INDIANAPOLIS – Legislators analyzing Indiana's trauma care system heard Wednesday about a statewide deficit in emergency medical services – something Fort Wayne has seen firsthand.
A summer study committee is reviewing all aspects of trauma care in the state – from initial assessment and transport to hospital care and lessons about injury prevention afterward.
The starkest testimony Wednesday was about ambulances, emergency medical technicians and paramedics.
"Our workforce is exceedingly stressed at this point," said Dr. Michael Kaufmann, medical director of emergency medical services for the Indiana Department of Homeland Security.
He said the number of certified EMT’s and paramedics has decreased slightly in the last three years. And in 2020, the number of new certifications was the lowest in at least a decade. Part of that is because the number of institutions providing the training also is declining.
But the number of runs has grown 44% since 2018 – to more than 1 million last year. This year's pace is even higher.
The number of ambulances has dropped – 1,789 statewide in 2020, a decrease from 2,022 in 2019.
That means fewer ambulances to respond to emergencies such as heart attacks and vehicle crashes. Kaufmann said that also means fewer ambulances to transfer patients to hospitals with more appropriate care, so patients sometimes wait hours in a facility and it could even result in a preventable death.
The state’s emergency medical system was designed to deal with 911 calls – not interhospital transfers, which needs to be addressed, Kaufmann said.
The Fort Wayne City Council is looking into a paramedic shortage at Three Rivers Ambulance Authority because the agency declared an emergency after its contractor, PatientCare Logistics Solutions, fell out of compliance in August for the time it takes ambulances to arrive at emergency incidents.
The ambulance authority board has fined PatientCare about $575,000 for noncompliance.
Many of the staff who are leaving the ambulance authority are going to agencies that are paying significantly more. The contractor is limited on how much it can pay staff by the reimbursements it receives for runs. About 70% of its reimbursements are from Medicare and Medicaid.
Kaufmann said Wednesday that reimbursement levels are a major reason for the funding problems and why entities are having trouble paying competitive wages.
He said 50 years ago the focus was on moving patients quickly and ambulances were reimbursed as transportation providers rather than health care. Now ambulances carry expensive equipment and medicine and the cost has risen while reimbursement hasn’t kept pace, he said.
"It is an extended practice of medicine," Kaufmann said, but noted reimbursement is still structured on miles transported.
He used a slide to show that someone injured in an urban or suburban county in Indiana has an average response time of 3 minutes and transport time of 5 minutes. For a rural county that jumps to 17 and 30 minutes. And if the patient needs to be transported to a trauma center it can take hours.
Indiana has 22 verified trauma centers – ranging from Level 1 to Level 3. That number is up from 1994 when Indiana had only three trauma centers – all in Indianapolis. Lutheran and Parkview are Level 2 centers.
Most of the state meets the 45-minute triage and transport rule – which means it takes a maximum of 45 minutes to get a patient to the nearest trauma center. But northwest and southeast Indiana have wide swaths without coverage.