AMR in compliance, but rising low‑acuity 911 calls strain Shawnee County EMS

Shawnee County commissioners were told May 8 that American Medical Response (AMR) met the county's ambulance‑service contract requirements for fiscal year 2024, but officials cautioned that a surge in low‑acuity 911 calls, limited paramedic supply and hospital turnaround delays are straining the local EMS system.

Nelson Castillo, Shawnee County ambulance compliance officer, told the Board of County Commissioners at a work session that “AMR is in full compliance with the contract.” Castillo said AMR has been out of compliance only four months since 2017 and that 2024 performance generally improved after adjustments made during and after the COVID‑19 period.

The county's ambulance contract uses an 80 percent on‑time response threshold as its primary performance metric. Castillo said the county and AMR removed scheduled inner‑facility transfers (IFTs) from the contract's compliance calculations after contract negotiations; excluding those IFTs changed year‑to‑year comparisons and increased apparent call volumes. He described IFTs as scheduled moves such as a nursing‑home patient sent to an emergency department for nonemergency lab results and said the county sees roughly 250–300 such IFTs a month.

Why it matters

County officials said the increase in nonurgent calls reduces available resources for high‑acuity emergencies and contributes to fines assessed under the compliance regime. John Hanks, regional director for Global Network Response (affiliated with AMR operations in the region), told the commissioners that many fines reflect low‑acuity calls rather than failures on critical calls: “The system is working,” he said, and provided February figures showing that, among late responses that month, 25 percent resulted in no transport, 72 percent were triage‑code green (non‑life‑threatening) and fewer than 1 percent were critical.

Key details and operational responses

- Fines and compliance: Castillo said AMR paid the fine structure for the months it fell below the 80 percent threshold in earlier years; total fines paid in 2024 were “just a little above $40,000,” down from a larger amount in 2023. Castillo also noted that many late responses are tied to long hospital turnaround times, and that dispatchers use internal timers to escalate if an ambulance remains delayed at a hospital.

- Nurse navigation program: The county's Nurse Navigation program has handled 2,661 patients since implementation; AMR and county staff use it to divert appropriate callers to clinical follow‑up instead of transport. Hanks said patient surveys found 33 percent of those contacted believed they had a life‑threatening emergency, 40 percent said they did not know another way to get care, 23 percent had no other means of transportation and 4 percent believed calling 911 would get them a quicker ER bed.

- Workforce and training: Commissioners and AMR staff described a national shortage of paramedics. Hanks and county staff said becoming a paramedic in Kansas typically involves an associate degree and an 18‑month paramedic program plus prerequisites, meaning sponsorship and training can take two to two‑and‑a‑half years. AMR partners with local training programs, provides field internships for Washburn Tech and other paramedic programs, and hosts a Barton County Community College paramedic cohort at AMR headquarters.

- System improvements and funding: The county funds a third dispatcher (provided by AMR, about $2,500 per month) to help manage high call volumes and has purchased a field‑force mobile application and crew mobile devices for first‑responder agencies. A first‑responder grant program, authorized by the county, provides annual disbursements for EMS‑related equipment and helps sustain the $25,000 annual support for the county fire mobile and crew force app; Topeka Fire Department was the largest single grantee in the most recent disbursement periods mentioned.

- Technology and coordination: Castillo described a completed radio and communications project designed to allow fire departments, AMR crews and law enforcement to communicate more directly on scene. AMR described “fly cars,” staffed supervisory paramedic SUVs equipped to respond to calls and support ground units; Castillo said the vehicle is equipped to manage calls but is not used for patient transport.

- Access to homeless encampments: Commissioners discussed difficulty locating and physically accessing some homeless encampments, including areas cut off by levees, railroad fences and construction. Castillo said the county and AMR are working on mapping known camp locations so dispatchers and field responders can find them more quickly; he estimated roughly three calls per week originate from such camps.

Open questions and limits of action

No formal policy changes or votes were taken at the work session. Castillo said the county continues to evaluate how best to handle low‑acuity calls and noted some decisions are constrained by statutes and regulations that limit AMR's ability to refuse to transport patients or to make decisions based on ability to pay.

What comes next

Commissioners were told National EMS Week is May 18–24 and that a resolution recognizing EMS personnel will appear on the county's consent agenda at the next regular meeting. County and AMR staff said they will continue monthly reporting, refine mapping of hard‑to‑reach locations, and pursue workforce development and grant disbursements to support first responders.

Ending

Commissioners thanked AMR and county staff for the presentation and for ongoing coordination among first responders, hospitals and the county to address operational pressures on the EMS system.