City considering contract amendment to adjust for paramedic shortage

The nationwide paramedic shortage is being felt in Great Falls and on Tuesday, the City Commission will consider an amendment to an ambulance transport contract that’s needed to adjust to a staffing shortage.

The city contracts with Great Falls Emergency Services for ambulance transport.

In July, GFES notified the city that due to a paramedic shortage it wouldn’t be able to meet the contract requirements of having Advanced Life Support on all ambulances on shift at all times.

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The contract, which was approved in 2014 and is set to expire in May, requires that GFES “shall, at all times, staff each ambulance with at least one person who is certified and licensed in the State of Montana as a paramedic and one person and one person who is certified and licensed in the State of Montana as an emergency medical technician. Staffing exceptions will be allowed only during times of disaster declaration.”

In a July 17 memo from Justin Grohs, GFES manager, wrote to Great Falls Fire Rescue Chief Steve Hester that the company has the ability to staff multiple Basic Life Support units, but “may have challenges staffing all trucks at an ALS level over the next few months.”

Grohs wrote that he wanted to open a dialogue with the city to address short and long-term solutions.

In a July 27 memo to GFES, City Manager Greg Doyon wrote that the staffing issues could constitute a breach of contract but that the city was willing to work with GFES to find temporary solutions. By offering assistance, Doyon wrote, the city was not waiving any rights it has under the contract, including declaring a major breach and collecting damages.

Grohs and Hester indicated that the paramedic staffing shortage would be a temporary problem for GFES.

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Grohs and GFFR Assistant Chief Jeremy Jones worked to find a solution.

Beginning Aug. 11, GFES was deploying three trucks daily, two of which were ALS and one was ALS some days and BLS other days. The third truck was on duty 8 a.m. to 10 p.m. on weekdays and midnight on weekends and on call the other hours.

Effective Sept. 1, and until further notice, the third truck will be staffed consistently at a BLS level.

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The Commission will consider an amendment during tonight’s meeting to the contract to allow that staffing arrangement.

In the event that a BLS ambulance from GFES is at the scene of an ALS incident, the city will provide a paramedic for transport. GFFR has provided ALS non-transport services to the community since 2000. The city also provides emergency medical and transport for continuity of care for critical patients.

It’s common for a GFFR paramedic to hop in the GFES ambulance and assist during transport for ALS calls. Some types of incidents simply require more sets of hands and city paramedics don’t hesitate to care for patients.

But when a GFFR paramedic rides with GFES, it drops the engine crew to BLS and the city is at a staffing disadvantage until the call is finished, Doyon said.

Depending on how long the GFES paramedic shortage lasts, Doyon said the city might have to consider other options since he doesn’t believe the city currently has the capacity to expand transport services.

The city EMS system has used Emergency Medical Dispatch protocol for several years to provide initial triage of patients and allow for a tiered response. EMD differentiates between ALS and BLS calls to send the appropriate level of service for a more efficient use of resources.

The city has the ability to provide ALS ambulance transport and typically does so when calls exceed GFES resources during surge events. That happens about six times a month but instances of GFFR transporting patients have increased and GFFR transported nine times in August, Hester said.

The amendment would also assess a $100 fee when the city provides a paramedic for transport by GFES. If the city transports a patient using a city ambulance, the fee is $500 per incident.

Hester and Grohs said the paramedic shortage has provided an opportunity to review the current EMS and transport system to “right resource” the system and reduce the instances of sending ALS units to what are truly BLS calls to keep ALS units available for true medical emergencies such as cardiac events.

It also allows officials to reduce the number of Code 3 calls, with lights and sirens at higher speeds, that are inherently dangerous for first responders and the public, especially when it’s unnecessary, Grohs said.

Dispatchers have had more training to better assess what’s a BLS call versus ALS, but “you really don’t know until you get there,” Grohs said.

Grohs said the city contract doesn’t stipulate how many ambulances GFES must have on duty to provide services, and the contract is instead based on response times. GFES must arrive on scene within nine minutes at least 90 percent of the time or face fines. Grohs said GFES provides the city with a deployment plan on how they’ll staff to meet the response times.

GFES has typically had three ambulances on duty and puts the third on standby overnight since the call volume is lower.

Grohs told The Electric that the paramedic shortage isn’t unique to GFES or Great Falls.

“We will totally recover,” Grohs said. “We’re aggressively recruiting and hiring. It’s by no means a crisis level.”

For GFES’ current paramedic shortage has been caused by employees moving away, pursuing other employment and maternity leave, according to information GFES shared with the city.

Great Falls Fire Rescue is also facing the shortage and has been actively recruiting paramedics and encouraging current firefighters to pursue paramedic certifications to reach its goal of having 24 paramedics on staff within the next three years. GFFR currently has about 16 paramedics, but wants to have enough to have one for each engine company for each shift with some left over to cover vacations, sick days, etc.

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Hester and Grohs said they aren’t sure what’s causing the paramedic shortage.

Hester said that in his experience, it’s often cyclical. Sometimes there are too many paramedics, sometimes there aren’t enough. He said there used to be multiple ways to become a paramedic but now the focus is on a two-year degree program.

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His suspicion is that the added time and academic requirements are preventing some people from pursuing paramedic certifications.

Grohs said many times the paramedic certification is a stepping stone to nursing or medical school, but that the paramedic program at Great Falls College MSU hasn’t had a full class in some time.

Grohs said his company loses some paramedics and EMTs to GFFR since the city has good benefits and there’s also normal levels of turnover.

As for why fewer people are becoming paramedics now, “it’s a bit of a mystery,” Grohs said.

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To get hired at GFES, Grohs said an individual must have paramedic or EMT credentials to get hired but they do internal training and support their EMT employees who pursue paramedic certifications.

GFFR is hoping to hire firefighters who are also paramedics, but has also added tuition assistance for their firefighters pursuing paramedic certification.