Ambulnz is a non-emergency on-demand ambulance provider that is working to improve on traditional medical transportation through the implementation and integration of various technologies. The firm describes itself as a “software-enabled medical transportation company.”
When a patient needs to be moved to a new facility for treatment out of a hospital, out-patient treatment clinic, doctor, dialysis, or chemo center, a pickup can be scheduled through the Ambulnz app.
The app can help expedite the patient transfer process by allowing protected patient information to be uploaded and moved with the patient. The system then provides real time information on the status of the non-emergency vehicles, similar to how Lyft and Uber apps show their riders where they, so that medical professionals can track their patients.
During this COVID-19 pandemic, Ambulnz services come in a timely manner, and they work on transporting patients between quarantine and other clinical care facilities. The fleet of transportation vehicles coordinated by Ambulnz are now in the communities of New York, Pennsylvania, Tennessee, Texas, California, as well as the United Kingdom.
Here are the precautions Ambulnz, along with many other ambulance providers, are taking in the wake of the current coronavirus epidemic: To minimize exposure and cross-contamination of COVID-19, Ambulnz is encapsulating patient compartments, which limits a patient’s contact with EMT service staff. Special vehicles have been identified within the fleet, which will only be used to transport patients who might have been exposed to the virus. Ambulnz has equipped all vehicles and EMTs with Body Substance Isolation (BSI) equipment as well as appropriate personal protective equipment (PPE) to carry out these services in a safe manner for everyone.
All patients receive an enhanced dispatch intake questionnaire to help identify patients who may be at-risk or may have been exposed, and which may exhibit symptoms of COVID-19. Ambulnz EMTs ensure that each patient wears a surgical mask during transport, and have thorough training on proper PPE usage and vehicle decontamination protocols, including the CDC-mandated thirty minute post-decontamination waiting period for each vehicle.
We had a chance to speak with Ben Sherman, VP of Business Development at Ambulnz, to find out
Alice Ferng, Medgadget: Tell me about yourself and how you got involved with Ambulnz. Were you one of the co-founders?
Ben Sherman, VP of Business Development at Ambulnz: I have been with the company for 3 years; joining March 2017 from UBS. I spent the 9 years prior as Head of the European Equity Distribution into the United States.
My motivation was based on seeing a company that was trying to provide benefits to all stakeholders. I liked the idea of building and scaling a company with those intentions. The whole ambulance/medical transport market is a broken model. All stakeholders are dissatisfied. EMT’s are paid low / minimum wage and have little opportunity for advancement. Ambulnz offers incentives for productivity and patient care to ensure our EMTs can make a good living, provide for their families, and not need to work a second job.
It’s not just employee satisfaction that I was drawn to. It was making a better product for all stakeholders involved in the medical transportation process.
Hospitals have challenges with patient flow due to unreliable transportation providers (TP) and the burden of calling TPs to arrange transport. In the past, nurses and other key people were stuck on their phones trying to get ambulances. Each pickup involves hundreds of data points that need to be relayed and communicated, and the current process of transmitting that info by one person reading to another is very inefficient and can take over 20 minutes. Staff frequently book two ambulances because they don’t know if someone will show up and have no way to track a transport en-route. Digitizing the process really helps with patient flow and transparency. This helps hospitals improve operations and throughput. It is very important to me that Ambulnz was setting out to solve these incredibly complex problems.
And finally, the most important stakeholder, patients. The traditional method of patient pickup entailed an ambulance coming to your front door with bright red flashing lights. They pick up patients with two EMTs in paramilitary uniforms. We felt this increases patient anxiety. So our vehicles are designed with soft blue colors, and our EMT’s are dressed in professional, non-militaristic uniforms that are meant to comfort instead of intimidate.
It’s not often you find a business that is looking to tackle all these issues in such a huge and broken industry.
Our aim is to consolidate the market and provide better service to hospitals, their patients, and to provide a better lifestyle for EMTs and all the other professionals working for us.
Medgadget: Tell me more about Ambulnz – when was the company started? What were some challenges getting it started initially?
Mr. Sherman: The actual formation was the end of 2015 and we ran the first transports at the beginning of 2016. The company started with a small fleet, about five ambulances. The co-founders spent a year and a half prior to forming the company researching the industry and understanding it. It also helped that one of the co-founders was a volunteer paramedic for 20 years and is very experienced in the technology space.
Ambulnz has rapidly expanded since then – New York, Colorado, Texas, Pennsylvania, New Jersey, Tennessee and in the UK. California is probably the most challenging market in U.S. for a variety of reasons. The heavily regulated industry possesses laws and reforms that extend from a State level down to a County and City level. To perform transports, you have to get a variety of credentials and licenses for EMTs and vehicles in each and every municipality. It is a challenge, and not a particularly efficient environment from anyone’s standpoint. On top of the challenges in obtaining licenses, labor laws in California are very challenging and not designed for a distributed workforce.
Another challenge is that the industry is quite a cynical one. We come in and tell paramedics and EMTs that we give them the opportunity to earn more and they don’t believe us! It literally takes proof of pay slips from other employees to gain trust.
There is an enormous amount of paperwork in every transport. There are over 500 data points per transport and when you are doing 1000+ transports/day that’s a lot of data! To make the situation more precarious, the processes had yet to be automated so we were starting from scratch. This industry still operates by fax and telephone, and we are trying to improve the quality of our service as well as the quality of the industry as a whole by investing in technology.
Other big challenges can be summed up in dealings with the US healthcare system. US Healthcare is a very fragmented, politicized, bureaucratic system that is designed by the healthcare insurance industry in order not to pay bills.
Medgadget: Which patient and caregiver populations are able to use your service? (e.g., Is the service limited to certain populations? Or are you targeting a specific population?)
Mr. Sherman: One thing we try to do as a company is ensure we provide the appropriate level of transportation for patients. If I were representing a small ambulance company and receive a call to pick someone up for a broken leg, if we go to pick that person up for transportation and they appear to be jumping around without an issue, Ambulnz would not transport this person by ambulance unless the individual wanted to pay themselves. We would still provide service, but by alternative means – via wheelchair or sedan. This is lower cost for insurance providers and enables us to use our higher acuity resources where they are needed most. Many other companies will simply pick the patient up and bill for a full ambulance transport without a prior assessment of the situation.
We are dedicated to providing the appropriate level of service for individualized need. Our base level is a car Partnership with Uber where we have the ability to send a sedan to perform curb to curb work. The next level is door to door, which we provide with our dedicated fleet of Ambulette vehicles.
For Ambulance transport, we have three distinct verticals. The most basic is BLS or Basic Life Support. The patient’s condition here is not too critical so there will be two EMTs present without a paramedic. ALS, or Advanced Life Support is a step up from BLS and requires a paramedic as well as an EMT on staff. CCT or Critical Care Transportation typically comes replete with a nurse or respiratory therapist, a paramedic and an EMT. In this case, the patient’s needs are highly specialized in terms of staffing and equipment, and we are capable of providing both. When it comes to transportation, we have everything outside of a helicopter (but can get one of those if needed)!
Ambulnz is also a leader in event medical care. All the EMTs for Barclays Stadium, Citi Field, Javitz Center, Jones Beach, and Formula E events are covered by Ambulnz. We provide vehicles and a staffed medical tent with nurses and physicians to look after and treat patients on the site. This helps ensure only the most critical cases are taken to hospital – freeing up time, cost and resource for those who need it most.
In the United States and the United Kingdom, we also provide mental health transportation for which there are varying degrees of severity. Patients that are either threatening to themselves or others need transport as well. This is almost always done via ambulance with a minimum of two people on board to ensure that no one gets harmed.
Medgadget: How do you staff your transport to deal with patients who have special medical devices or life assist equipment (e.g., air tanks, IVs, etc.)? Do you have special training that is required?
Mr. Sherman: Yes. Even the most basic BLS transport would include two EMTs who are trained to evaluate and operate the majority of medical devices that patients need. In the event that a patient uses a specific device that is less common, patients may inform us and we will make sure that we have the appropriate level of service staff to handle their individual requirements. Our technology extends beyond medical devices. For example, women who have been in a vulnerable position may not feel comfortable around a group of men. We can make the proper accommodations by sending an all-female crew. There are very few occasions where we cannot service the patient’s needs. If someone is on life support via a balloon pump, we can accommodate that as well; whatever the need, we have the right staff and equipment to handle it.
We partner with hospital networks and groups. If there was ever something we needed from them, they would be more than happy to help us so we can help the patient.
Medgadget: Please elaborate on “how this technology can ensure better safety and patient care.”
Mr. Sherman: Our vehicles have speed monitoring systems and are barred from going above 70 mph. Additionally, there are cameras set up and running twenty four hours a day in order to monitor things like braking too heavily, failing to wear a seatbelt or cornering too fast. The technology also detects if the driver picks up a cellphone, which would create an immediate red flag. Drivers who are cited and do not adhere to remedial processes are sanctioned. This ultimately fosters a culture where safe driving comes to the forefront of our staff’s attention. EMTs want to work for us and stay with us as they care about their job and because of that, are acting more carefully. Active monitoring of the vehicle, consistent evaluation, safety training.
Records are typically kept by filling out a patient care report (PCR) as well as a Physician’s Certification Statement (PCS). Typically, to obtain a PCS, EMTs arrives at the hospital and receive a PCS from a doctor. The EMTs will often have to find someone to sign it and then retain it for their records. This creates unnecessary delays and inconvenience
Through our integration with Electronic Health Record systems, we can have PCS’s completed electronically and much more quickly which ultimately frees up time for EMTs and doctors. This system eliminates illegible handwriting and inaccurate information; saving time and improving accuracy which is crucial when dealing with health records. The level of credibility and reliability of our data is much higher when compared to conventional methods.
Often when hospitals discharge patients, they are unaware of what happens on the way home. Did the patient get sick? We can send a PCR back to the hospital in order for hospital staff to gain an element of closure and stay informed as to what happened. This method, via the integration of our technology, gives hospital staff the confidence that the patient made it home safely.
Medgadget: How does Ambulnz plan to grow and scale up? What is the plan with the recent Uber partnership?
Mr. Sherman:We plan to grow and scale up both organically and inorganically. We are happy to enter market greenfield with partners (good example is Colorado – launched from scratch no existing infrastructure), Pennsylvania and New Jersey. Texas involved a small local acquisition in Kingsville. From here we intend to grow across that State both through acquisition and greenfield expansion. In the UK we acquired a single site and now operate from six locations. In Tennessee we partnered with HCA and operate with them as well.
Going forward, we have an exciting partnership with Fresenius, the largest provider of kidney dialysis in the US. Each dialysis patient needs 3 treatments a week (6 transports), so we want to make sure they get reliable transportation to their treatments and receive the excellent level of care that Fresenius provides. We will continue to roll-out across the US with Fresenius. They are an ideal partner as they share our passion for patient care and innovating to find efficiency.
Medgadget: Describe some technological challenges Ambulnz has had to overcome – have there been times when you have been unable to pick up or transport a client?
Mr. Sherman: Medical transport by its very nature is at the cross section of logistics and healthcare, two very complex industries. Adding technology increases the complexity initially, but ultimately helps streamline the processes and create a more efficient healthcare system.
The real world is not a spreadsheet or a computer program; traffic is unpredictable and vehicles break down. We schedule everything to know where, when and why each vehicle will be at all times. We have optimized that flow to be more efficient which in turn helps the company, EMTs and patients. Although, we are constantly learning. If you’re picking someone up from a hospital ward they might be located past security and up an elevator. Historically companies rely on general knowledge to estimate the time taken – Ambulnz uses AI and complex algorithms to estimate the time it will take to transport a patient. We track all points of data and pinpoint why the trip took the time it did. We can then incorporate that data and information into our future planning so that things will continue to run more and more smoothly.
All our vehicles are tracked and personnel ability and license are recorded. The system knows what license and crew is the most appropriate for any given transport.
Healthcare in the US is very complex due to billing and insurance. We use technology to monitor and optimize our processes to ensure proper care appropriate level of treatment and detailed data for claims management. Through our integrations with Electronic Health Records we are also able to gather accurate and detailed billing information – a key struggle for the industry.
This integration also enables our system to ‘talk’ to bed management programs. If we picked someone up from bed 28, our technology can send a janitorial team to make up bed 28 and get ready for the next patient.
There have been instances where we can’t pick up a patient. Unfortunately, no one can be 100% all of the time although we use our technology and systems to adapt and to strive for 100%. We won’t be satisfied until we get there! To help carry forward our mission, we have incredible partners that share our vision – UC Health, Jefferson Health System, Fresenius, Uber… and more to come!
Link: Ambulnz homepage…
Related: Partnership with Uber