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Alameda County — Falck Alameda County — the provider of emergency ambulance services for much of Alameda County — has until Oct. 19 to provide a corrective action plan after the company failed to meet its contractual emergency response times across its service area in August.

That service failure also prompted the county to reinstate financial penalties should Falck continue to underperform.

Alameda County Emergency Management Services (ALCO EMS) — the agency in charge of managing countywide ambulance service — demanded the action plan in a letter to the company dated Oct. 4. The letter, which served as a notification of noncompliance, indicated that Falck had failed to meet the 90% on-time threshold for Code 3 service calls in each of the three deployment zones throughout the entire county served by Falck. A Code 3 call requires an urgent response using flashing lights and sirens by the responding unit.

“These performance shortfalls represent an unacceptable progression of Falck's poor response-time trends, which the EMS Agency has been raising with Falck with increasing alarm and to which Falck has responded with a disappointing lack of urgency,” wrote ALCO EMS Director Lauri McFadden. “As the EMS Agency has discussed with Falck over the past several months, it is clear there are significant problems with Falck's operational plan. Noncompliance with response time requirements — particularly those pertaining to high priority requests for service — is a serious matter.”

A spokesperson for ALCO EMS declined to specify the exact nature of the problems identified with Falck’s operational plan. Falck, however, has placed the source of its response time problems on its staffing shortages and on the amount of time spent at local hospitals waiting to transfer patient care from ambulance crews to hospital staff, referred to as wall time or ambulance patient offload time.

“The pandemic-induced staffing shortage is a national crisis that affects virtually the entire labor market, especially healthcare,” said Jeff Lucia, Falck USA director of marketing and communications, in an email to The Independent. “But it has particularly impacted hospitals and EMS agencies of all types — ambulance services, fire departments and other public agencies alike. All over the nation, at every hour of the day, ambulances are stuck outside hospitals while paramedics and EMTs care for patients waiting, sometimes hours, for hospital beds.”

According to Lucia, ambulance wall times have long been an issue, but in pandemic times, they have become a crisis.

“Ambulance services across the U.S. are finding themselves stuck in the middle of a crisis they didn’t create and can’t control,” he continued.

Rob Lawrence, executive director of the California Ambulance Association, described compounding, systemic problems that are impacting emergency patient care across the country. Staffing shortages at hospitals increase the time it takes to admit a patient to an emergency department. That results in longer wait times for ambulance crews. Added to that are high turnover rates among paramedics and emergency management technicians (EMT) that are exacerbated by a diminished flow of replacements coming out of schools. The COVID-19 pandemic stopped in-person schooling; many paramedic and EMT programs were forced to shut down as those programs required in-person instruction.

“This is almost the microcosm, in Alameda (County), of the national picture right now,” Lawrence said. “I think it’s fair to say that these issues are going on across the country. We hope, of course, things get better. But right now, we are where we are.”

While not oblivious to the increased wall times at county hospitals, ALCO EMS met with Falck to discuss increasing patient offload times and other operational issues “unrelated to the pandemic” that hindered the company's performance. McFadden stated in a Sept. 1 letter to Falck that meetings about these issues were held in June and July. As Falck’s performance continued to deteriorate, a full-day meeting, which included the CEO of Falck, was held to address ALCO EMS’s concerns over “worrying actions” taken by Falck. That meeting did not relieve the county’s apprehensions.

“Despite the EMS Agency's warnings and suggestions on how to improve on-time performance, Falck has consistently displayed a lack of urgency in proactively correcting identified issues, resulting in increasingly poor performance,” wrote McFadden.

McFadden also warned in her September letter that if on-time responses fell below the 90% threshold, the county would reinstate the assessment and collection of penalties that were temporarily waived in deference to the unforeseen challenges presented by the COVID-19 pandemic. In McFadden’s Oct. 4 letter, she indicated that those penalties had been reinstated. Stating that Falck’s “increasingly poor performance goes beyond the effects of the pandemic,” McFadden added that Falck’s August performance would have resulted in a $440,000 penalty.

Falck must present a corrective action plan to ALCO EMS by Oct. 19.

“In Alameda County, we’re definitely taking the increase in response times very seriously,” Lucia said. “We are aggressively pulling every lever we can, such as mandating overtime, aggressively recruiting, and offering unprecedented signing bonuses. As a result of those efforts, we are staffing more unit hours today than we did on day one of the contract … Unfortunately, our heroic paramedics and EMTs are spending more than 30% of their time stuck at hospitals and unable to respond to emergencies. And equally unfortunate, no number of additional ambulances, paramedics or EMTs will free a single hospital bed or add a single nurse to a short-staffed emergency department.”