The number of ambulance calls has dropped, leading to a sharp drop in revenues. The county’s private ambulance provider says it is taking steps to avoid furloughing paramedics.

Alameda County’s ambulance fleet has seen a sharp drop in calls for service in recent weeks. We may be in the midst of a global pandemic, but since we’re all staying home, car crashes have plummeted. Some hospitals are seeing far fewer heart attacks and strokes, though doctors don’t know exactly why.

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The reduction in transports means a sharp drop in revenues — leading Alameda County’s private ambulance provider to caution that local paramedics and emergency medical technicians could be put on a mandatory leave of absence.

Citing a “very real and very pronounced” downturn in the need to transport people to the hospital, Kenya Howard, an executive with Falck — which is the world’s largest emergency medical transport company and has a contract to provide ambulances for Alameda County — emailed employees on Monday, March 30, letting them know they might be furloughed.

“We are currently working closely with your union and have already been in discussions about the course of action,” Howard wrote. “We have not received confirmation this will definitely take place in Alameda but it’s being implemented in other Falck locations; globally and locally.”

Ambulance calls dipped first after March 16 when Dr. Erica Pan, Alameda County’s interim health officer, issued a mandatory shelter-in-place order. There were about 384 calls for an ambulance per day in the first half of March, but by the last week, the average was down to 300. The prior year, there were 421 calls daily for an ambulance in March.

According to Alameda County Health Care Services Agency data, the county went from an average of about 220 ambulance transports per day down to 150 by the end of March.

While a Falck human resources director alerted employees by email that furloughs are possible, Jeff Lucia, a spokesman for Falck USA, said that the company is not furloughing emergency medical technicians or paramedics.

“With patient transport volume down as much as 44 percent over the past month, Falck has taken carefully measured steps to preserve our ability to respond to patients in the future,” he wrote in an email to Berkeleyside. “These measures include temporarily reducing back-office and support staffing.”

Some seasoned Alameda County emergency workers say Falck’s potential furloughs are only the most recent problem facing emergency medical services workers on the front lines. They say there hasn’t been enough testing of EMS workers for COVID-19, and that sick leave policies haven’t been adequate.

In addition, ambulance response times were a problem in Oakland well before the coronavirus. Falck has already had to pay hundreds of thousands of dollars in fines for slow response times in Oakland and surrounding areas, including $372,500 for its first two months of service in Alameda County.

Public fire departments also operate ambulances, and while they’re much more expensive to staff, they are less vulnerable to market forces that could cause furloughs or service reductions during a crisis.

“The problem with the emergency medical system isn’t too many ambulances going to too many calls,” said Zac Unger, president of the Oakland Firefighters Union. “It’s too few ambulances taking too long.”

Alameda County Fire Chief David Rocha said local firefighters have seen an overall reduction in calls for medical help because of the stay-at-home orders, but an increase in calls that need a “heightened level of infectious disease control measures.” That’s why his agency is “ramping up” for a potential surge of COVID-19 patients.

“We are expecting to use all personnel and arranging for recently retired personnel to return to support our operations with planning and logistics so our firefighters remain available to respond,” Rocha told Berkeleyside via email. “We do expect to have some firefighters become ill, so we need everyone.”

Under its contract with Alameda County, Falck can recall workers in an emergency, and the company could be spared fines during that emergency if their response times don’t meet typical benchmarks.

Falck employees have criticized their employer’s sick leave policies. Until recently, if a Falck employee was feeling sick, they had to use their paid time off, or PTO, a problem for newer employees who may not have accumulated enough sick days for the two-week coronavirus isolation period required by the health authorities.

Falck told Berkeleyside that it has changed this policy in light of the pandemic. Front-line employees who become symptomatic are now sent home with full pay, without having to use their PTO. “Falck has committed to advancing PTO for employees who need it to care for family members who are ill,” said Lucia, the Falck spokesman. “To date, no employee in our Alameda County operation has needed to use this benefit.”

Lucia said Falck is complying with Governor Newsom’s directive that healthcare workers and emergency responders remain at work after an exposure to coronavirus unless they become symptomatic.

Falck employees in Alameda County, like other emergency medical service providers across the nation, have also complained they don’t have enough access to personal protective equipment, or PPE, and that they are forced to reuse masks. They’re worried about their safety, considering each transport could mean spending time with a COVID-19-positive patient in the small confines of an ambulance. “We don’t even have what we need to protect ourselves,” another Falck employee told Berkeleyside.

The California Department of Public Health’s COVID-19 mitigation handbook says ambulance personnel should follow guidelines from the Centers for Disease Control for personal protective equipment. Falck says it is supplying staffers with PPE in accordance with federal, state and local standards. That includes managing their levels of N95 masks, which are in short supply across the country.

“All field personnel are issued masks at the beginning of their shift and the masks are immediately replaced if they become damaged or soiled,” Lucia said. “To preserve supply and ensure protection for our clinical staff and patients, some of our locations allow reuse of N95 masks following CDC guidelines for doing so safely.”

Guidelines also state that “EMS personnel should have a designated area to doff their personal protective equipment and clean their ambulance between patients.” Three Alameda County emergency workers who spoke to Berkeleyside say that’s not happening, and that some employees come in early to give their ambulance a proper disinfecting before their shift. “We’re literally in and out of hospitals during an entire shift,” one employee said.

Watching New York City’s healthcare system become overwhelmed with COVID-19 patients, local Falck employees say they’re glad that Alameda County’s curve has shown signs of flattening, but that they worry this is merely, “the calm before the storm.”

“It’s only a matter of time before this all bursts open,” one employee said.

Clarification: This post was updated to clarify that Jeff Lucia, spokesman for Falck USA, says Falck is not furloughing emergency medical technicians or paramedics.