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Bay Area Paramedic Shortage Increases Ambulance Wait Time

Nationally, more than a quarter of paramedics leave their jobs every year. Calls for ambulance services in Santa Clara County, Calif., have increased by 25 percent over the past three years.

Ambulances outside of the emergency room
Ambulances outside of the emergency room at Regional Medical Center on Nov. 23, 2020, in San Jose, California.
(Nhat V. Meyer/Bay Area News Group/TNS)
One morning in September, a Morgan Hill, Calif., day care called 911 with a dire situation: A 2-year-old was having a seizure and turning blue. Within two minutes, first responders on the scene confirmed that the toddler needed emergency care. It took 25 minutes for an ambulance to arrive.

While the child survived, the delayed response time highlighted a lag in care that could prove deadly for South County residents. A paramedic shortage has led to fewer fully staffed ambulances and longer wait times for ambulances throughout Santa Clara County. In more remote communities such as Morgan Hill and Gilroy, this has led to patients and emergency responders sometimes waiting half an hour or more for an ambulance, even in dire emergencies.

The county isn’t alone. Emergency-response services throughout the U.S. are trying to cope with a deepening paramedic shortage. Nationwide, more than a quarter of paramedics leave their jobs every year. Many paramedic training programs also shut down during the height of COVID-19, contributing to the shortfall, according to Baraka Carter, South Santa Clara County District fire chief.

At the same time, the number of calls for ambulance services in the county have climbed by about 25 percent in the past three years.

Although county ambulance companies are working to craft solutions to the shortage, some say relief could take months.

“Something has to give, and right now we just don’t even have the resources necessary to handle this ambulance crisis,” Gilroy Fire Chief Jim Wyatt said. “Anything that the county can do to help relieve some of that stress (helps).”

The shortage means longer response times around the county. But leaders in Gilroy and Morgan Hill said that it has hit their cities uniquely.

Morgan Hill does not have its own hospital, meaning patients must be transported north to San Jose or south to Gilroy to receive care. According to a preliminary analysis from Morgan Hill Support Services Manager Sarah Tada, 98 percent of ambulance responses in Morgan Hill this year took more than 30 minutes from a call’s being assigned to the patient arriving at a hospital.

While the county does not have a goal set for getting a patient to the hospital, the ambulance provider’s contract requires 90 percent of ambulances to arrive at the scene within 12 minutes, according to a letter from Wyatt to the county.

While Gilroy has St. Louise Regional Hospital, patients with severe trauma or cardiac issues must be sent to San Jose, a trip that can take more than a half an hour, Wyatt said.

In addition to stalling patient care, ambulance delays can tie up firefighters who respond to medical emergencies because they must attend to a patient until an ambulance arrives. Because the Gilroy Fire Department, which is facing its own staffing issues, only has three full-time stations, this means that having one engine at an emergency can cut available firefighters in Gilroy by a third. In one instance, Gilroy firefighters were stuck waiting on an ambulance, while only blocks away another patient with a higher level of emergency needed help, forcing that patient to wait longer for urgently needed care, according to Wyatt.

“When the firefighters are working as hard as they can to go to every emergency, and they’re stuck on calls and we can’t respond, it’s very frustrating,” Wyatt said. “There are no bad actors here. Everybody is doing their best with the resources that they have to try to serve the entire county. But in South County, we do see longer response times, and we feel isolated down here.”

During a meeting on Thursday, Santa Clara County officials and ambulance providers hashed out possible solutions to the shortage.

According to a county report, ambulance services need to add 30 more full-time paramedics to the current staff of 214 before staffing can reach “optimal” levels. To try and compensate for shortages, paramedics are required to work overtime — extra 12 hours a week on average.

“Certainly the demand for paramedics far exceeds the supply we currently have,” said Brian Henricksen, a representative of American Medical Response, the private company that provides ambulance services to the county.

In the long term, the county is seeking to bolster the number of paramedics by partnering with the training program at Foothill College in Los Altos Hills to increase the number of students who graduate from the program.

American Medical Response also runs a paid training program, which it says currently has 48 students. However, paramedic training programs take around 18 months to complete.

Shorter term, the ambulance company is focusing on managing demand for paramedics and ambulances. County officials suggest that hospitals could deploy ambulances without paramedics to calls that are less urgent or send a vehicle equipped with medical equipment other than an ambulance to non-emergency calls or for psychiatric patients.

The county will also pilot a program that would direct 911 callers without emergency injuries or illnesses to a nurse. The nurse would then refer the individual to medical care without having to dispatch an ambulance and could direct them to a virtual appointment or schedule a ride share. However, this program could take months to achieve a 10 percent drop in ambulance calls, Henricksen said.

Representatives from the ambulance service acknowledged that they are not meeting standards for serving the county but said that similar plans had worked to improve service elsewhere in the state. “We have a high degree of confidence that if we stay the course on this plan, we are going to see the improvements,” said Henricksen.

Moving forward, Joe Simitian, chair of the county’s Health and Hospital Committee, requested monthly reports and for the ambulance company to collaborate with first responders in coming up with solutions.

“These are solvable problems,” Simitian. said “They’re not easy problems, but they’re solvable.”

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