Staffing shortages and increasing demand are crushing health care systems and first responders across the country, including in southwestern Pennsylvania.
In hospitals, UPMC's Dr. Don Yealy says workers are more strained than ever as they try to juggle COVID-19 patients, patients needing other care at pre-pandemic levels and tough decisions about which cases take priority.
"I've never seen this combination of both very high patient need and demand and stressors on those, not just the physical locations, but the people," he said.
A hospital staffing shortage is the first domino to fall in a vicious cycle that creates long wait times at hospitals and longer ambulance response times, according to Josh Wiegand, fire chief at West Deer Volunteer Fire Company and employee with McCandless-Franklin Park Ambulance Authority.
"Some hospitals in the area have been holding people in the ER's because they don't have enough beds upstairs," he said. "That backs up the ER, and then that backs up EMS. That causes significant wait times."
Paramedics are more frequently asked to wait outside with their patients in the ambulance until the hospital has the space.
"For the first time ever in my career, I went to a hospital and the charge nurse came outside and said 'hey, just stay in your truck. We'll let you know when we have a bed for you,'" Wiegand said.
In some areas of the country where demand for emergency care is especially high, some paramedics report they're waiting hours with patients.
Locally, Economy Ambulance Service manager Kevin Joy said his EMTs are typically waiting for 20-30 minutes at hospitals. His crews are working on techniques to talk with patients dealing with less urgent matters about choosing a different option.
"If we take you to hospital B instead of hospital A, their wait times are very minimal," he said. "It may be a 10 minute longer ride, but you're going to get the care you need when you get there."
As paramedics see increasing wait times at hospitals, there's concern it's taking resources away from other calls.
It comes at a time where EMS agencies are already short staffed and many EMTs are reporting burnout.
Joy said the effects aren't just mental.
"From having to work extra shifts, we're noticing more injuries to our people, probably because they're doing more, lifting more patients on a regular basis," he said.
Staffing issues at EMS agencies have been prevalent throughout the pandemic as they deal with COVID-19 outbreaks. Joy said that shortage has only gotten worse, mostly because EMTs are leaving for other opportunities in health care and the pandemic put many training sessions on hold to bring on new EMTs.
Typically, EMS agencies will call on other local agencies out of their coverage area when they need help with a call. Joy said the staffing issues are evident by how far they're traveling to respond to emergencies.
"We're running as far away as Beaver Falls, Rochester, Center Township, Aliquippa," he said. "We'll be out in Cranberry. We will be in Sewickley. Not too long ago, we were sent to a call in Moon Township. Other services are feeling the same crunch we are."
Both Wiegand and Joy believe part of the solution lies with municipalities becoming more involved.
Wiegand says funding is one of the greatest areas of need, especially for volunteer fire departments.
"We're still funding public safety with bingo," he said. "That's just how upside down things are."
As Economy Ambulance Service works to recruit more workers, Joy said he wants their municipality to help them with different initiatives.
"We had approached our local municipality to say we want to go into our local high school and work with our local community college and basically put on an emergency medical training class," he said.
Joy said he hasn't received word from the municipality about that idea.