Steven Potter:
How does the staffing problem that you've just mentioned affect the ability of EMS systems to provide care?

James Small:
Well, we don't get to pick when the 911 call comes in. So when a 911 call comes in, if that ambulance and that area is not staffed, that call is going to be given to somebody else and that's something that our survey spoke to. 78% of services reported having to do calls for their neighbor within the last year because of staffing issues with their neighbor. So let's say that in ambulance service A is unable to get out so ambulance service B now comes over and takes that call for ambulance A. Well, there's nobody there to take that call for ambulance B. So ambulance C may end up taking a call for ambulance B and it creates this domino effect through the system potentially, or it could be that ambulance B also isn't available and it becomes ambulance C coming to ambulance A's area which is leading to really long response times. We even saw that in 10 communities there were services that reported that an ambulance never got to a call at all, that there was 911 calls requesting ambulances. They didn't have staffing available and they never had an ambulance make it to a call.