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Knox County EMS system needs overhaul, new report shows

Submitted, AMR

New bids for Knox County’s emergency medical services contract could be thwarted by the current contract’s design, according to a new report presented to the Knox County Commission on Monday. That report also found that some ambulances are waiting close to an hour at area hospitals before they can hand patients over to hospital staff, and that EMS response times are not equitable across the county.

The report, from Fitch and Associates, was presented to the Knox County Commission on Monday as it considers new bids for the Emergency Medical Services contract. The county currently has a contract with American Medical Response.

“Your market changed, so the contract that you currently are under was not going to be financially feasible going into a ... process to obtain a bunch of bidders,” said Todd Sheridan, a junior partner at Fitch, who pointed out that the higher costs associated with emergency medical care are being seen across the industry.

The average time spent for hospital turnaround in Knox County, meaning the time that EMS medics had to wait to relinquish patients into hospital care, was 53 minutes in 2022. Those delays are causing “a significant reduction” in the number of available ambulances in the county, according to the report. Hospital staffing shortages are at the root of that problem.

Fitch’s report points out that those wait times at hospitals “make it impossible for an EMS contractor to be sustainable,” which could hinder competitive bids in the search for EMS services. Fitch said the current EMS system is “financially unsustainable without subsidies or adjustments to performance expectations.”

With 43,507 hospital transports a year, 29,004 hours are spent waiting at hospitals, costing the system about $4 million a year, according to Fitch.

Knox County has a high percentage of self-pay patients, adding to the financial burden.

Fitch recommended new locations for EMS to allow for faster travel times, to meet a 10-minute response time, around the county. The firm also made recommendations for additional ambulances.

Fitch also recommended hiring a medical director and purchasing software to automate the required record-keeping, which is now done manually.

“If that contractor was to leave you and another contractor was brought in, then you are starting from scratch,” Sheridan said. “From a medical-direction oversight and a software oversight, that you all own that software, you all have a singular medical director to provide a system of controls for your community.”

Knox County Commissioner Kim Frazier raised concerns over awarding the contract to a single company. Fitch replied that two EMS providers could partner, but that only one would hold the main contract.

“I want to make sure that as a county [we] provide the most comprehensive, emergency response services to every citizen in every corner of this county and that we are looking at every available resource,” Frazier said.

Knox County will decide on a count EMS provider that will service the county starting Feb. 1, 2024. AMR, AmeriPro of Tennessee, Falck and Priority Ambulance have made bids.

Jon came to WUOT in 2022 as the local host for NPR’s Morning Edition. He previously served as a producer, reporter, and on-air talent for several stations within the former Citadel Broadcasting group of Knoxville. Jon’s later pursuits in communications were found in the civil service branches to include Anderson County Emergency Services, The Federal Emergency Management Agency, and most recently with the U.S. State Department in Iraq.
Riley was born in Wisconsin before moving to Tennessee at a young age to live in Nashville. She is a recent graduate from the University of Tennessee-Knoxville, where she graduated with a Magna Cum Laude degree in Journalism and Electronic Media. Riley started at WUOT as a news intern in 2021 before working with donor relations and becoming the weekend announcer.