Coronavirus crisis squeezes ambulance operators

The coronavirus crisis is putting an unexpected financial squeeze on ambulance operators, ratcheting up costs and tanking revenue even as they audibly remind people of the virus’s proliferation throughout the county.

Drivers and emergency medical technicians are spending far more time with each patient they transfer in ambulances.  

In some of the hardest-hit areas of the country, the first weeks of the outbreak in March were a chaotic flurry of activity, as ambulance operators struggled to understand the disease they were seeing just as much as the doctors and nurses who would receive those patients in the emergency room.

“The volume we were dealing with was astronomical. The severity of cases was something that was really new to us,” said Rich Straub, an operations supervisor at Empress EMS in Westchester, N.Y. “It just became nonstop. It went from a slow trickle to a constant flood.”

And at the same time, non-coronavirus traffic has plummeted, eating into the bottom lines of ambulance operators.

People who typically need an ambulance for serious medical conditions not related to the coronavirus are either not calling or refusing to be transported to hospitals. In some cities, virtually every call to 911 is from someone suffering the worst symptoms of COVID-19.

“For the last five, six years, we’ve been seeing this incredible growth in call volume, 15 to 20 percent every year,” said Chris Anderson, director of operations at Bell Ambulance in Milwaukee, an increase he attributed to an aging baby boomer population. “All of a sudden, one day in March, things started to change.”

In other places, those who do call 911 for an issue other than COVID-19 are often refusing to be taken to the hospital, for fear of being infected. Ambulance services are usually only paid when they actually transport a patient to a medical facility; they are not paid when they treat a patient at his or her home.

“The ambulance system is structured that we get paid as an Uber. The health care is free and the transportation has a price tag,” said Hanan Cohen, Empress EMS’s director of corporate development. “We provide a fee for service and hope that a couple of weeks from now the insurance company decides our service was worth it and pays us a reasonable rate.”

“The costs of providing care went up exponentially. There’s no change in reimbursement structure,” Cohen said.

There are signs that those who are not seeking treatment for other more serious conditions are suffering as a result. Cohen said his region has seen a 400 percent increase in patients who experience cardiac arrest.

In a typical month, Empress uses a few hundred boxes of surgical gloves to treat patients and protect their workers. In the first month after the coronavirus broke out, first in New Rochelle and then in Yonkers, the company blew through 41,000 pieces of much stronger and much more expensive personal protective equipment (PPE).

The easy transmissibility of the coronavirus has also meant ambulance operators have to spend much more time cleaning their vehicles in between patients. Empress uses a team of newly hired, specially trained staffers to sanitize their vehicles. In Montana, Great Falls Emergency Services uses an aeroclave, a special machine that completely disinfects a vehicle in 10 minutes before it must be aired out for another 20 minutes. Bell Ambulance in Milwaukee uses aerosolized hydrogen peroxide to clean its vehicles.

“Pre-COVID, crews had a procedure on cleaning the ambulance, putting equipment back in order, disinfecting things that had been used, wiping the cot down, stuff like that. Now it’s much more intensive, there’s a detailed approach after every single patient,” said Justin Grohs, the general manager of Great Falls Emergency Services.

Cohen said Empress’s costs have doubled, and so has the time it takes to complete a call — from dispatch to delivery to cleaning the vehicle for a return to duty.

Operators at 911 centers across the country are also taking more time to collect information from those who call emergency hotlines. Potential coronavirus patients are asked up to 22 questions about their symptoms and exposure, so that EMTs can prepare themselves by donning personal protective equipment and hospitals can learn about their incoming case, said Matt Hauth, who supervises dispatchers at the Regional Emergency Medical Services Authority (REMSA) in Reno, Nev.

“The crews are donning PPE on every single call they run now,” Hauth said.

At the same time, ambulance operators are taking added steps to protect their own buildings. Employees coming to work are screened before their shifts. In Reno, REMSA employees use an app to screen themselves on days off. In Milwaukee, Bell employees have access to assistance programs to maintain their mental health.

“Everyone has a really positive outlook on this. The overwhelming message is hey this is historic, I’m glad to be a part of it,” Anderson said. “We’re just pushing that message, we’re all in this together.”