AMR proposal aims to combat ER overload, dwindling staff issues

Source: AMR

A new proposal by the ambulance contractor for Knox County  would allow some patients to be transported to the hospital without a paramedic’s care, but how will it affect patients and their pocketbooks?

Officials say the answer will vary from case to case.

Knox County Commission is set to consider at its meeting today a proposal to allow first-responders employed by East Tennessee American Medical Response (AMR) to travel separately from paramedics.

The company hopes the program will help first-responders assist more people who need emergency care despite staffing shortages, according to AMR Regional Director Joshua Spencer.

“Basically, what we’re asking and looking to do is to allow ambulances to transport the lower-acuity patients that don’t need paramedic level care during the transport time and get the paramedic freed back up for the next high-level call,”  Spencer told commissioners during a Nov. 8 work session. 

AMR hopes the program can also help more patients by preventing paramedics from spending more time than is absolutely necessary waiting at hospital emergency rooms that are struggling to keep up with the recent increased need for emergency care. 

“Holistically, I mean, there’s a nationwide staffing shortage. It’s not just in emergency medical services (EMS), it’s in many public sectors, but certainly EMS is no different. We certainly feel the pain that others do when it comes to staffing. One of the challenges that we’re having, obviously locally and nationally, is there is just not enough EMS personnel,” said Spencer. 

An illustration explaining AMR’s new proposal shows the vehicles that would arrive at all emergency calls (top) and the two transport options that would be available (middle and bottom). Source: AMR

“There are also issues and concerns with the hospitals,” he continued. “While they do a great job … they get backed up, you know, and so it creates kind of a log jam where paramedics are now sitting at the hospital or staying longer than they typically would and not getting back in service to the community. That’s not the hospital’s problem. That’s a holistic problem in healthcare right now that we’re seeing everywhere across the country, and specifically here in Knox County.”

If the proposal is approved, first-responders would be allowed to offload non-critical patients to wait at the hospital while the paramedic returns to the field.

“It’s really about being able to free up resources, having more paramedics on the streets and available for service. In today’s current model, you send an ambulance with a paramedic and EMT on them, they arrive on-scene to transport that patient, they have to do a report, give a report to the hospital, get a bed, offload that patient and move out. In this model that paramedic, on a low-acuity patient, will be able to go back into service from the scene while that patient is transported to the hospital,” said AMR Knox County Operations Manager Daryl Warren.

If the program is put in place, both an ambulance and an additional Quick Response Vehicle (QRV) — an Ford F-150 truck — would respond to the scene of emergency calls.  The trucks would be staffed with one paramedic who would arrive ahead of the ambulance to assess the situation but would never be used to transport patients. The paramedic would make a decision about whether the patient’s condition required the paramedic’s care during transport to an emergency room.

“Once our paramedic gets on-scene, we can assess that patient. If the paramedic doesn’t need to ride with that patient to the hospital, because it’s a lower-acuity type patient, they will downgrade that call and the Advanced EMT ambulance will transport, and that allows that paramedic QRV to go back in service to serve the community,” said Warren.

An Advanced EMT ambulance is staffed with two EMTs but no paramedics. Alternatively, for more life-threatening situations, the paramedic may recommend an Advanced Life Support Ambulance —staffed with two EMT’s and a paramedic — to respond. In the latter case, an EMT would follow behind the ambulance, driving the QRV to the hospital.

Sometimes patients don’t even need to be transported, thanks to the use of virtual doctor’s consultations that can be held in the field.

“What we have been doing is we have been doing Teladoc visits. A Teladoc visit is when we arrive on-scene to low-acuity patients, the patient consents to seeing a doctor virtually either on our computer and if our computer doesn’t have connectivity, they will do that on a cell phone,” Warren said.

“The physician will make a recommendation about whether you should go to the emergency room or say ‘I can get in touch with your physician or I can call in a prescription to help you with this.’ And that really is designed to alleviate some of the stresses on the emergency departments for those really, really low-acuity patients,” said Warren. 

While the program won’t help patients save on the costs of emergency transportation, it may at least save some patients with less serious injuries an unnecessary trip to the hospital, thereby hopefully reducing overall costs and mitigating hospital emergency room overload issues, officials said.

Warren did not respond to requests for information about the exact costs of being transported by AMR. 

Officials emphasized that the program’s main goal is to help more patients in less time and with fewer employees. 

County Commission meets at 5 p.m. today in the Main Assembly Room of the City-County Building.

The full proposal is available to view online at

Megan Sadler can be reached at

Published on November 15, 2021.