ROANE COUNTY, Tenn. (WOKI / WVLT) — Roane County Emergency Services is facing a recurring strain on its resources, with every ambulance in the county tied up on calls two to three times a week. Officials say the bottleneck is driven largely by lengthy delays when crews arrive at area hospitals to transfer patients.
Roane County EMS operates four ambulances 24 hours a day, 365 days a year. When all four units are busy and no ambulance is immediately available for the next emergency, the agency enters a status known as “Level Zero.”
What Happens at Level Zero
Despite the terminology, Roane County Emergency Management Agency Director Tim Suter emphasized that residents are never left without emergency help. Medically trained fire crews are dispatched to stabilize patients when an ambulance isn’t immediately free.
“We give the illusion that nobody’s coming. And that’s just simply not true,” Suter said. However, while fire crews can provide immediate medical care on scene, a patient needing hospital transport must still wait for an ambulance to clear up. “Our problem isn’t when we hit Level Zero. Our problem is when we hit Level Zero and there’s an emergency pending,” Suter added.
Rising Response Times and ER “Wall Times”
According to Roane County EMS Director April Miller, crews are spending significantly more time on each call than they did in years past.
“Years ago, 10 minutes was kind of the mark for everything… 10 minutes on response time, 10 minutes on scene times, 10 minutes on offload times,” Miller said. “Now, if we’re 20 minutes or less, we’re good. So our times have almost doubled and we’ve just gotten used to that.”
A major factor behind the longer turnaround is what first responders call “wall time”—the period paramedics must wait inside an emergency room before a hospital bed becomes available for their patient.
“When we take a patient to an ER, we walk through the door, we’re hoping to get a bed assignment right away. If we don’t get that assignment right away, we stand next to the wall and we wait,” Suter explained.
Miller noted that average wall times run 30 to 40 minutes, though they remain wildly unpredictable. One patient might get a bed in 10 minutes, while the next crew waits 45 minutes or even two hours. Until the patient is officially transferred to hospital staff, the ambulance cannot return to service.
“And when you add the wall time in addition to a drive time, it makes it significant. That means that ambulance is not in this community taking care of patients here,” Suter said.
The delays create a circular bottleneck across the healthcare system: ER patients cannot move upstairs until inpatient beds open up, and discharged patients cannot leave the hospital for home or a nursing facility because the ambulances needed to transport them are stuck waiting at the ER wall.
Hospitals Respond
Regional hospital systems face high patient volumes across East Tennessee. Miller pointed out that UT Medical Center, as the region’s only Level 1 trauma center, absorbs critical patients from every hospital and EMS agency within a two-and-a-half-hour radius. UT Medical Center did not respond to multiple requests for comment regarding the delays.
Covenant Health released a statement emphasizing its ongoing partnership with local first responders:
“Covenant Health values our longstanding partnerships with Emergency Medical Services agencies across East Tennessee and the important role EMS professionals play in caring for our communities. Our focus is always on providing safe, high-quality care to our patients. We continually evaluate our processes and work collaboratively with EMS and other community partners to support timely, appropriate care for the patients we serve.”
Searching for Solutions
While extreme five- and six-hour hospital waits have become much less frequent, officials say fixing the broader issue requires incremental adjustments rather than a single silver bullet.
Roane County does own three reserve ambulances, though they are not consistently staffed. When asked if simply putting another full-time ambulance on the road would solve the problem, Suter noted the fluctuating nature of emergency call volumes: “It would today. And then it’s a wasted resource tomorrow.”
Instead, EMS leaders are leaning on technology and process improvements. Ambulances are now equipped with a tracking resource that displays real-time average wait times at area hospitals, allowing crews to route patients to a different facility when one emergency room becomes overwhelmed.
“I don’t think there is one single solution to fix this major complex problem,” Miller said. “I think we’re going to have to tackle it with small wins, aggregated marginal gain, shave a few minutes here, fix a bottleneck there, improve a process and take those small wins.”
