Medics and EMTs: Lack of Ambulance Staff Impacting Emergency Response Times in the City

Employees of AMR, the city’s ambulance company want the public to know about situations where ambulances are too far away or unavailable to respond to emergencies in time.

Medics and EMTs working in the city of San Diego tell NBC 7 Investigates they are seeing ambulances unstaffed in neighborhoods across the city, leading to longer response times to emergencies.

Employees working for American Medical Response (AMR), the company contracted to provide ambulance services in the city of San Diego, would not go on record with their accounts, fearing the company may retaliate against them. Instead, the employees provided staffing rosters and response times for 911 calls they say were impacted by the staffing challenges.

In the city’s emergency medical services (EMS) system, ambulances are designated as “station units” or “float units.” “Station units” are assigned to fire stations and respond to 911 calls alongside the fire engines that are dispatched. “Float units” are not assigned to fire stations, rather they go to areas of the city where they are needed most, based on 911 call volume.

The employees we spoke with said they’ve seen “station units” go unstaffed, sometimes days in a row, meaning the only ambulances available to respond to 911 calls in that specific community are the “float units” coming from other parts of the city.

Rancho Bernardo Condo Fire

On October 28, 2017, a witness called 911 around 3:18 a.m. when they saw fire coming out of a condo unit on Bernardo Terrace. Fire engines from Stations 33 and 42 arrived on the scene in less than four minutes and found a father and his two children inside.

“Three victims were pulled out of the fire,” San Diego Fire Battalion Chief Alan Arrollado told reporters that night, “At the time they left the scene, they were basically in critical condition.”

The ambulance “station units” assigned to Engine 33 and 42 were unavailable to respond to the fire.

Sources within AMR told NBC 7 Investigates crews that staff the ambulance closest to the fire or less than a mile away, Medic 33, were unable to respond due to being too tired or on a “recovery delay.” Dispatch records support this, showing Medic 33 marked out-of-service from 2:06 a.m. to 4 a.m. on the night of the fire.

According to AMR staffing rosters, Medic 42 was unstaffed that morning. The rosters show red question-marks where staff names are usually entered in.

Medics and EMTs shared with NBC 7 Investigates documents they say show response times were delayed to a deadly fire last year due to staffing levels.

NBC 7 Investigates obtained 911-dispatch logs showing the ambulances' response to the condo unit fire did not meet the city's requirement for responding to life-threatening calls. The closest ambulances available to respond was Medic 40 and 44. Medic 44 was “in quarters” or at the fire station more than nine miles away. Medic 40, also “in quarters” was more than six miles away.

Dispatch records show the ambulances arrived on-scene of the condo fire 19 minutes after crews were dispatched. According to the city’s contract with AMR, ambulances are required to respond to life-threatening calls in 12 minutes or less.

Both children died in the fire but there is no evidence that the delay in ambulances responding played a role in their death.

Medics and EMTs who spoke to NBC 7 Investigates said they want the public to know about these situations where ambulances are too far away or unavailable to respond to emergencies in time.

Emergency System Hitting “Negative Levels”

NBC 7 Investigates has been looking into ambulance response times for the past two years and in December 2016, reported on what it means when the emergency system hits “level zero.”

A former EMT for Rural/Metro, now owned by AMR, spoke to NBC 7 Investigates and the city’s Public Safety Committee about the “level zero” problems he witnessed.

“It’s shocking how close or how often the ambulance level gets to ‘Level Zero’ or close to ‘Level Zero.’ What this means is there are no ambulances left in the city,” Joseph Ross told the committee.

Both San Diego Fire Department officials and AMR have told NBC 7 Investigates they do not track how often the city’s EMS system hits “level zero” but crews tell us they know it’s happening based off of alerts sent out on their pagers.

NBC 7 Investigates obtained pager alerts and learned now, in addition to “level zero” situations, the system is sometimes hitting “negative levels”, meaning there are no ambulances available and there are already 911 calls waiting for ambulances to respond.

Pager Alerts on Ambulance Staffing Hitting Negative Levels

Ambulance Staffing

Ambulances in the city of San Diego are staffed with one Medic and one EMT but AMR employees say due to staffing shortages, these positions are not being filled. AMR officials have attributed staffing challenges to a nationwide paramedic shortage. 

Staffing schedules shared with NBC 7 Investigates show both ambulance “station units” and “float units” going unstaffed for shifts on certain days last year. 

According to data pulled from the staffing schedules, on October 28, the day of the deadly Rancho Bernardo condo fire, 20 medic positions and 18 EMT positions were unstaffed that day. These positions accounted for at least 16 ambulances unavailable in the EMS system that day, according to the AMR sources who spoke with NBC 7 Investigates. 

This past Christmas Eve, data shows 21 medic positions and 19 EMT positions were not filled. The unfilled medic and EMT positions were assigned to fire stations in neighborhoods like Pacific Beach, UTC, Scripps Ranch and Rancho Bernardo. On Christmas day, five medic and eight EMT positions were not filled, according to the staffing rosters. 

Staffing rosters for New Year’s Eve show 12 medic and 14 EMT positions being unstaffed, accounting for at least 12 ambulances unavailable in the EMS system. On New Year’s Day, the rosters show 10 medic and eight EMT positions being unfilled, accounting for at least eight ambulances unavailable that holiday. 

To see the staffing rosters, click here.

NBC 7 Investigates sent these findings both to the San Diego Fire Department and AMR for a comment. San Diego Fire officials did not respond to the findings. 

In an email, Madeleine D. Baudoin, the Government and Public Affairs Manager for AMR told NBC 7 Investigates, “The numbers provided to NBC 7 are not reflective of our actual staffing schedule each day, which changes hour-by-hour, minute-by-minute, based on needs across the city.” 

The statement continued, “Our operations team works with our fire department to deploy units and staff as needed to cover areas based on the changing volume each day. AMR caregivers respond to approximately 390 EMS calls per day, providing exceptional service to the citizens of San Diego.” 

AMR’s contract with the city of San Diego expires in June 2020. Last October, the San Diego City Council approved ambulance rate increases for AMR and said if the city finds another ambulance provider to take over the contract before the 2020 date, AMR will be released from the contract early. 

In an email, San Diego Fire Chief Brian Fennessy told NBC 7 Investigates, “We are preparing the [ambulance contract] request for proposal now and would like to have it out to the public by late summer/early fall.”

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