Wake EMS director talks staffing shortages
Dr. Jose Cabañas, medical director for Wake County EMS, discussed staffing shortages and an influx of calls at the Wake County Board of Commissioners meeting on Monday, Oct. 18, 2021.
which is essentially uh some of the significant impact we have seen throughout sort of the search and in this past summer, next slide, just for context. Uh here's our growth calling call volume data over the past several years and you will see that the E. M. S system continues to see a record pace of call volume growth. Now, I want to just provide some context. In 2020 we did see a drop in call volume because of the first part of the year, during the, at the peak of the stick at home orders. In that initial stages of the pandemic, we had a significant call volume drop in the months of March april and May Having said that throughout the year, in the second part of 2020, the call volume was returning to a regular baseline. Um but in 2021 as we came out of the restrictions in May and head into the summer we have experienced a 10.49% called bottom group which will be expecting 2021 to end. So if the projections maintain the VMS system will likely finish the 2021 over 120,000 calls, which is unprecedented for for AMS system in our community. Next slide please additional context. Uh this graph, the goal here is super. Show that are cobalt and grove over the several months has been records. Uh the red line uh sort of shows a 10,000 counts of incidents and obviously you will see that for the first time ever in the E. M. S systems history, uh since May we have experienced record called volume growth with august 2021. This sort of months ago we ran over 11,000 calls in one month. So all these record volume growth is completely unprecedented for the E. M. S. Systems history next life. Uh in August 2021 we had over 11,000 calls for that month which around 360 average calls per day. Um several days in July and August we exceeded 400 calls in 24 hours. And our highest called volume in a single hour was around 36 calls reminder. Uh it is not only the total calls in a day is when those calls comes in and as I mentioned before and sort of meetings and several um polling locations. We've had Days where we've had 82 calls, we've been three hour span. So it's not only the amount of calls in the 24 hours is when those calls are coming in next line. Now I want to uh remind are all of you and the committee and all of the commissioners that wake county uh uses clinical outcome based measures to modern and measure the quality of the care we deliver and our quality metrics are being maintained. We're providing excellent service, excellent clinical care to our to our community but essentially the system is under stress because of the significance and Kabul improve that we have experienced and has shown the paragraphs next slide now before we head into E. M. S. Staffing any questions so far questions Okay Vice chair Anderson. Good morning, good morning by Sure. Could you give us a few details about what you think is driving the call volume because it is increasing faster than growth in Wake County. It is it is a great great question. So um there are several things that come into play that that could explain why we're seeing this rapid growth this past summer. First we have we have significant more economic activity in the in in in the summer given the restrictions were lifted in May. So a lot of more desire for people guess visitors to be out in the community which you know unfortunately sometimes requires mhm services number two. I think there is a correlation with the fact that a lot of patients unfortunately in the community uh delayed care throughout 2020 and and what we saw here is a lot of lot of members of the community trying to access care trying to get their surgeries done now trying to go to the hospital. Now all those things come into play, creating a choke boarding and access to health care in the community. Third part that we cannot forget is the fact that we had the Delta search and the Delta search also caused additional cases an additional uh need to access health care services in the community and lastly like I have shared before Wake County did not start growing in the background. The pandemic uh the amount of new population in the community and more people coming into a county. All those things together certainly plays a key factory into why we have seen the significant girlfriend call volume. Thank you very much. Okay, we'll keep going next slide please. So uh Wake County has like many E. M. S. Systems in the country and in the state and in the region. Um uh We're not immune to the same challenges that anybody else in the industry. So we've had our staffing challenges uh this past summer which has been uh which is a combination of multiple factors but very two vacancies has been a significant challenge for for the system as a reminder of virtual vacancy is uh when we have an employee which is a longer leave. So F. M. L. A. Unfortunately and quarantine unfortunately sick military relief. So their employees that are not able to be uh staffing a unit um In the system We have successfully uh over the last 18 months be able to recruit. But we're starting to see a decreasing number of permanent applicants uh for all for a lot of reasons. And I'm going to those in a few minutes next slide please. So as you all may be aware uh This is not a Wake County only situation. It's a it's a it's a broader regional state and national problem in the industry. The issue is not unique to E. M. S. We know that health care in general is experiencing the same challenges that we are experiencing. What is unique and it's uh sort of new is the fact that we're now seeing competition, active competition for from non M. S. Typical non M. S. Employers for AMS clinicians to try to fill some of the gaps in other areas of the health care system. As we all know, there is a significant shortage of nursing staff that has affected our hospital systems and a lot of hospitals in the in the in the country. And now there is a desire to also recruiting explanations to feel some of those voids within those health care domains and that creates significant challenges for mm systems that already have uh stressors regardless to recruitment, potential and staffing and those have been more likely noticed in the last four months next life please. So I wanna, I wanna dive into a little bit of what strategies have we have already implemented and actively working on and things that we're gonna be looking doing forward first. Uh We already have implemented a number of things to manage the challenge that we've had over this summer in this past several months. First, I want to thank the commissioners, the board for the resources to address the Saudi adjustments that we did in july that's part of our compression pay study that was important were very critical for a workforce. Um We have also in order to manage resources uh more efficiently effectively throughout the challenges we have worked with the hospitals to modify a diversion policy as reminder of diversion when the hospital is completely oversaturated when they have to pretty much asked James to consider other options and don't bring patients because they don't have Uh space or they're completely overwhelmed at that point in time. So we've worked with hospitals to try to mitigate those instances so we don't have to drive longer for transports. We've also modified response plans to find opportunities to decrease those multilateral responses as a reminder. Um, even though we've had 11,000 incidents in August Those equates sometimes those equated to 16,000 responses because sometimes an incident requires more than one resource. Um and obviously our administrative staff has been actively actively involved in the field supporting our operations and helping uh just to make sure that we have resources to respond to those incremental calling that we have seen this summer. Next time. In addition we have deployed what we uh explains and second BLS ambulances. So the typical ambulance in Wake County has one Mt one paramedic regardless of the call that comes into the system. So we have in order to manage some of those non emergency call types that we see that we have received and seen an increase this past summer. We've deployed ambulances that with E. M. T. S. Uh an advanced E. M. T. S to free up some of those paramedic level ambulances for higher security calls. And the program seems to be working well and it's something that we're going to look towards expanding in the future. We're also working to bring into the system a nurse navigation line to decrease those sort of calls in which E. M. S. Needs to respond and decrease some of the overall uh load into the emergency departments. As a reminder, we uh in the AMS system have seen an increase in those non emergency calls uh, into the system. So sore fraud, um, ankle pain, leg pain, things that are non emergent doesn't mean they're not urgent, doesn't mean the patient needs access to health care, but we're trying to figure it out better, innovative ways to connect patients with the best resource at that point in time. And that would help free up some capacity to manage higher acuity or calls with higher needs. That's like another critical aspect that we have to keep our mind on is the fact that we have to maintain or improve our position in the market regards to pay for AMS clinicians while being mindful of our incoming personnel. We have to continue work very hard to produce credential clinicians paramedic through original paramedic program and our partnership programs. Um, the community college system doesn't have the capacity provide the number of credential PMS professionals needed to support E. M. S. Mystery needs. And that's a well known challenge across the industry. So we have uh several strategies in place to bring uh candidates into our apprenticeship programs and a paramedic programs to build the future workforce that will care for the for the community. We have been in the past actively uh with our HR departments and regional colleagues, making sure that we are in a competitive position in the market to attract uh new professionals into the M. S. System. But this market has changed, the market is very fluid uh is changing very rapidly. So we're working very aggressively with our human resources uh colleagues to make sure that the worst thing ahead of it. Next line with that and before I stop, I wanna chair, if it's possible as our Deputy rector, Don Garner, to talk very briefly an update on how apprenticeship programs and and the work we're doing. It's sort of pointing out, don, can you come in a minute? Yes, thank you. Um Really this started about a decade ago with a very concerted effort for us to create our workforce development pathways. Um So as you may be aware, we offer an E. M. S. Camp during the summer because of the population of that camp. In the popularity, we've we've grown that program where we offer two basic M. S. Camps and now to advanced M. S. Camps uh geared towards high school students. We also offer an M. S. Club again as a way to introduce high school students uh into the E. M. S. Industry as a whole, to get them interested in it, to see if they would want to pursue a career. Uh and E. M. S. And then really since um 2018 we've partnered with the Wake County public school system with a couple of initiatives. Uh the first is in 2018 with the previous county manager, uh we asked to have E. M. S. As an industry as part of the North wait Korea in college Academy. And as you, as you know, those high schools allow the students to earn credit towards an associates degree in partnership with Weight Tech. Um We had some hurdles initially, but we've worked through those uh and that program is running very smooth now we have a great relationship with the principle of their doctor battle. Um and we've actually hired five of those students um from that program uh that not work for us. Um Last year we were approached by the school system to see if we would be interested in teaching 1/5 period MT class. So this is an after school E. M. T. Class that is open to all high school students within Wake County. Um and we think that here at RsX and our training center, Um and again, it's opened up to to all high school students, we have 15 students uh in the cohort this year. Um and we uh we are very excited about that program and the opportunities that it presents. Um and all of these initiatives really sort of funneled into our registered apprenticeship that we started um in earnest in 2019 before we really knew about the way it works program. Um So we we create an apprenticeship here. Wake County M. S. Um we currently have seven apprentices in the program. Um We we realized earlier this year that we actually had a gap uh into who we could get into the apprenticeship program. There are a lot of deadlines associated with apprenticeship when students graduate high school, when they have to enroll into the E. M. S. Program at Wayne Tech. Um and we have a lot of students who don't go to Wake County public schools, we have private schools and home school students. Um and so we created a pre apprenticeship this year. Um and as a result of that, we were able to enroll 30 students in our pre apprenticeship initiatives. A good example of the gap that we identified as. Um there's a senior at a high school who plays football, uh but because of his after school sports activity, he couldn't attend the E. M. S. Uh M. T. Class that we do here at the SX. So by putting him under the pre apprenticeship umbrella that allows him to go to a tech and take an E. M. T. Class um while he's having to do some some other things to get used to the industry and so that pre apprenticeship really helps us sort of bridge the gap between all of our workforce of strategies and again, it's dr Craven's mentioned, we do offer the internal paramedic program here where we teach uh initial paramedic education uh to our MTs and advanced MTs that worked for us. Um We started that in 2019 and we've graduated 13 of those employees that are now fully functional paramedics within our system, We currently have a class going on right now and we have 10 employees registered in our in our class, so we are really ahead of the game when we talk about pathways to getting people into E. M. S. Um and hopefully these initiatives, while they're starting to point out now really will take off here in the next um Year or two and we can really see some big numbers from these initiatives. Thank you very much. Doctor cabanas. Are we at the commission and questions and comments section? Yes, sir, sorry for the wait a little longer than expect. No, no, this is all very, very helpful and we really appreciate it. Um Okay, uh Commissioner questions and comments. Okay, I think I saw Commissioner Sabana by hair and then commissioner thomas. Mhm. Okay, I'm gonna try to consolidate all my questions, so thank you so much. Doctor cavanaugh says um and um Mr Gardner for thinking of innovative ways to try to um get more people to get involved in in having M. S. As a profession. Like I can't believe the innovation that you all are thinking of and I totally appreciate especially in this shortage um I will comment in that. I was at the Guatemala Independence Day with your staff some of your staff there including some of your students and you couldn't tell the difference in their professionalism. You all have been training them so well it's seamless and and hopefully you'll have more fruitful prospects and cadets who will be future employees. Um I do want to go back into um nurse navigation line that is so Such a great idea I do want to ask and we can go into the weeds later offline. But is there an opportunity um in that are 911 operators get retrained into doing triage better in identifying non emergency. And is that how they're getting to a nurse navigation lines? So there's more credibility that a nurse triage. So that's a great question. Commissioner Sylvania and and and and without getting to the all the very very specific operational nuances. Um There's a lot of regulatory pieces and parts that go into um sort of how I now want call its handle are now one call centres use international standards of medical part dispatch which pretty much is a system that allows you for and undifferentiated call caller when calls number one to be able to um asked some key questions, provide instructions when needed, but categorize the call whether it is a, an emergent that needs a lot of resources responding now or something that is not uh, emergent. Uh, another million response. What we're trying to do with the nurse navigation line is for those calls that we know based on data and also in our system data that are non emergence. Can we provide them better options for accessing care? Um, and if there are transportation gaps or things of other nature, how we actually fix some of those and held those in a better way. So it provides patients with a better option to connect them with the right resource and the right amount of time so in and those will be sort of a handoff so warm hand up and and and the nurse will do a more in depth assessment and provide additional information options and so forth. But once we get closer to what we can turn it on, we'll be sharing more information. Thank you very much harm us. Thank you. Um, I just wanted to say that, thank you so much. I really appreciated seeing, um, strategies that were already implemented as well as the strategies that are in progress. You know, the hospital diversion policy and hospital destination, I think were really important to note that those things have already been implemented, but I really really wanted to comment on what mr Garner had to say about how we're going to fill the pipeline. I mean, I am such a proponent and champion of exposure, right? So giving kids in high school the opportunity to see that this is an option for them and then giving them the opportunity to really get their hands in there and do the work to know that this is something that they might like. Um, and so I love the idea of the after school club and then of course the apprenticeship program and I'd love to hear more about that. I know that there of course are probably some challenges, especially with high school kids talking about transportation, not everybody has a car to be able to get, you know here or there. It's different when it's after school or at a school. Um, so I just love to hear in the future about some of the challenges and maybe a one on one conversation about how we can really make that program both high school and college apprenticeship through weight tech more accessible to more people in our, in our county and more of our population, but super excited to hear about that, thank you so much. Absolutely, Commissioner thomas, thank you so much for for those, those comments were happy to at some point whenever you all feel like it's appropriate or the chair is appropriate, would be happy to come in and do a more in depth conversation about our partnership programs were very excited. We believe that our vision is that the future workforce will come from with the community care for the community and and this program will allow us to also expand in our diversity of our workforce and making sure that we are reflecting the community where we serve and and uh, Mr Garner, dr Garner and I there they went to the high school to listen to the students percent sort of their project after summer internship with PMS. And it was fascinating. It was very powerful, seeing students connected with the emails profession, the overall health care profession. And it's the future. And certainly, um, as the community is growing very rapidly, uh, we have to be very innovative and be mine thoughtful about how we approach the future workforce and this is their plan and we're committed. Thank you very much. Doctor Habanos, Vice Chair Adamson, thank you for this information. It does seem like a very innovative program. The question I have is When the 911 operator goes to do the warm hand over, is that with the consent of the collar, Does the collar get to say no, I don't want that. I do want M. S. Services in my home. Yeah, we're still we're still working through those processes, ensure Adamson. So it's not ready for prime time. But yes, I mean the the goal here is to making sure that our patients, no what options are available for for them to access care when they have a non critical call to non system. So if I have a something that is not an emergency but I'm accessing M. S. Because I don't know I have other options. We want to make sure that there is a process that informs him very well. But what those options are um bottom line. The goal here is that if a patient needs E. M. S. Or need access to care, we're always gonna be there. But I think the future E. M. S. Service delivery is gonna require that we diversify how we deliver services that we diversify our options on how we care for the community. So once we have a more sort of a detailed approach and how how is gonna play out. We're happy to share that information. Thank you very much other answer questions. Okay well doctor cabanas we really appreciate you and your staff for dealing with what everybody knows is an extremely difficult time, especially for your industry and your specialization. So I know that we're all extremely grateful and we know that your leadership has really saved lives in the county and that's really something to be proud of. So we really do appreciate it. Obviously we want to have what we want you to have what you need to succeed and to keep everyone healthy and safe and so we appreciate this presentation today and I know all of us are also really appreciate the interest in an exploration of um opportunities to diversify our offerings and really make sure that we have. We don't just use the same tool for every situation, but really diversify our tools and try to make sure that we're doing things as effectively and efficiently as we can amid a labor crisis, national international pandemic, a number of other headwinds that you're having to deal with. So, um, thank you again very much for for everything. Thank you. Larry, thanks commissioners and I appreciate your support. And again, I want to also thank to all of our providers out there are emails and personnel from now on call takers or firefighters too. RMS clinicians, they are doing an amazing job caring for the community during this unprecedented time. So thank you so much. Thank you. Okay, um, that has brought us to the end of our public Safety committee agenda for today. Is there anything else that anyone wants to raise before we adjourn going? Once going twice? Uh, Commissioner Sylvania Just very quickly I wanted to mention that are professional organization, the North Carolina Association for County Commissioners. Um, the new President Frank Williams has uh, established his new initiative for the year as 100 counties prepared. And so this goes along with public safety and and I've been lucky to actually be selected for this task force. So as more information comes along, um, I'll share it and hopefully get on the agenda just for a brief time to let you know, uh, the efforts as they're progressing.