What Is Keeping Private Emergency Medical Services Providers Awake at Night During COVID-19?
By: Sandra Marini
Tags: Healthcare, Covid 19, Emergency Medical Service, Economics, Current Events

Emergency Medical Services (EMS) sits at the intersection of emergency medicine and public safety. It is often called the out of hospital component of the acute care system.

There are many different levels and types of service provided in Alberta (Figure 1). The key is identifying, responding, assessing, treating and transporting patients.

Figure 1 Sectors of Emergency Medical Services in Alberta

I interviewed two industrial medical service company owners in the province to have better understand the impacts of COVID 19 on demand for their services, workforce sustainability, efficient service provision and some surprise market growth (Podsiadlo, 2021). One owner focuses specifically on industrial site standby and the other provides both industrial onsite and specific events standby.

Keeping the Wolves from the door

First and foremost, this sector of EMS differs because it is a competitive market and susceptible to the demand for and the supply of the product or service required. This competition is monopolistic as there are many small industrial medical services providers in the market, each with slightly differentiated product (Curtis & Irvine, 2020). As an example of this differentiation with the services being interviewed, one focuses on onsite industrial medical standby in rural Alberta, whereas, the second provides industrial standby, clinical, inter-facility transport and special events standby.

Each provider influences its market share to some extent by defining its price (Curtis & Irvine, 2020). The price for the service can vary depending on the number of industrial contracts available and/or the number of medical staff available to fill the. Steve remembered that in 2018 a change in safety standards increased the demand for paramedics and because of a shortage provincially, the price to staff increased over a short period (moving from $450 to $1400 per day). Conversely, this sector is affected by changes in the economy, such as the economic downturn in oil and gas. Both owners spoke about how “we were already feeling pressure because of the reduction in our industrial contracts with the oil and gas downturn” where they had a 50 -60% reduction in contracts for onsite medical care services and they needed to hibernate 70% of their industrial workforce into 2020. With this large portion of their staffing compliment waiting to get back to work, it was not great news when on March 5, 2020; the first case of COVID 19 appeared in Alberta. Things deteriorated when on March 24, 2020, the first outbreak on an industrial site happened and everything changed from there (Government of Alberta, 2021).

Even with the economic downturn both owners still had industrial onsite and special event contracts in place as of March, 2020 when the Province instated public health measures. COVID 19 stalled the work as industrial sites were closed, special events were cancelled, and the remaining staff were hibernated for 2 to 3 months while the organizations, the province and the medical service providers developed the COVID standards that would be in place before the return to work. This post will look at the product costs because of the new infection control standards, the human resource costs from the hibernation of staff, and the exploration of future growth opportunities that highlight the new economic realities for these companies.

How can I survive with these costs?

The product costs during COVID increased considerably because of three things. First there was an increased demand for personal protective equipment (PPE) products , such as masks, gowns, gloves and protective glasses (in Alberta on a regular day pre COVID 100,000 N95 masks were used, compared to during COVID that increased to 250,000 masks per day [Government of Alberta, 2020]). They can also play a role in preventing sick people from spreading the virus when coughing, simply talking, or breathing. Second, there were a larger number of consumers looking for the PPE products, but not any additional suppliers providing the PPE initially. With COVID infection control standards — many non-health organizations were now ordering PPE without an initial increase in the supply available. “It was tough enough getting PPE supplies when we were competing against health organizations, with COVID everyone and everything needs PPE!”(Steve). Third, the simultaneous shift in supply and demand together created an increase in price for these products (Curtis &Irvine, 2021). COVID-19 has caused a dramatic shortage in the supply of PPE, which is mainly explained by a surge in demand but also affected by limitation in supply chain. The smooth operation of transportation infrastructure and logistics, especially air cargo, is critical to support the PPE value chain during the crisis (Ferron et al., 2021). This increased demand for and a reduction in available supply of PPE –created shortages and urgency as workers may have responded with inadequate or absent PPE. All these forces pushed the price for PPE from pre COVID a box of 50 N95 Masks cost $55.00 — at Wave 2 same box was $235 — and April 2021 $400 (Weichel, 2021).

Meeting demand for PPE will become one of the main issues for governments fighting the pandemic. Masks may play an even greater role in the next phase of the crisis, when lockdowns are lifted and economic activity resumes, while the virus remains a threat. An alternative, more effective and cost-efficient solution in the long-term may involve the combination of strategic stocks; upstream agreements with companies for rapid conversion of assembly lines during crises; and supportive international trading (Xie et al., 2021).

My People are the greatest

he labour costs related to demand and supply of industrial medical services onsite staff has changed during COVID. Labour offers services such as time, skills and energy when hired by an employer. Curtis & Irvine (2020) noted that the value of labour springs from it value to the service provided and reflects the value of that labour in the market. It is important to distinguish between the long and short run demand requirements. First, providers have been asked during COVID to supply ever broadening primary and preventative public health services, through activities such as mobile care for worksite monitoring, COVID-19 testing, vaccination clinics, and home delivered testing and vaccinations. The broadening scope will exist for COVID but not beyond the pandemic. Both of these services have demonstrated the adaptability and flexibility to accept opportunities and be successful, however, they will admit that this has overextended the EMS workforce and it is not sustainable. Second, the elasticity of the supply of labour responding to extraordinary demand during the COVID-19 pandemic. Tim and Steve spoke about their frustration as a number of their staff did not return after the hibernation and it has been challenging to recruit with so many other job opportunities available. There has been a dramatic increase in market size during the pandemic, especially for those specialties central to COVID-19 care (Xie et al. 2021).

Challenges …….. Became Opportunities

These owners have done some incredible work and have taken leadership roles in education, training and support for the organizations they are working with and their teams. This leadership and support opened up a number of additional markets and COVID opportunities:

· At the beginning of COVID, each accepted contracts from companies to provide COVID testing for employees. This work was provided pre and post work shifts.

· One owner has a contract providing COVID testing within correctional facilities within the province.

· The rural owner accepted contracts for clinical services in rural clinics providing COVID testing and vaccination administration.

· At this time both owners have contracts and is, vaccinating varied populations within the province.

· One owner gushes at the success with the NHL 2020 bubble and 2020/2021 NHL season and the World Junior bubble.

· Finally, with the increased call volume within 911 Emergency response, the owners have increased their capacity to complete stable inter facility transfers within the Alberta EMS system. The owner noted that their call volume has increased by 75% to an average of 16 calls per day with a single unit.

“It’s been a crazy year” “We’ve learned more about who we are” “We’ve survived some crazy days, weeks and months” “I may never be the same again” “I think I will take a year off to recover from this year”

Final Thoughts

The economic impact of COVID-19 can be felt everywhere, even in EMS. A lack of preparedness was a major contributor to the struggles experienced by Emergency Medical Services. Many private emergency medical services (EMS) are struggling due to higher expenses for extra gear and safety precautions during a global pandemic (Ferron et al., 2021). Encouragingly, the deficiencies exposed by COVID-19 have prompted healthcare organizations around the world to invent new care models for patients. Alternative strategies such as telemedicine, social distancing, mask-wearing, handwashing, and quarantining have all helped decrease the effects of the COVID-19 pandemic and will likely influence healthcare for the foreseeable future (Xie et al., 2021).

Sources

Government of Alberta (April 2020). COVID-19 Alberta Statistics. Retrieved May 20, 2021from https://www.alberta.ca/stats/covid-19-alberta-statistics.htm#total-cases

Ferron. R., Agarwal, G., Cooper, R. & Munkley, D. (2021). The effect of COVID-19 on emergency medical service call volumes and patient acuity: a cross-sectional study in Niagara, Ontario. BMC Emergency Medicine 21 (30), 1–8. https://www.doi.org/10.1186/s12873-021-00431-5

Fuentes, G. (7 May, 2020). What’s next? How EMS can survive the economic downturn? Fitch and Associates. https://www.fitchassoc.com/whats-next-how-ems-can-survive-the-economic-downturn/

Podsiadlo, B. (17 March, 2021). Pandemic threatens future Emergency Medical Services. Petrie-Flom Centre of Law. https://blog.petrieflom.law.harvard.edu/2021/03/17/pandemic-threatens-future-emergency-medical-services/

Weichel, A. (21 April, 2021). $400 boxes of KM95 masks reflect high cost of bringing PPE to Canada. CTV News Vancouver. https://bc.ctvnews.ca/400-boxes-of-kn95-masks-reflect-high-cost-of-bringing-ppe-to-canada-company-says-1.4906469

Xie, F., Yan, Y., Agarwal, A. & Ferron, R. (2021). Economic analysis of Mobile Integrated Health Care delivered by Emergency Medical Services Paramedic team. JAMA Network Open, 4(2), e210055. https://www.doi.org/10.1001/jamanetworkopen.2021.0055