During the height of the COVID-19 pandemic, many ambulance and EMS providers across the U.S. have reportedly experienced fewer emergency calls.

The reasons ranged from state executive orders that temporarily banned elective surgeries to people being fearful to visit hospitals, said Wayne Jurecki, vice president and COO of Bell Ambulance in Milwaukee.

“March was a busy month for the first half, then it entirely dried up,” Jurecki said. “By April, we were down by 35% on call volume. People were pushing off medically necessary procedures and letting their conditions exacerbate.”

Despite sick patients’ medical conditions going untreated, some still refused ambulance transports, said Matt Zavadsky, MS-HSA, NREMT, chief strategic integration officer with MedStar Mobile Healthcare in Fort Worth, Texas, and the president of NAEMT.

For some patients who arrived at this decision, it was born out of stringent hospital visitor policies that restricted loved ones from visiting patients, according to Zavadsky.

In one case, a crew member tried to convince the patient, who was having a heart attack, to go to the hospital. Even after the crew member showed the EKG as proof of a heart attack, the patient still refused ambulance transport out of fear.

“We had one of our patients tell our crew, ‘If I’m going to die, I would rather die here with my family than alone in the hospital,’” Zavadsky said.

Precarious part-time work

EMS staff hit hardest by fewer emergency calls were those on part-time schedules, according to Jurecki.

“We did have some part-time employees file for — and qualify for — unemployment, for reduction of hours, but not a layoff or loss of a job,” he said, adding that part-time employees filled shifts for people taking vacation time.

Since Bell Ambulance has fewer than 500 employees, Jurecki said these part-time employees qualified for the federal Paycheck Protection Program under the CARES Act, and it allowed them to keep dedicated full-time staff in place despite the dip in call volume.

The CARES ACT provided $175 billion of relief funding to hospitals and healthcare organizations, according to U.S. Department of Health and Human Services.

The Paycheck Protection Program authorized $659 billion in total funding relief to help small businesses pay eight weeks of payroll to employees and provide loan forgiveness benefits. Healthcare and social assistance organizations reportedly collected $67 billion in paycheck protection loans, according to a NAICS report from the Small Business Administration, published by the Treasury Department in June.

Realigning services to meet patient needs

Since Bell Ambulance handles emergency and non-emergency calls, the loss of transport business from non-emergency calls took a bite out of business. To make up for that, Jurecki said they made a tough decision to dedicate three ambulances for the sole purpose of transporting COVID-19 positive patients with other health conditions.

“Like a kidney dialysis patient who had to go to dialysis visits three times a week,” Jurecki said. “This is one reason why our call volume bounced back.”

He said they followed strict sanitization and cleaning protocols for these dedicated ambulances. This came at a cost and required procurement of personal protective equipment at a time during supply chain uncertainties.

“An hour for a transport became an hour and 45 minutes,” Jurecki said. “We increased our hard cost on every transport because of gowns, face shields, N95 respirators and cleaning supplies.”

By August, Jurecki said emergency calls were nearly back to normal numbers. He attributes this to the dedicated ambulances for COVID-19 positive patients. Plus, a stroke of luck brought a new set of ZIP codes to serve.

“One of the ambulance providers dropped out of Milwaukee, so we picked up an extra geographic area,” he said. “There were four private providers and now there are only three for the city of Milwaukee.”

Challenges accompany fewer emergency calls

The advent of telemedicine brings many positive facets for healthcare providers and their patients. Yet telemedicine can create unanticipated consequences related to 911 call volumes, according to Zavadsky.

“A lot of low-acuity patients who would have called 911 to go to the emergency room can use telemedicine instead and talk to a doctor to get their needs met,” he said. “So we may see call volumes decrease.”

The upside to fewer emergency calls, Zavadsky said, is that it helps free up EMS and ambulance providers to treat higher acuity patients who need critical care treatment and transport.

No ambulance provider can predict the percentage of low-acuity calls they will receive in a given week or month, or the reimbursement risks and write-off entanglements unique to each transport.

“A lot of people call 911 and go to the ER, and since they’re considered low acuity, they don’t really need 911,” Zavadsky said. “Many times, when we take these people to the ER, we don’t get reimbursed because the insurance company says it was not a medical necessity.”

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