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Alameda County — The county’s beleaguered provider of emergency ambulance service, Falck Alameda County, was recently assessed a financial penalty when it failed to meet its contractual service levels. However, the company received approval of its corrective action plan (CAP).

Alameda County Emergency Management Services (ALCO EMS) — the agency in charge of managing countywide ambulance service — assessed a $215,000 compliance penalty last month on the service provider after ambulance response times fell short of the standard in September.

ALCO EMS has been critical of Falck’s operations. As the company’s performance deteriorated through the summer and fall, ALCO EMS complained about a lack of urgency on Falck’s behalf to improve ambulance response times. In early October, ALCO EMS Director Lauri McFadden demanded that Falck submit a CAP outlining the steps it would take to restore service levels. A first draft of the plan was rejected by ALCO EMS, while a revised draft was accepted Oct. 29.

“Upon review of the submitted update received on October 27, 2021, we have found that Falck has adequately identified the issues that contributed to the response time performance shortfalls in August and September of 2021, provided a plan to address these issues, highlighted efforts already underway, and provided trackable metrics to monitor progress as Falck works to improve their performance,” wrote McFadden. “Based upon this determination, this letter serves as approval of the submitted Correction Action Plan for implementation.”

Falck splits the county into three service zones — North, South and East. The cities of the Tri-Valley fall into the East zone. Each zone is further divided into rural, suburban and metro/urban subzones. Calls for service are divided into code 2, code 3 and 5150 calls. A code 3 call is a time-critical emergency that requires the responding ambulance to use lights and sirens. A code 2 call is not time-critical, and a 5150 call refers to an individual experiencing a mental health crisis. Each call type in each subzone is assigned response time, and Falck is expected to achieve that response standard 90% of the time.

Most of the call volume originates in the metro/urban subzones. In September, Falck missed the 90% standard for code 3 calls in each of the three metro/urban subzones. The same was true in August, though the service levels were actually worse in September, indicating that Falck’s efforts to reverse its performance slide had not yet started to yield results. As of this writing, Falck’s October performance report is not yet available.

“Falck is committed to making steady improvements in line with our commitment to provide Alameda County residents and visitors with the best possible emergency medical care and transportation,” said Jeff Lucia, Falck USA director of marketing and communications, in an email to The Independent. “The initiatives will take time to have a significant effect, but we hope to see improvement quickly.”

According to Lucia, the CAP focuses on five areas including reducing the amount of time required to transfer a patient from an ambulance to a hospital emergency department; improving staffing and improving operations.

The time it takes to transfer a patient to hospital care is known as wall time. Extended wall times have been a problem across the country as hospitals struggle with high patient loads resulting from the COVID-19 pandemic and staffing shortages of their own. Lucia reported that the average wall time that Falck has tracked dropped from 57 to 52 minutes recently.

While not oblivious of the increased wall times at county hospitals, ALCO EMS previously met with Falck to discuss increasing patient offload times and other operational issues “unrelated to the pandemic” that hindered the company's performance. Gary Breazeale, treasurer for Local 510 — which represents emergency medical technicians, paramedics and support staff — said that Falck blaming wall times for the long responses aims to detract from its staffing shortcomings.

Keeping ambulance crews staffed has been, and continues to be, a challenge for Falck. The CAP states that while Falck has hired 74 paramedics and emergency medical technicians (EMT) in 2021, they have lost 117.

“We're being very aggressive about recruiting, including offering generous signing bonuses and working with specialty recruiters,” Lucia said. “As almost all paramedic schools shut down during the pandemic, we are competing for a more limited number of qualified caregivers than in the past. Another contributor to the decreased talent pool is the EMTs and paramedics who have left the profession entirely, like many other health care professionals across the U.S.”

Extended ambulance response times impact operations that extend beyond Falck. Most medical calls result in the dispatch of a fire department unit in addition to the ambulance crew. Fire crews are committed to those incidents until patient care can be transferred to Falck paramedics and EMTs.

“When our apparatus sits on scene for an extended time waiting for the ambulance, that means that they’re not available for another call in their respective district,” said Eric Moore, deputy chief with the Alameda County Fire Department. “So, we would be sending the next appropriate unit to respond to that call.”

ALCO EMS is expected to review Falck’s progress at the end of the month. A spokesperson for ALCO EMS said the agency is closely monitoring Falck’s performance and they are meeting on a regular basis.

"It is critical that our residents receive timely ambulance responses, and I'm glad that our EMS agency is holding Falck accountable to their contract and responsibility,” said Alameda County District 1 Supervisor David Haubert in an email to The Independent. “Now that the corrective action plan has been accepted, I'm looking forward to seeing the needed improvements."