Police and firefighters sound alarm: You can't count on ambulances to arrive swiftly
Knox County residents who dial 911 for urgent medical help are discovering a frightening reality that has become increasingly common: If ambulance crews are overwhelmed with calls, it could be 30 minutes, an hour or longer before one arrives.
There's a chance an ambulance might not come at all.
“There is an expectation and widely held assumption that when you call 911 for a loved one experiencing a medical emergency, an ambulance will show up quickly,” Knoxville police spokesperson Scott Erland told Knox News in an email.
“The harsh truth is that, in the current state of ambulance services in Knox County, there’s no guarantee an ambulance will show up quickly or at all, leaving residents who need urgent care in a situation where they potentially have to find their own way to the hospital.”
Knoxville Fire Chief Stan Sharp is so concerned about the lag in wait times that he started requiring firefighters to carry more advanced medications to treat patients having a seizure or suffering great pain.
The delays are caused by a variety of factors, some of them out of the control of the county's ambulance provider, the private company American Medical Response, or AMR. They include local hospitals whose emergency rooms are overwhelmed by people using them as primary care, forcing ambulances to wait with patients because AMR policy requires medics to stay with patients until a hospital has taken over care.
AMR Regional Vice President Brett Jovanovich told Knox News in a written statement that the "Knox 911 center is equipped and utilizes the latest in emergency medical dispatch protocols to ensure that all 911 resources are appropriately responded to in-line with the caller’s medical condition.
"911 callers experiencing life-threatening emergencies continue to receive the fastest and prioritization of 911 resources."
AMR's failures to get ambulances to injured and sick residents with urgency is fueling frustration for police and firefighters who are limited in their abilities to treat and transport people in crisis. And AMR's delays have become the key issue as the Knox County Commission decides later this fall who it should rely on for ambulance service.
These problems aren’t unique to East Tennessee, or to AMR. They're happening across the country as ambulance providers become the first option for residents who lack health insurance and access to routine care.
A third-party review of the Knox County's emergency crisis found the current ambulance contract is "financially nonviable," or to put in it plain language, broken.
The bottom line is that if you experience a medical emergency, there’s no guarantee an ambulance will arrive quickly.
Waiting in pain
Brad Brinson was home with his wife, Beth, in March 2022 when he experienced the crisis firsthand. The Farragut resident and retired pastor was putting on his socks when he dislocated the prosthetic hip on his right side. He fell to the floor in excruciating pain, unable to move.
Beth called 911 and dispatch told her it would be a while, but they’d get an ambulance over as soon as possible. Fifteen minutes later she called back and received the same reply. Over and over, she called, and an ambulance didn't arrive.
The wait stretched for nearly two hours.
Brinson, suffering terribly, was stuck. Had he injured his leg or arm or suffered chest pains, he said, Beth could have whisked him to the emergency room. But with a dislocated hip that left him unable to move, it was impossible for him to make his way into a car.
Eventually his neighbor went up the street to the Rural Metro Fire station on North Campbell Station Road and asked for help. Firefighters there told the neighbor they’d never received a call about Brinson. They sent help to Brinson's home, and some five minutes after they arrived, an ambulance from AMR finally showed up.
AMR didn’t charge him, Brinson said, and a company executive later apologized, telling him their system was simply overwhelmed. Still, Brinson wonders why dispatch didn’t call another county or another agency for an ambulance if they knew it would be hours before they could get to him.
“We’ve grown up with the expectation that they’ll grow the services that would meet the demand and I don’t think they’ve done that," he told Knox News.
“It was excruciating and awful, but I don’t think there was any one individual driven by greed. It’s just a perfect storm across the board and there’s probably people dying because we haven’t figured out a solution.”
Ambulance delays are public safety concern
It’s not uncommon for Knoxville firefighters (three times in 2023) or police (Erland said it has happened on an “weekly basis”) to transport patients in city vehicles because an ambulance was not nearby.
Sometimes, police officers stay with a sick or injured person waiting for an ambulance. Every minute devoted to that wait is a minute officers aren't engaged in their primary responsibility to police, Erland said, calling the situation “unacceptable and unsustainable."
“It is a serious problem, and one that creates the daily potential for grave consequences,” he told Knox News.
City firefighters are worried, too, about the cascading effects of ambulance delays.
“If a fire truck is occupied at a location for a long time, it limits our ability to respond to other emergencies, like fire/rescue/EMS calls,” fire department spokesperson Mark Wilbanks told Knox News in an email.
“It's important to note that we offer emergency medical care to stabilize patients and prepare them for transport or assist the ambulance service with additional medical care if necessary.”
Wilbanks worries about whether a firefighter injured during a fire would be taken to the hospital swiftly, or that firefighters will be delayed responding to fires or end up on a scene without the full personnel and equipment they need to carry out a rescue.
A growing problem (in penalties)
The third-party review of the contract, performed by Fitch & Associates, found there were three main problems contributing to delayed ambulance service: extended (hourslong) emergency room wait times, the reduced amount of money AMR makes when it transports an uninsured patients, and a general rise in expenses since the COVID-19 pandemic.
The problem is getting worse.
From 2017-21, AMR was assessed about $800,000 in penalties for delayed responses, according to documentation provided to Knox News through an open records request. In the 17 months after, from January 2022 to May 2023 (the most recent records available), AMR has been assessed nearly $1.7 million in fines.
The company is current on the payment of the fines, according to Kevin Parton, senior director of the Knox County Health Department.
The crisis couldn't come at a worse time for AMR. Its contract with Knox County is up for rebidding, which allows the terms to be changed and gives commissioners an opportunity to reevaluate the company while weighing competing bids other ambulance services.
Jovanovich, the AMR executive, told Knox News the company supports changes in the contract that "will embrace new and innovative EMS system design and new performance measures.
He pointed out that "EMS worker shortages, nonemergency call demands on the 911 systems, and hospital ER times, all have placed pressures on both private and governmental providers alike."
Even with a new contract, though, many of the problems with the system will remain, said Knox County Chief Operating Officer Dwight Van de Vate in an Aug. 17 letter to commissioners.
"All components of the health care delivery system - at the local, state and national level - are struggling," he wrote. "Healthcare staffing remains a concern not only in EMS services but in many related settings such as hospitals and assisted living facilities. Severe bottlenecks at emergency departments remain as much the norm as the exception nationwide. This has significant negative effects on the EMS system and ambulance availability and response.
A day of firsts
On Sept. 12, the day bids for the county's contract were due, the crisis came to a head. In a span of just over six hours, there were 31 calls for EMS service, an abnormally large number considering there are typically 60-75 in a 24-hour-period.
The wait times were so severe that the Knoxville Fire Department and Rural Metro opted to activate the Emergency Operations Center through the Knoxville Knox County Emergency Management Agency, for the first time in a situation not related to weather.
The calls and wait times were documented on the county's dispatch system, and a person with access to it shared some of the events of that day with Knox News (names of callers are protected by privacy laws).
Fall injury
3:12 p.m. – A person has fallen and is injured in Knoxville's Beaumont community. They call 911 and request an ambulance.
3:19 p.m. – The Knoxville Fire Department arrives on scene.
3:31 p.m. – The caller calls back, requesting an updated ETA on ambulance arrival.
5:31 p.m. – Another request for an updated ETA on ambulance arrival.
5:36 p.m. – An ambulance from Roane County was dispatched to the address.
5:45 p.m. – Knoxville firefighters leave the scene.
Stroke
4:07 p.m. – A person in Knoxville's Burlington neighborhood calls 911 requesting an ambulance for another person who has had a stroke.
4:15 p.m. – Knoxville firefighters arrived on scene.
4:38 p.m. – An ambulance has not arrived, and the call is canceled after someone decides to take the stroke victim to the hospital in a personal vehicle.
Fall injury
4:09 p.m. – A person calls about a fall injury at the J.C. Penney at the West Town Mall.
4:11 p.m. – Knoxville firefighters arrive on scene.
5:24 p.m. – An ambulance arrives.
5:45 p.m. – The call is closed.
Fire crews stock new medicines
Sharp, the Knoxville fire chief, made his decision Oct. 4 to require firefighters to carry advanced medications after an Oct. 3 call when firefighters arrived on Baxter Avenue to treat someone having a seizure, Wilbanks said.
Fire crews were with the patient for over an hour waiting for an ambulance, and the person experienced seizures off and on the entire time, Wilbanks said. Because of the patient's condition, they couldn’t be loaded into a chief’s vehicle for transport to a hospital, he said.
Correction:: This story has been updated to more accurately depict which agencies requested the county's Emergency Operations Center be opened September 12 and clarify AMR policy requires medics to stay with patients until a hospital has taken over care, not state law.
Tyler Whetstone is an investigative reporter focused on accountability journalism. Connect with Tyler by emailing him at tyler.whetstone@knoxnews.com. Follow him on Twitter @tyler_whetstone.
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This article originally appeared on Knoxville News Sentinel: Knox County ambulance service AMR experiencing long response delays
