Rural/Metro addresses staffing issues with Knox County

Ambulance service points to new Tennessee law for EMT shortage

KNOXVILLE (WATE) – Rural/Metro said they are having problems with staffing their ambulances due to a new EMS rule change and educational institutions not keeping up with the demand.

The Knox County Director of Purchasing issued a notice to Rural/Metro earlier this month concerning several performance issues. Rural/Metro has disputed the listed problems.

Previous story: Rural/Metro says performance concerns are unfounded; Knox County mayor still concerned

In August 2014 the Tennessee Department of Health Bureau changed requirements for EMT’s, requiring them to have more staff members with EMT – Advanced certifications in order to run their ambulances. The advanced EMT requires two full semesters at a community college or training from a municipal fire department.

“Educational institutions have admittedly not kept up with the demand for EMT – Advanced applicants,” said Rural/Metro regional Director Erin K. Downy in a letter to Knox County. “EMT – Advanced versus EMT – basic requires twice the cost and double the time thus a deterrent for many looking to pursue a job in this industry.”

More: Rural/Metro letter to Knox County Purchasing Department [PDF]

Downey said Rural/Metro met with Roane State Community College and Cleveland State Community College to help assist with their staffing challenges, but have had no success. She also said they brought their concerns to the State EMS Board, along with other EMS organizations on June 24. The board recommended a survey according to Rural/Metro.

Knox County Health Department Director Dr. Martha Buchanan said that Downey will meet with Knox County Health Department bi-weekly to address staffing issues. Rural/Metro said they are offering paramedics a $2,500 and EMTs with advanced certifications a $1,500 signing bonus.

2 fines for no available Rural/Metro ambulances in April

WATE 6 On Your Side has been looking into complaints from residents about the company’s response times for months. Other times, there were no ambulances available from Rural/Metro to respond to emergencies and other ambulances services were requested to fill in for calls. That situation is called a Level 0, where Rural/Metro does not have ambulances available. According to the contract, they are fined by the county every time that happens.

Previous story: Knox County raises concerns about Rural/Metro ambulance service

Rural/Metro was fined for two Level 0’s in April as well as two exceptions. According to Rural/Metro’s contract with Knox County exceptions include factors beyond Rural/Metro’s control, requests which are cancelled prior to the ambulance’s arrival at the incident, but before the contracted response time has expired, severe weather conditions and requests during a disaster, locally or in a neighboring jurisdiction, which has requested assistance from the county. The EMS coordinator may also determine exceptions.

More: Knox County contract with Rural/Metro [PDF]

Rural/Metro said the two Level 0 notifications they were fined for in April include:

  • 3:18 p.m. April 14 – The response time was 12 minutes 37 seconds.
  • 4:20 p.m. April 17 – The response time was 14 minutes 11 seconds.

When Rural/Metro reaches Level 0 during a pending request they are fined $1,000, according to the ambulance service’s contract with Knox County. During an emergency, they are fined $5,000.

Rural/Metro calls Knox County Purchasing Department letter ‘grossly inaccurate’

The county must also be notified every time Rural/Metro gets to a Level 3 and is almost out of ambulances that can respond to Knox County calls. Level 3 means only three ambulances from Rural/Metro are available to respond in Knox County. At that point Rural/Metro requests mutual aid from other ambulance providers or first responders.

Downey said a notice, issued by the Knox County Director of Purchasing to Rural/Metro earlier this month highlighting concerns with response times and mutual aid is inaccurate. The letter asked for an action plan to remedy several performance related issues including “the use of mutual aid approximately 78 percent of the time from January – March 2015.”

More: Knox County Purchasing Department’s letter to Rural/Metro [PDF]

The statement, according to Downey, is “grossly inaccurate.” She said that every time Rural/Metro inquires about mutual aid the inquiry is logged. “If we contact mutual aid providers to determine their availability at Level 3, and we return to higher levels within moments that is tracked and reported,” said Downey. She said that while Rural/Metro has asked about mutual aid on 78 percent of the days during those three months, they have only used mutual aid .55 percent of the time.

“The citizens of Knox County would never be in danger secondary to a robust mutual aid notification system,” said Downey. The regional director said she believes that practice is proactive, but admits the company is focused on the increased notification of mutual aid from partners. She said they are monitoring and reviewing trends with Knox County Health Department.

PREPRO-HAILEY-level-3-notifications-Rural-Metro-page-3A WATE 6 On Your Side investigation found an increasing number of Level 3 notifications by Rural/Metro in March, April and May. Rural/Metro was fined every month in 2014 and paid Knox County $45,250 in damages; so far, the fines are up to $35,000 this year.

In June, only 89.1 percent of the response times met the contract requirement for less than 10 minutes. Rural/Metro’s contract with Knox County requires response times to be less than 10 minutes 90 percent of the time.

The Knox County Mayor’s office said that an early assessment of the June 2015 performance numbers indicate that Rural/Metro’s response times may not meet contractual obligations. Rural/Metro argued that Knox County’s findings were only preliminary, but Dr. Buchanan, said that, historically, preliminary numbers for Rural/Metro response times don’t change.

“I appreciate Rural/Metro’s response and I and my staff at the Health Department and Knox County Purchasing look forward to working with Rural/Metro to continue to ensure public safety,” said Knox County Mayor Tim Burchett.

A review is scheduled is scheduled for July 20 with the Knox County EMS coordinator. Rural/Metro will be required to report back to the county afterwards. If final June compliance numbers do not meet 90 percent they will be required to submit an action plan.



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