County funds ambulance alternatives as call volumes remain high

With 911 call volumes still near pandemic records and EMS staff shortages limiting ambulance availability, the Travis County Commissioners Court agreed to spend more for ambulance alternatives.

Commissioners voted Tuesday to increase the county’s share in the 2024 interlocal agreement with Austin by roughly 11 percent to reach $17.6 million. The additional funds will be used to develop ambulance alternatives first explored during the pandemic, Austin EMS Chief Robert Luckritz said in his presentation to commissioners.    

At the urging of Precinct 2 Commissioner Brigid Shea, they also directed the county attorney to explore legal options against the state of Texas for adding to the county’s health care costs.

Luckritz began his presentation by reminding commissioners that in some ways the pandemic has never ended. 

“Prior to the pandemic, we were seeing about a thousand calls a month in Travis County,” he said. “Now we’re seeing about 1,400 to 1,500 calls.”

Life-threatening emergencies are “less than 10 percent” of what EMS handles, Luckritz said, and “the remainder of those calls can potentially be cared for utilizing other resources.”

Many people call 911 but don’t need an ambulance, he said. They call because they have no other options.

“There’s a huge subset of the community that utilizes 911 because they don’t have anyone else to call,” Luckritz said. “The urgent care center may charge you upfront and if you don’t have resources to get in the door, the ultimate fallback is to call 911.” 

This is not the best use of 911 resources, he said, “particularly as we see this growth in volume and we realize that ambulances are a limited commodity.”

During the pandemic, EMS personnel realized that taking someone with a minor issue to the hospital might actually make their condition worse, Luckritz said. They began exploring alternatives. 

“If we can identify what your emergency is and care for you outside the hospital, either through our own resources or through telehealth, it’s better for everyone,” he said.

This approach has advanced rapidly, Luckritz said. 

“As we evolved into 2021, we saw that there’s a whole host of things we can do outside the walls of a hospital to provide services,” he said.

This includes the paramedic practitioner program, which provides pre-hospital physician assistance from licensed paramedics. Next came efforts to quickly identify critical cases and divert noncritical calls to other resources.

“We estimated about 35 percent of calls … don’t need to have an ambulance and we could solve their problems using telehealth and other nonambulance resources,” Luckritz said. 

All 911 call takers are certified medical dispatchers, he said. When they identify a nonemergency call, they transfer the call to a paramedic with access to a physician and a physician assistant.

Another option is to dispatch a paramedic to check on the caller in person and bring a physician in on video if necessary, Luckritz said. Specialist paramedics, including some in mental health care and some specializing in opiate use, are also available.

“By doing this, by recognizing that low-acuity calls might not need an ambulance and medium-acuity calls may not need the closest ambulance … this is actually increasing the number of ambulances available for high-acuity calls,” he said.  

Shea said issues with Texas’ health care system may have contributed to the spike in calls and costs. 

“I think it’s logical to assume that there’s some relationship to the millions of people in Texas who got kicked off Medicaid,” she said. “Now local communities have to use tax dollars to cover this cost.” 

She requested that EMS gather information about how many people call 911 because they lost their Medicare or Medicaid. 

“I’m assuming this is a pattern happening in most urban areas and probably some rural areas around the state,” she said. “If the state had participated in Medicaid expansion … would we be seeing less of this reliance on ambulances and emergency personnel for people to get health care?”

“It’s hard to say for certain,” Luckritz said, “but I certainly think that any barrier that we put up for someone to be able to access health care is going to increase the workload on the ambulances.”

As the amendment and renewal of the interlocal agreement came to a vote, Shea asked to include a request for the county attorney to look into legal options against the state. The vote was unanimous.

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