Everything you need to know about changes to EMSA, and why response times are slow

Changes are coming to the operation of Oklahoma City and Tulsa's ambulance service provider that officials hope will improve the organization's ability to respond to emergencies in a timely fashion.

Response times in Oklahoma City from the Emergency Medical Services Authority, or EMSA, have been out of compliance since June of 2020. City and EMSA officials have said this is a symptom of the COVID-19 pandemic, the nationwide paramedic shortage and the organization's separation from its contracted service provider in late 2020.

EMSA is required to arrive by a certain time to more than 90% of calls in Oklahoma City and Tulsa. In the last year, EMSA's best month was April, when it arrived on time to 64% of priority 1 calls. In July, August and September, compliance was around 50% in Oklahoma City.

Jason Ferbrache, Oklahoma City's assistant city manager over public safety, said it was time to make some changes that could give EMSA more tools at its disposal.

"We want to continue to provide high levels of service," Ferbrache said. "And we don't want to be bound by a specific model or type of service delivery."

EMSA has provided ambulance service to Tulsa since 1977 and came to the Oklahoma City market in 1990. In the Oklahoma City area it also serves Edmond, The Village and Nichols Hills.

In the city's most recent residential satisfaction survey, 75% of respondents said they were satisfied with the ambulance service. This was a drop from 80% in 2021 and 82% in 2020, but on par with the satisfaction levels before 2020.

EMSA can now directly hire employees instead of contracting out

Under EMSA's current agreement, it must contract out services, with the ability to take over operations for up to two years when necessary. With the proposed changes, EMSA will always have the ability to hire employees directly.

This is the model EMSA is using now, and has been since it terminated its contract with American Medical Response Ambulance Service, or AMR, over disputed contract breaches in 2020. If the city council approves, EMSA would have the flexibility to continue this model and even switch back to contracting at some point, or use a combination of both.

EMSA has not changed its model of service since its inception in the 1970s, and Adam Paluka, EMSA's chief public affairs officer, said it was time to modernize.

"A lot has changed in 45 years, and we needed to bring the governing documents of EMSA to 2022," Paluka said. "We're really happy about the progress that these documents allow us to make. And also they give us more agility, they allow us to be an organization that can make changes."

The EMSA Board of Trustees approved a $10.5 million settlement of its lawsuit against AMR, which was filed in 2020 over a dispute of $16 million in excess profits EMSA claimed AMR owed the trust due to its 10% profit cap in the contract. EMSA withheld $16 million in payments to AMR to mitigate financial harm, and the $10.5 million settlement will come from those funds.

"The settlement resolves all claims asserted by EMSA and all counterclaims asserted by AMR," Paluka said in a statement. "The parties were able to resolve their differences through mediation, thanks to the help of the Honorable Judge Robert Henry, Former Chief Judge of the United States Court of Appeals for the Tenth Circuit."

Cities could provide supplemental ambulance service to alleviate call pressure

Oklahoma City and Tulsa are proposing to allow the cities to provide supplementary service, opening the opportunity for EMSA and the cities to propose a plan of what this would look like.

Ferbrache said that while this is still theoretical, the idea is for Oklahoma City to purchase a limited number of ambulances to be operated by the city's firefighters. Oklahoma City would essentially be a contractor for EMSA, Ferbrache said.

"It's just adding more ambulances and paramedics and more dots on the map," Ferbrache said. "Resources that EMSA can then pick and choose from to provide this dispatch and response."

Nothing would change for residents, Ferbrache emphasized. Emergency calls still will be made to 911, and EMSA dispatchers will determine whether to send EMSA employees or a contractor.

The Oklahoma City Fire Department has recently advocated for the ability to provide medical transport service in situations where an ambulance won't arrive in time. A bill passed the Oklahoma Legislature earlier this year that would allow just that, if approved by the board overseeing a district.

OKC and Tulsa are still committed to using EMSA

Another change to the EMSA agreement is the removal of the "window of opportunity" recurring every five years, in which Oklahoma City and Tulsa each review and decide if they will continue to use EMSA.

That window came up in October 2021, and was extended for six months twice "to allow additional time for EMSA to stand up operations and begin getting a handle on responses especially coming out of the pandemic and facing staffing shortages," Ferbrache said.

Oklahoma City or Tulsa will still have the ability to end its relationship with EMSA, but are no longer required to do the five-year review.

Ferbrache also said he hopes this change will make it easier for EMSA to recruit, so that new employees don't have to wonder, "What's going to happen in five years?"

During Tuesday's city council meeting, Ward 4 Councilmember Todd Stone asked why EMSA's compliance is so much higher in Tulsa than Oklahoma City. Compliance in Tulsa has remained fairly close to the required 90% even through the pandemic and change of operation. The lowest month for compliance in Tulsa, at least since the start of 2020, was January 2022, when only 82% of priority 1 calls arrived on time.

Oklahoma City Manager Craig Freeman said Oklahoma City's sheer size has made it difficult for EMSA to get to compliance on top of its staffing challenges.

"We want to give them as many tools as we can and work together in partnership to try to help resolve this," Freeman said.

Correction: An earlier version of this story said EMSA serves the city of Mustang. Mustang is no longer part of the EMSA system.

This article originally appeared on Oklahoman: EMSA, OKC's ambulance service, requesting changes to service delivery