AMR misses mark on ambulance calls 32% of the time in first Knox County report

A change in the makeup of a Knox County committee is designed to enhance communication with American Medical Response, the ambulance provider the county hired to serve patients in dire need of medical care.

Brent Seymour, Knox County's public safety director, said adding an AMR point of contact will be convenient. The renewed contract is under scrutiny because the county is paying for quicker service, and the company has promised to deliver. AMR hit the new compliance goals 68% of the time in the first month of the contract.

But changes are in the works to get ambulances to patients in life-threatening situations more quickly.

That 11-person committee advises the county mayor and the commission. Having an EMS specialist would allow the committee to take a deeper look at various emergency protocols.

"We can look at patient outcomes and do what we can to provide a better outcome for the folks in our communities," Seymour said.

The committee is made up of:

• Fire chiefs from across the county

• Knox County Emergency Communications District executive director

• Knoxville-Knox County Emergency Management Agency director

• Knox County finance representative

• Knox County Health Department emergency response coordinator

• Knox County Community Development director

• Mayor’s Chief Operating Officer

• A Knox County commissioner

Commissioner Carson Dailey, who cosponsored the ordinance with Chairwoman Terry Hill, serves on the committee. He said he always thought the county's EMS provider should be on the committee anyway, and was able to get other members to agree.

Commissioners will vote on the changes April 22.

It's been over two months since Knox County's new contract with AMR began. Its approval was a contentious process that shed light on the county's strained medical system.

Delayed ambulance response times, long emergency waits and hard-to-access services plague much more than the county. They're evident all over the country.

Commissioners promised to hold AMR accountable when the contract started Feb. 1. Compliance reports for the first month of the contract are available and the Knox County Health Department met with AMR officials for the first monthly compliance meeting March 19. Those meetings are closed because of patient privacy laws, health department Senior Director Kevin Parton told Knox News.

He said no commissioners have reached out asking to see February's data, but AMR will give them a report with data in May.

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What did February's reports say?

AMR's first monthly reports to Knox County, which Knox News obtained, cover compliance with target response times, systemic errors impacting service, customer hotline reports and "other reports requested by Knox County."

Josh Spencer, AMR's regional director, told Knox News they're still setting up the software needed for some reports and that February's data will serve as a control group for the months to come.

Response times were compliant with the contract's requirements 68% of the time

Targeted wait times are 10 minutes for inside Knoxville city limits and 20 minutes for Farragut and the Corryton, Mascot, Powell and Strawberry Plains communities, according to the contract. AMR is required to meet those response times or face a penalty.

In the report, the county is split into three different zones: Knoxville, West Knox County and East Knox County. The report measures the seriousness of calls, with priority 1 being life-threatening and priority 3 being the most minor.

• Response times in Knoxville were within 10 minutes 63% of the time overall and 65% for priority 1 calls.

• Response times in West Knox County were within 20 minutes 79% of the time overall and 87% for priority 1 calls.

• Response times in East Knox County were within 20 minutes 72% of the time overall and 77% for priority 1 calls.

Spencer told Knox News wait times were more compliant outside the city because the volume of calls within city limits was higher. He called it a "fractal measurement."

Nurse Navigation put 100 hours of ambulance availability back into the system

Under the new contract, AMR and Knox County have instituted a program, Nurse Navigation, aimed at alleviating strain caused by patients using ambulances for primary care. 911 calls with nonemergency injuries or illnesses aretransferred to a state licensed nurse who can assist with care.

Nurses can arrange transportation, like Ubers and Lyfts, to urgent care facilities, provide telehealth or recommend at-home care. In February, 241 patients were referred to nurses.

• 25 received advance life support transportation.

• 119 received basic life support transportation. That number includes patients who declined other options presented to them by nurses.

• 11 were ordered ride shares to urgent care facilities.

• 26 were ordered ride shares to the emergency room .

• 4 were referred to primary care physicians.

• 50 were advised to self-care.

• 6 were administered telehealth care.

40% of patients with Medicare, Medicaid or no insurance were kept out of EMS system

AMR also tracked the insurance types of patients referred to Nurse Navigation and what type of care they received. Of the 160 patients with Medicare, Medicaid or no insurance at all, nurses diverted 64 from emergency rooms. That saves patients money and opens up availability for ambulances.

"It's not just about this one call," Spencer said. "A lot of these patients dial 911 because they have no other option. If we do take them to urgent care, we're not just taking care of the problem now. The goal is to get them set up with a primary care physician that accepts their insurance or get them set up with (Medicare or Medicaid)."

Spencer clarified that AMR doesn't assist patients in getting insurance, but can take them to clinics that do.

"In the long run, that will take them out of the 911 system," he said.

What did AMR learn from the reports?

One of the benefits to having the first set of reports, Spencer said, is that AMR can adjust ambulance deployment methods based on response time data.

He said they took all of February's data and worked their way backward to figure out how many ambulances to have available at certain times to meet demand. They now have new target data and Spencer expects to see improvements in future reports as a result.

"We're trying to learn the new system," Spencer said. "I know you'll see with the March and April reports, (response times) are tremendously better."

A report the county used for reference during the contract process predicted 19 ambulances would be the target number to be compliant with response times. February's data showed they need more.

They're also diving into Nurse Navigation data to determine how they can divert even more patients from the system.

While 100 hours of ambulance availability saved might seem like a lot, Spencer said he wants the number to be even higher.

What do county officials think after the first round of reports?

Parton told Knox News the county will learn new something new about improving ambulance services every month. He declined to say whether he's satisfied or dissatisfied with the first round of reports.

"The new monthly reporting gives us new insight, discussion, and follow-up areas into the clinical and operational monthly events with the provider," Parton said in an email. ""There was not an assumption that a light switch would be flipped on Feb. 1 and all issues would be resolved."

He said moving forward, they're expecting improvement.

Allie Feinberg reports on politics for Knox News. Email her: allie.feinberg@knoxnews.com and follow her on X, formerly known as Twitter, @alliefeinberg.

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This article originally appeared on Knoxville News Sentinel: AMR misses mark on Knox County ambulance calls 32% of the time