Some Austin-Travis County Emergency Medical Services ambulances have been replaced with "squads," or life-saving SUV units, under a new pilot program. The change is meant to improve call and personnel management within budget limitations, according to the EMS department, while the city medics' union says the initiative could negatively impact local 911 responses.
What's happening
ATCEMS officially began using squads in place of ambulances April 22. EMS spokesperson Capt. Christa Stedman said the staffing plan was in development for several months leading up to its rollout this spring.
Ambulances have full patient transport capacity, advanced lifesaving gear and are staffed with at least a paramedic and EMT. The smaller squad units are staffed by one paramedic with similar capabilities and medications on board, but don't have some equipment like ultrasound and can't transport patients.
A closer look
Stedman said ATCEMS was eyeing the squad model for years ahead of the April launch. The resource change also comes as Austin and Travis County officials have expressed concern about local governments' upcoming spending plans amid tighter financial conditions. Stedman and Austin EMS Association President James Monks both pointed to medical staffing costs as a factor in the recent change.
The department had more funding available for overtime when vacancies were higher, but hiring and training gains leave less vacancy savings for added expenses. Stedman also said overtime now takes up more than a third of daily staffing costs—up from a planned 13%—which she said isn't sustainable.
"[The squad model] aligns with national best practices and offers a smarter way to manage low-acuity calls that don’t require transport. That said, it’s true that reducing our reliance on overtime was a necessary consideration," department officials said in an email. "As we grow the workforce, reducing our reliance on overtime is essential; not only to stay within budget, but to ensure we can continue expanding our staffing capacity long term."
According to Monks, there's a disconnect between the department's messaging and service on the streets under the shift to squads. He said less resources are now available for emergency response and that the paramedic SUV units should be viewed as a supplement, rather than replacement, of the department's more than 40 ambulances.
“In addition to being a reduction in services, this is going to put an additional workload on our medics. It’s going to put citizens in danger, essentially," Monks said in an interview. "This is not the best way to go about this whole thing.”
Looking ahead
Stedman said ATCEMS views the squad replacements as a boost for the system that won't result in reduced service. The change also comes as ATCEMS has remained below its response time goals for years; less than 83% of responses were on time in April.
"We do not expect this pilot to negatively impact response times or patient care, quite the opposite in fact," the department officials said. "The goal of the squad program is to more efficiently match the right resources to the right calls; not to remove service, but to improve how we deliver it."
Although it's been less than two weeks since the new deployment model started, Monks said some medics have already raised frustrations about the change.
Concerns include the potential for delayed response times, limited capacity for higher-priority calls, and impacts on other services like mental health calls traditionally handled by squads. Monks also noted the pilot is getting underway ahead of EMS' busiest time of the year.
“Day or night, it’s going to have an impact. But it’s going to have a bigger impact at night," he said. "We’re heading into the summer season, and call volume does go up during that time. And now we’re drawing back our transport resources during that time as well. The squads are just not an adequate replacement."
Going forward, the squads will be targeted to the lower-acuity calls not requiring transportation to a hospital that make up a large share of 911 responses. The units can also respond to more serious medical situations for immediate care before patients are moved by other personnel.
"By responding to appropriate calls with [advanced life support] squads, we can preserve full ambulance units for higher-acuity emergencies. This approach is part of a broader evolution in how EMS systems across the country are adapting to growing call volumes and increasingly complex patient needs," officials said.
The EMS department will continue to monitor response times and other metrics under the staffing change, with adjustments to be made as needed. City and county leaders will also begin their formal budget planning processes, including funding for EMS, this summer.
