiz said in testimony.
Albuquerque Ambulance’s Kasper testified, “AFR’s inability to articulate what it wants to do with unlimited authority, is frankly, very frustrating for AAS (Albuquerque Ambulance Service).”
He said that if Albuquerque Fire and Rescue began transporting more patients to hospitals, too many rescue units would be tied up in transports and waiting at hospitals for patients to be admitted.
The priority level of a medical emergency call is decided by an Albuquerque Fire and Rescue dispatcher after questioning the 911 caller about the nature of the emergency.
Priority 1 Calls – Shooting or stabbing victim(s), accidents with major injuries or cardiac arrest, victim not breathing.
Priority 2 Calls – Traffic accident with all patients out of their vehicles and walking, or person with a diabetic episode.
Priority 3 Calls – Person is sick with no complicating factors, intoxicated person or assist citizen.
Because people calling 911 may not explain the situation well, a priority 3 call can be upgraded once an Albuquerque Fire and Rescue unit responds. Priority 1 calls can also be downgraded once paramedics are on the scene.