The COVID-19 strain on East Tennessee's healthcare system now extends to ambulance services.
Full hospitals mean more ambulances stuck outside emergency rooms, which means fewer available to respond to people who call 911 for help.
It's called "level zero" — when there are no ambulances left in Knox County to respond to calls. It happened on Monday, dispatchers said.
At Level Zero, ambulance company AMR must call for backup from across county lines, though operations manager Daryl Warren said the company has not yet seen any "significant delays" because of the short supply.
One reason for the lack of available ambulances sits in the parking lot: EMTs can't leave patients at the emergency room until they're admitted and the surge in people with COVID-19 means hospitals haven't had much space to admit people into.
"We do see ambulances that are spending greater than an hour at times in an emergency room waiting to offload patients and sometimes that hour turns into a couple of hours," Warren said.
He said Knox County hospitals are issuing more frequent advisories asking his crews to find somewhere else to bring people.
"Advisories come out daily and those lists used to be relatively short and those lists now are quite lengthy," he said.
It adds stress on already worn-out emergency staff. Crews must spend more time disinfecting and now worried if every patient could spread COVID-19 to them.
Quarantine guidelines have cost the company 8,000 manhours — a number Warren calls "a conservative estimate."
"The best advice I could give the community to help us," he said. "Don't get infected.