Ambulance shortage concerning for fire and rescue personnel

An increase in calls for emergency medical services and a decrease in ambulances for patient transport has put local fire departments in a pinch trying to serve the community. 

With AMR ambulance service — the private ambulance service authorized by the New Mexico Public Regulation Commission to transport medical patients in Valencia County — cutting the number of units stationed in the county, municipal and county fire departments have been picking up the slack since June. 

Valencia County Fire Chief Matt Propp and municipal fire chiefs say while fire departments can do medical transports from time to time, the number has increased dramatically since June, leaving their fire services short staffed. 

During a workshop with three of the five Valencia County commissioners on Oct. 30, Propp presented concerns he and the municipal departments have about the increased need for emergency medical services.  

Rio Communities Fire Chief Andrew Tabet attended the meeting and said the shortage of ambulances is putting a strain on all departments. 

“AMR has shown they can’t continuously staff their trucks. We’ve been told they can put four down here during the day but sometimes it’s only three,” he said. “Even with four, that is still going to pull firefighters out of Rio Communities, out of Valencia County, to run to Albuquerque.” 

Tabet said as recently as early October, five fire stations based in Valencia County had staff and units at an Albuquerque hospital at the same time. Fire departments in the county operate under a “certificate of necessity” from the PRC, which allows them to transport patients if the person is critically ill or injured and there are no ambulances available. 

If all AMR transport units are busy, the system hits what is called “status zero,” meaning county and municipal EMS units are dispatched to medical calls. They are supposed to wait for an AMR unit to return to service and let the private company make the transport, but that isn’t always possible and has come close to having disastrous consequences. 

Propp recounted an incident when all AMR units were busy, which pushed a call for medical services to the county fire department. At the time, county rescue units were at a fire scene and unable to respond. Dispatch operators began calling for other medical units in the area, but there were none available. Forty minutes after the call, a county unit was cut loose from the fire scene and picked up the patient. On the way to Albuquerque, the patient went into cardiac arrest. 

“Not to sound theatrical, but that keeps me up (at night), patients waiting 30, 40 minutes,” Propp said. “It’s not just us. It’s county wide.” 

Tabet agreed, telling the commissioners EMS units from Rio Communities are transporting patients to Albuquerque multiple times a week, saying local departments are “transporting in a gray area. It’s supposed to be rare. Now it’s kind of the norm and it’s a very scary place we don’t care to be in.  

“We are transporting two to six times a week, just from Rio Communities. That doesn’t count mutual aid. On (Oct. 29) we transported twice for Belen,” Tabet said. “We had the ability to do it and they repay the favor, just like Valencia County. We have good partnerships, but it’s scary because all of us have the primary responsibility to fire.”  

According to Valencia Regional Emergency Communication Center statistics presented by Propp, from June to September, there were 4,885 incidents of emergency medical calls county wide. Of those, 356 calls were not acknowledged by or assigned to AMR due a lack of response by the company. During “status zero,” 424 incidents were created, Propp said, leading to 192 transports by local EMS units, which is about 400 hours of “out-of-service” time for firefighters. 

Looking at average response times to EMS calls, Valencia County fire averages about 18 minutes and AMR is just more than 19. Fire departments for Los Lunas, Belen and Rio Communities average from just more than eight minutes to nearly nine and a half. The national response standard for a suburban area is right at nine minutes and 12 minutes for a rural areas. 

“The biggest thing for everybody to realize is we have an exceptionally busy county when it comes to fire and EMS …” Propp said. “Our call volume has increased by 40 percent. It’s higher than it has ever been. We’ve seen a dramatic increase of transports since June.” 

Looking for solutions 

Propp said the county fire department has purchased two transport-capable rescue units, which should be in service soon, as well as applied for a transport certificate from the PRC, which will allow the department to transport patients and bill them. He anticipates the PRC will hear the county’s application in January. 

EMS aside, the county and municipal fire departments still face the issue of having to provide fire protection first and foremost, he said.  

During the county’s ISO (Insurance Services Office) pre-evaluation, four county stations were in jeopardy of being shut down, with lack of staffing being the main deficiency, Propp said. The county recently consolidated its individual fire districts to one county-wide service area to allow for staffing numbers to be applied in all areas, as well as equipment.  

With medical calls pulling firefighters out of service more frequently, lack of staff puts the county’s ISO rating — which has a direct bearing on insurance rates for home and business owners — at risk, which can lead to a decrease in state funding for fire equipment. 

Propp would like to eventually increase paid fire staff for the county with an additional six firefighter/EMT positions and create three battalion commander positions to allow for four staffed fire stations — Los Chavez, Tomé, El Cerro and Meadow Lake.  

“This would increase the response on the fire and EMS sides, increase the ISO and drop our response times to the national average,” he said. “This gives the community the response it expects and deserves.” 

He estimated the additional positions would cost about $1.2 million.  

The Rio Communities Fire Department is also applying for a certificate of transport. A certificate won’t add staff to either department but will allow the agencies to bill patients and their insurance for transport service in the hopes of recouping some of the costs. 

“Once we get a certificate of transport, it won’t obligate us to a certain level of service. We’ll continue to do what we’re already doing but with the chance to offset some of the costs,” Tabet said. “This problem will not be resolved quickly. It will be done through teamwork and working hand-in-hand with AMR. No one fire or even a for-profit (company) can stand alone.” 

A county-wide issue 

“We are a fire-based system and if we have two people on a transport, that puts us in an immediate short staffing situation, which can result in the injury of a firefighter or community member in the event of a fire,” said Los Lunas Fire Chief John Gabaldon.  

With holiday season in full swing, Gabaldon encouraged residents to be as preventative as possible in terms of both fire safety and medical situations.  

“Check your fireplaces, go see your primary care physician before something gets worse and you have to call an ambulance,” he said. “If we can prevent emergencies, we can all be part of the solution and make it through this together. We have some of the best firefighters and EMS providers in the state and we will continue to provide the service residents deserve. Will it be challenging? Yes, but we can do this together.” 

Belen Fire Chief Charles Cox said the problem isn’t going to be solved in the next week or next month, maybe not in the next year.  

“The city is working very hard to increase our manpower. Valencia County is growing, so we have an increase in calls,” Cox said. 

Peralta Chief Jeremy Fiedler agreed “this isn’t just a ‘county’ problem. It’s a county-wide problem.  

“At any given point during the day, we’re at status zero — sometimes three or four times a day … so it’s up to fire to try to transport,” Fiedler said. “It’s like trying to hold back a flood with a colander. We are all invested, county wide, to make sure there’s a way to get patients to a hospital.” 

The Bosque Farms EMS service is in a rebuilding phase, according to village Clerk/Administrator Vernon Abeita, who also served as the village’s EMS director from 2015 to 2020.  

“The long-term goal for Bosque Farms is to be able to put two (rescue) units out on the street at the (advanced-life saving) level,” Abeita said.  

“Before I left, we were right at the verge of that so I know that can happen. We want to make sure we can pick up calls and take care of our people. For every department in Valencia County, that is the end goal — to take care of our people.”