A New Orleans EMS ambulance at Tulane Medical Center. (Marta Jewson/The Lens)

The weeks leading up to Mardi Gras typically mean a relentless work schedule for emergency responders in New Orleans. But some years are worse for them than others. Mardi Gras 2020, the last Carnival season before COVID-19 shut down annual parties and city-permitted parades, was one of the bad ones

“Last Mardi Gras was awful,” a New Orleans Emergency Medical Services paramedic said in a recent interview. 

“That was the one where two people got run over. We worked two weeks straight, with no breaks. And then, we had maybe one week where Mardi Gras was over.”

“Then COVID happened, and we have not had a break since.”

More than a year and a half later, the city is now in its fourth COVID surge due to the highly infectious delta variant. 

The paramedic, who spoke on the condition of anonymity because city policy prohibits employees from speaking directly to the press, described overwhelming work conditions that have led to turnover in the EMS during the past few weeks, and said that they were the culmination of issues with pay and burnout that precede the pandemic.

“People are just reaching a breaking point. Not even new people,” said the paramedic. “People who have been through some ups and downs with New Orleans EMS already. If those people are leaving, that means something’s wrong.”

About 20 percent of the budgeted operations staff have quit this year, and because of additional staffing shortages partly related to COVID cases, the agency is down several ambulances on each shift.

The paramedic said that during much of the delta surge, which began last month, even the most serious calls sometimes didn’t receive an ambulance for an hour, and that medics didn’t have time to completely clean ambulances between shifts, or to use the bathroom or eat.

A second New Orleans EMS paramedic — also speaking to The Lens on the condition of anonymity — confirmed that account, though added that state-funded relief ambulances, which arrived in the city earlier this month, have alleviated those conditions for the moment. Still, the second said, pre-existing issues, including a lack of hazard pay, mean that the staffing shortages will likely return when the relief ambulances are gone.

“It’s obviously necessary,” the second paramedic said. “My concern is, what’s going to happen when they leave? It’s just a Band-Aid. We need a long-term plan, not a short term solution.”

“We’ve been asking for these changes for years,” the first paramedic said. “These long wait times for an ambulance are not going to magically go away. As of right now, we receive constant lip service from the powers that be, thanking us on social media but not making any meaningful change to improve our situation.”

Responding to the paramedics’ comments, a spokesperson for Mayor LaToya Cantrell indicated that the administration is aware of the complaints from EMS employees and is working on solutions. 

“There are many issues that affect staff retention that are exacerbated during this difficult time,” Beau Tidwell wrote in an email last Thursday. “We fill vacancies when able to and are working with the CAO on additional staff retention incentives that may assist with attracting and keeping staff in this competitive market.”

Case volume and ‘hemorrhaging employees’ 

Early in the pandemic, the paramedics said, they were told to simply assume they’d been exposed every day.

Some of their coworkers moved out of their homes to avoid exposing their families, the first paramedic said. The second paramedic praised the city for helping employees find temporary housing for that purpose.

“I personally have been disinvited from family gatherings, birthday parties, and crawfish boils,” the first wrote early this month in a five-page letter describing the conditions EMS employees face. “I miss my friends and family. I miss being around people. And I’m not alone in that.”

So many staff have been in quarantine, sick, or injured that the EMS has operated with six or seven ambulances per shift, rather than the standard eight. At times, it has been as low as four or five, Lt. Jonathan Fourcade, a spokesperson for the EMS, told the Lens in an interview.

In a budget brief filed during the 2021 budget hearings last fall, EMS Director Dr. Emily Nichols noted that the service’s response time compliance had improved by seven percent after adding eight employees in 2020. 

“NOEMS is already at risk of losing this progress once special events return to the City,” the brief reads. “Reducing personnel will directly affect public safety.”

Contributing to the burnout, the second paramedic told The Lens, is it’s often difficult to take vacation days because there’s often no one available to fill in.

“That alone is going to make people quit,” said the second paramedic.

‘I’ve never seen anything close to the past six months’

As delta led to a spike in COVID cases, the paramedics said that morale collapsed.

In the final weeks of July, said the first, “I started seeing people with flu-like symptoms again. And all of a sudden, within a day and a half, half of my patients had symptoms. It’s been that way ever since.”

In the last two weeks of July, the first medic said that the EMS lost six paramedics, out of 135 budgeted operations staff. Because each ambulance is supposed to go out with a paramedic (paramedics have more training than emergency medical technicians) that loss has an immediate impact on the number of ambulances that the city can field, the first paramedic explained.

“We’ve lost the equivalent paramedic coverage of an entire shift,” that paramedic wrote in a letter to the Lens. “Gone, in less than a month.”

In early August, the EMS told the Times-Picayune/Advocate that 23 of its employees had left this year. Fourcade told The Lens that the number had increased since, but didn’t have an updated number immediately available.

“We’ve always been a busy service, but I’ve never seen anything close to the past six months,” said the second paramedic. “Not even at the beginning of COVID.”

The agency is of course also dealing with other, non-COVID calls: car accidents, drug overdoses and a summer spike in some categories of violent crime.  

“We have no rest or breaks between calls,” the first paramedic wrote in the early August letter. “They give us our next call before we’ve even left the hospital. Just finished working an hour-long cardiac arrest using every single drug in your bag? Take a person who’d been shot to the hospital and now the back of your ambulance is coated with blood? Had a patient who drowned in their own lung fluids due to COVID-19 and got COVID molecules all over you and all of your equipment? Tough luck, there are calls holding and people need help, so dispatch clears you and gives you another call while you’re still working on cleaning all of the equipment you just used.”

“We barely have time to wipe off the stretcher, much less clean anything else,” the paramedic continued.

Fourcade agreed that medics were under intense time pressure to pick up new calls.

“What I will say is, it’s nonstop. As soon as the dispatchers hear that the patient is off of your stretcher, they’re trying to get you clear quickly, so they can dispatch another call,” he said. “We’re still cleaning the ambulances–it’s not like they’re going to the next call with dirty linens. But there’s always calls holding. Is that the best thing to do? No, that’s what leads to burnout.”

Fourcade disputed that ambulances weren’t being cleaned thoroughly.

““I can’t say that that’s completely correct, but I understand what they’re saying,” he said.

Relief ambulances

The state relief that arrived this month added 15 vehicles to the city’s rotation. According to Tidwell, the ambulances are “requested and managed through the state” via a contract with FEMA.

“The city doesn’t pay anything for these ambulances,” Tidwell wrote. “We re-evaluate the contract every [two] weeks.”

This month is the second time that the city has drawn on the state for surge ambulances. Last March, the city also received surge ambulances through a contract with the state.

New Orleans EMS has also recently worked with private ambulance services to fill the gaps. 

Acadian Ambulance Service, which is based in Lafayette but serves most of the state, normally provides mutual aid to the New Orleans EMS during “large mass casualty event[s],” said Randall Mann, Acadian’s vice president of marketing and public relations.

But before the FEMA relief arrived this month, Acadian provided three ambulances and crews “under the direction and dispatch authority of NOEMS,” Mann said. 

Asked about plans to fill vacant positions, Tidwell wrote, “The NOEMS continuously interviews and hires qualified candidates. Over the past 60 days we conducted [two] new employee academies that put 15 new employees in service and there are currently 15 vacancies left to fill.”

Fourcade also noted that the EMS hired five new paramedics last Wednesday, two of whom were hired from outside the service, and three of whom had been EMTs with the service previously.

High acuity cases held

At the worst of the crunch, in early August, less urgent cases usually didn’t receive a response for hours, if at all.

But the first paramedic said that more serious cases didn’t receive an ambulance for times approaching an hour as well.

That paramedic described those cases as “high acuity” or “Code Threes,” meaning “shortness of breath, chest pain, a cardiac arrest, potential stroke. It could be a possible life threat.”

“Can you imagine having a true medical emergency and waiting hours for an ambulance to arrive?” that paramedic wrote in the letter. “That is absolutely unacceptable for both me and you.”

“Code Threes shouldn’t be holding,” the first paramedic said in an interview. “Unfortunately there were so many calls, and Code Threes just kept popping up. All the Code Twos were holding, and we didn’t have enough trucks to cover the Code Threes. It was a lot of shortness of breath—we just couldn’t keep up.”

The Lens requested response time data from July 26 to August 13, which showed that in most cases, ambulances were dispatched quickly. But some were held for extended periods of time.

The EMS dispatched ambulances to about 90 percent of Code Three cases within 15 minutes, with the average case holding about nine minutes. But five percent of cases held for more than half an hour, and two percent held for more than an hour. 

“Before COVID even, we’ve had calls hold,” Fourcade said. “But obviously not as many as we do now.”

As for why some of the calls had held so long, he said, “It could be many things. We just don’t have enough staffed ambulances to respond. But also when we do have crews responding, they can’t immediately offload at the hospital, because there’s no hospital beds.”

“There’s a few things we’ve done to make it a bit easier,” he added. Sometimes, the EMS will dispatch a medic to the hospital to wait with a patient, freeing up the ambulance to take more calls. “And when hospitals get really saturated, we will make an announcement saying, all units avoid going to this hospital.”

Reviewing one August 2 case with a six-hour hold time, Fourcade said that based on records from the Orleans Parish Communications District, the caller initially called in with a lower-priority concern, and then called back later with a more severe problem.

He said the same was true of three other multi-hour hold times flagged by The Lens.

That also highlights hazards in low acuity cases being delayed.

The second paramedic who spoke to The Lens said that cases are triaged based on the information given during 911 calls, which isn’t always accurate.

“Someone said one thing over the phone, and we get there, and it’s actually something else. Or their condition has deteriorated,” that paramedic said. “Or they downplay it, or it’s a family member calling on behalf of someone else. You know, flu symptoms can be sepsis, or a fall can be a hip fracture.”

Both paramedics said that patient care suffers for other reasons when calls are held.

“I feel like I’m always apologizing and getting yelled at,” the first paramedic said. “It makes it hard for patients to trust you.”

“It’s demoralizing to just day in and day out see that there are so many people who are waiting for you,” the paramedic continued. “And it’s like, you’re one person against the world. I used to say that I took things a day at a time, but at this point we’re down to one patient at a time. You can only focus on this one call. It’s just so overwhelming, all the time.”

‘It’s that we don’t get paid enough

The first paramedic said that city officials had implied “that the reason we’re having staffing issues is solely because of COVID.”

But, that paramedic said, that was only part of the story. 

“Yes, COVID is a factor. COVID has increased our call volume, it has increased the risk of us catching communicable diseases. But that’s not the only issue. It’s more that we don’t get paid enough. The pay and stress is not worth it.”

Both paramedics said that a lack of hazard pay was a key factor in the staffing shortage.

Medics with the EMS weren’t furloughed last year, though senior EMS administrators were. But they, along with other first responders and essential workers, were only offered a  $250 rebate from the state last summer. That rebate was paid for using CARES Act funding. 

Other states used that funding to provide cash payments that often topped $1,000, or, in the case of New Hampshire, $300 per week.

New Orleans police officers and firefighters requested, and were denied, extra COVID pay for first responders last year. But unlike EMS employees, they receive $500 in supplemental pay directly from the state on top of their regular salaries, whether or not they are working during a declared emergency. The first paramedic said that police officers and firefighters deserve the supplement, but “EMS deserves the same pay that the other emergency services receive.”

That paramedic pointed out that they responded to many of the same scenes as those other responders, and are often in harm’s way. They said that they’ve been punched, harassed, and threatened while responding to calls, and have been in a car crash in an ambulance.

A bill to pay medics the same was proposed in 2014, but died in the senate budget committee.

Last year, the New Orleans City Council unanimously passed a resolution calling on the federal government to fund hazard pay for first responders.

Representatives from the city’s firefighters union and a police association requested retroactive time-and-a-half emergency pay for critical first responders, who were working in person when non-critical city employees worked from home during a state of emergency. 

At a Civil Service Commission meeting on the request last May, a representative for the City Attorney’s office, William Goforth, said that the city was willing to provide 5 percent emergency pay if it could secure funding from the federal government or another outside source. The request failed, with all but one commissioner voting against it. 

Both the paramedics and Fourcade pointed out that New Orleans’ EMT pay is among the best in the region. But the paramedics said that they knew of better paying opportunities for their experience levels elsewhere.

“Other services are getting hazard pay, other services are getting sign on bonuses, and they’re paying for experience,” the first paramedic said. “I think anybody who works at my job hypothetically should be able to afford to support a family,” 

“I feel like [the relief] creates some complacency,” said the second. “No, this is only temporary. We still need to be worried about what we’re going to be doing in the coming months. We still need to be fighting for the pay we deserve, and the staffing to be able to do our job appropriately, and have enough ambulances to respond to the calls that go on in the city. It’s not rocket science. It’s all about money.”