Medic deputy director Jonathan Studnek stepped inside a dimly-lit room on a recent afternoon at the agency’s headquarters in west Charlotte. Operators talked into headsets while seated in front of panels of computer screens glowing with charts and graphs and maps.
This room is Medic’s communication center, also known as CMED. It’s where emergency medical care in Mecklenburg County often begins. Studnek gestured to a computer screen with rows of different colored boxes — each box representing a different operator’s desk.
“This is our call-taking board,” Studnek said. “The people in red are talking to a 911 caller. The people in green are available to talk to a caller. The people in orange are probably at the end of a call.”
Medic recently changed the way it responds to some of these 911 calls in the city of Charlotte because of staff shortages and other problems at the agency exacerbated by the pandemic. But some firefighters are worried that the new policy is bad for the Charlotte Fire Department — and, ultimately, for the public.
Sierra calls
Medic announced on Oct. 21 that it was adding a new classification of 911 call —nicknamed a Sierra call, like the letter S in the NATO alphabet. Sierra calls include people who dial 911 for medical problems that don’t appear to be life-threatening, like a headache or stomach pain.
For these calls, a fire truck from the Charlotte Fire Department will still respond as quickly as possible but Medic can take up to 30 minutes to send an ambulance. Previously, Medic would respond to similar call types in around 11 minutes maximum. The change, according to Studnek, is designed to keep more ambulances available in case of more serious calls.
“The standard of care shouldn’t be ‘rush, rush, rush, hurry, hurry, hurry,’” he said. “It should be, ‘Be judicious in the use of your resources. Protect your ability to get on scene quickly for those patients that need it and then pause and understand how best to serve the other patients.’”
Studnek said Medic’s resources have been strained for a long time but the pandemic made the new policy even more necessary. Medic currently has a shortage of 38 paramedics and emergency medical technicians, or EMTs. The agency implemented mandatory overtime in June to fill all of its shifts.
Medic has also been struggling to predict how many 911 calls it will receive on any particular day, Studnek said. While the agency used to be able to predict the number of responses within around 1%, according to Studnek, there are now unexpected surges. When the delta variant caused a jump in COVID-19 cases, by August Medic was transporting some 25 COVID-19 patients per day, compared to one or two earlier in the summer.
The agency has also seen an uptick in people calling with serious medical problems, which Studnek hypothesized is in part because they delayed going to the doctor due to the pandemic.
“When it’s difficult for us to predict how many calls are going to occur, it’s difficult then to predict how many unit hours we need to put on the street and to manage that volume,” Studnek said.
Where ambulances are most needed has been constantly changing, too. Early in the pandemic, according to Studnek, there were fewer calls from uptown Charlotte because people were staying home. Demand was higher in the suburbs. Now that some people are back in the office and some are still working from home, he said the pattern of where emergency medical services are in highest demand has shifted again.
“We’re still trying to learn how to manage a new city, basically,” he said.
‘It reduces our resources’
The Charlotte Firefighters Association, a union with about 700 members, released a statement opposing Medic’s new Sierra call policy.
“It reduces our resources by keeping them (fire trucks and firefighters) on scenes longer,” said union president Tom Brewer.
The Charlotte Fire Department did not make anyone available for an interview about the new Sierra call policy. But fire department Chief Reginald Johnson appeared to express support for the policy in a video posted online dated Oct. 6.
Brewer said firefighters are worried that waiting longer for a Medic ambulance means firefighters will be unable to get to other, more urgent calls like house fires or car accidents. Medic said firefighters can leave a scene if they follow a checklist to make sure the patient is stable enough. The list includes, among other things, making sure a patient’s vital signs are normal and giving them a neurological exam. But the checklist is too complicated, Brewer said, and it puts firefighters who arrive at a scene in an awkward spot.
“When someone calls 911, it’s probably the worst day of their life,” he said. “... Try to put yourself in their shoes. If you’re there assisting them, waiting on an ambulance, and then you … tell them you have to leave.”
Brewer said the new policy doesn't address the underlying problem at Medic: a shortage of workers.
The Charlotte Fire Department has had some staffing problems, too, mostly because of workers calling in sick or quarantining after possible COVID-19 exposure. At the end of September, the department had the lowest percentage of vaccinated employees among city workers — 49%. The fire department offers overtime to firefighters who pick up extra shifts and sometimes sends out the minimum required four people on a truck instead of the ideal five people.
Brewer said he would also like to see Medic put more time into educating people about how to use emergency medical services, like when to call 911 and where to find other transportation to the hospital or an urgent care center so as to avoid using an ambulance.
Studnek acknowledged there are some growing pains with the new Sierra call system. He said his agency is hoping to expand the policy to include other fire departments in Mecklenburg County and is scheduled to meet with those departments to discuss possible expansion in the next two weeks.
