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Low pay, high stress: What's behind Richmond Ambulance Authority's staffing woes

Posted at 2:00 PM, Jul 06, 2021
and last updated 2021-07-06 23:19:15-04

RICHMOND, Va. -- A pregnant woman injured in a crash waited an hour for an ambulance on Richmond’s Southside.

“They’re trying to get an ambulance from Chesterfield because no one is available,” Shannon Ronaldson, who live-streamed the aftermath of the June 12 crash on Facebook, said. “This is not okay and there needs to be light to the situation.”

After our story aired, more than a dozen current and former Richmond Ambulance Authority (RAA) employees contacted the CBS 6 Problem Solvers to share their experience of low pay, low morale, overwork, and stressful conditions.

Two former employees, who recently left for higher-paying healthcare jobs, agreed to talk to Problem Solvers under the condition we protected their identities.

“The lady waiting for an hour, that’s a shame. I can’t say I’m surprised about it,” one former RAA employee said. “Retention at Richmond Ambulance is tough. A lot of people don’t like it. People get there and quickly go to different departments.”

Founded in 1991 and established by a General Assembly act, RAA operates in the city like a business.

By city ordinance, the agency is solely tasked with responding to both 911 calls and “NETS” calls or “non-emergency transports.”

NETS calls, also known as pre-scheduled calls, include driving a patient from their home to dialysis or to another hospital.

The system works when the agency is fully staffed. But with low employee numbers right now, sometimes 911 calls that aren’t considered Priority 1 or life-threatening injuries - like in the case with the pregnant woman - tend to wait longer for an ambulance.

A Richmond Ambulance Authority spokesperson said all eight RAA ambulances were on emergency calls at the time of the crash.

  • Two units were already responding to Priority 1 calls
  • One unit was at the scene of a Priority 1 call
  • Three units were en route to hospitals with patients
  • Two squads were at hospitals delivering patients to the emergency department

    Priority 1 calls are prioritized because the patient or patients are suffering from life-threatening injuries.

    But employees and supervisors are tasked with juggling fulfilling both 911 calls and NETS calls during their shifts.

    “It would be often we would go to North Carolina. It would be often we would go to different states,” the former employee explained regarding the NETS calls.

    RAA is unique to the region in that they answer to a Board of Directors.

    Other jurisdictions, like Henrico and Chesterfield counties, operate jointly as one fire and EMS department.

    RELATED: Why a pregnant Richmond woman had to wait an hour for an ambulance after crash

    The City of Richmond is historically one of the busiest localities in the country for EMS calls.

    Often, RAA recruits young individuals without experience who earn training while on the job.

    “Knowing when you’re walking into work at 6 a.m. and marking up and you’re the second truck only. There are only two ambulances in the entire city and knowing that truck is staying late from last night,” another former RAA employee, who left the agency to work at a rural agency making more money and running fewer calls earlier this year, said. “Not that dialysis appointments aren’t important, but the fact that this difficulty breathing patient is waiting while I’m waiting to go meet someone on dialysis — it just didn’t sit right with me.”

    Chip Decker has served as CEO of RAA for the last 12 years.

    “It’s difficult at this moment in time to be in healthcare in general, EMS in particular. It’s more dangerous now than it probably has ever been,” Decker said. “For what the City of Richmond gets, we cost the average taxpayer very little.”

    In 2020, RAA ran more than 13,000 NETS calls compared to more than 32,300 911 calls. The NETS calls help supplement the agency's $25 million budget while billing either the patient or Medicare and Medicaid.

    About a quarter of their budget is provided by the City of Richmond.

    “We are short on staff, and calls are not decreasing because of it,” Decker stated. “So the people we do have must run the calls that more people would have run so they have to work harder. Their stress level is higher and they need to be compensated more.”

    “How are we fixing this because I’ve heard it’s only going to get worse?” CBS 6’s Brendan King asked Decker.

    “Well, what we are doing is working on ways to pay them more and working to reduce the number of hours in the workweek,” Decker responded.

    Field employees work 48 hour weeks, according to an RAA spokesperson.

    “EMTs with little to no experience start at $13/hr – $13.39/hr. That equals a starting salary ranging from $35,828 - $36,902. Our EMTs with 2 years or more experience and/or advanced certifications can start at $13.79/hr - $16.61/hr. That equals a starting salary ranging from $38,005 - $45,777," the spokesperson wrote in an email. "Our paramedics can start at $17/hr - $19.14/hr based on their years of experience. That equals a starting salary ranging from $46,852 – $52,750."

    RAA also saves money by using historic data going back seven years to predict how many employees are needed to meet demand. But because of low employee numbers, the agency staffs about half of the number of ambulances the city needs during the day.

    “There are a whole lot of ambulances that just sit because there’s no one to staff them,” a former employee said.

    During the 2020 COVID lockdown, Decker said pre-scheduled calls decreased while some residents called 911 to be tested for coronavirus. Former employees argued that responding to 911 calls that are not true emergencies took resources off the streets.

    EMS is a fee for transport and does not receive a payment if a patient isn't transported to the hospital.

    “If you want to avoid situations where you wait for an hour for an ambulance, we as a community, really need to talk about when it’s appropriate to call an ambulance and when it’s not,” the employee said.

    Decker said he needed more funding from the city or the federal government possibly with American Rescue Plan funds.

    Starting on July 1, RAA is receiving $4 million from the city.

    That's $1 million less than previous years and $3 million less than Decker requested.

    City officials said RAA ended last year with a $1.9 million surplus.

    Decker had hoped to use the additional funds to purchase additional ambulances rather than lease the trucks and to hire additional employees.

    The Richmond Times-Dispatch reported in April that “the city recently pulled $9.4 million from a rainy day fund to make it through the current fiscal year that ends June 30.”

    The mayor’s budget also froze hundreds of new job hires, according to the newspaper.

    "EMS patient care and patient outcomes are paramount, and our primary concern is that persons in need of emergency medical assistance or transport to the hospital receive it in a timely fashion," a spokesperson for the mayor's office said in response to the Problem Solvers investigation. "RAA’s leadership and its board are responsible for providing this service and ensuring no emergency calls go unanswered in the city. While we recognize these are challenging times for all first responding agencies, it is our expectation that RAA meets the needs of our residents and is accountable. We will continue to work with the authority to help improve its service to our city."

    City officials called any suggestion that budget cuts, which went into effect on July 1, 2021, impacted RAA service prior to that date misleading.

    As for the pregnant woman last month, she gave birth to a girl more than three weeks before her due date.

    These former employees speak out in hopes of bringing awareness to the job and preventing someone else from waiting for help during an emergency.

    "If they took the effort to want their employees to stay, pay them well, treat them well, they wouldn’t have the problem," the former employee said.

    Watch for Problem Solvers Investigations Tuesdays on CBS 6 News at 11 p.m. Click here for more of our investigations or to submit a tip to the Problem Solvers.

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