Takeaways from TransCare's Bankruptcy

In a recent article published by the New York Times called When you Dial 911 and Wall Street Answers, the author sets out to highlight some of the bad practices employed by private sector emergency services companies on their relentless march to turn a profit on what is traditionally a government sponsored function. This response is not meant to defend or attack the validity of private sector ambulance companies. Instead, I will point out how proper reporting and oversight of the operational state of the ambulances and equipment on them would have prevented the rather grim state of affairs these private ambulance companies have left in their wake.

One passage is particularly telling of the woes faced by an emergency responding organization without proper oversight:

And ambulances regularly broke down. On the day TransCare filed for bankruptcy, more than 30 percent of the company’s vehicles were out of service, some for hundreds of days, according to internal documents.
“We drove buses on the 911 unit where the brakes didn’t work properly,” said Rayshma Raghunath, a former TransCare employee, referring to her ambulance. She started feeling uneasy during the Ebola scare in 2014, when she said workers had trouble getting enough sanitary wipes to disinfect their ambulances.
Caitlin Cannizzaro, another former employee, said that even starting the ambulances became tough. One morning, it took four hours to get some running, she said. “You really had to become a MacGyver in the field.”
By early 2015, the company had racked up health department violations for failed ambulance inspections, internal documents show. Employees spotted bedbugs in the Brooklyn dispatch center. Suppliers refused to provide drugs or repair ambulances because of unpaid bills.
“We were constantly having problems with the heart monitors,” said Mr. Almodovar, the former emergency medical technician. “It started getting scary. The last thing we want is for a patient to die on us because the equipment is failing.”
By February 2015, shortages became critical. According to meeting minutes reviewed by The Times, TransCare executives discussed how their New York locations would be “unable to make it through the weekend with current medical supplies.”

Problems Faced

Equipment slid into an extreme state of disrepair causing many serious problems. These include:

Degradation in Services Rendered to Patients

The heart monitor is almost always step number one when the patient gets on the ambulance. It is an ALS function, but nearly every BLS provider you talk to can navigate a heart monitor. Reliable care goes out the window if the machine that provides you vitals statistics - Oxygen Saturation, Heart Rate and EKG information - is on the fritz.

Response Slow Down

Dispatch needs to have an up to the minute picture of what resources are available for a response and where they are located. Dispatchers can avoid wasting precious seconds calling on incapable resources if they have a clear understanding of what rigs have working equipment that are up for the job.

Additional Costs to a For-Profit Company

What is most surprising about this excerpt is the fines this company received as a result of not investing in proper equipment upkeep. The health violations ambulance companies can receive are very costly. In 2015, Lifefleet LLC received over $235k worth of fines for not investing properly in first responder PPE - more on this here: OSHA Regional News Release.


Call to Action

Firefighters and EMTs' ability to be effective at their job hinges on the assumption that the tools they need when they arrive on scene are in good, working condition. Consequently, it is standard operating procedure in nearly every emergency responding organization across the US to do apparatus and equipment checks on a regular interval - daily or weekly depending on the frequency of calls.

It is not clear if TransCare made these reports available, or even if they were performing apparatus checks on a regular interval. The ad-hoc, anecdotal nature of the issues reported in the times article indicate that TransCare preferred to keep their equipment deficiencies internal. So why are these reports kept internal to the private ambulance companies? In the case of TransCare, issues with the company’s quality of care could have been caught earlier if the crews’ daily ambulance checks were exposed to the right stakeholders.

The overseers of the private ambulance companies can avoid costly government fines by noticing failing equipment and PPE early enough to fix it before government oversight must step in.

Dispatchers can make informed decisions on the best resource for a job based on up-to-date information on the equipment health of available resources in the area.

Residents and government officials could have noticed the degradation of equipment condition with weekly summaries of the truck checks. With this information, they could have threatened a termination of their contract or at least planned for TransCare not being able to provide services longer term.

Imagine if TransCare EMTs’ performed daily truck checks that were aggregated into time trended equipment quality reports that were dispersed to residents, government officials, dispatchers and TransCare corporate decision makers. If this policy had been put in place, do you think that TransCare would have ever been allowed to fall into such a total state of disrepair?