It’s not easy to fill the ranks of emergency service posts in the best of times.
And few would argue we’re living in the best of times, with a volatile virus keeping medical personnel on their toes and overworked.
The problem is that they were already overworked and EMS workers are in short supply nationally.
In March, Bloomberg News reported that “turnover among paramedics and emergency management technicians ranged from 20% to 30% annually in 2020, according to a survey the American Ambulance Association released late in 2021. That means ambulance services can expect to replace their entire staff roughly every four years.”
“I don’t know of a service out there right now that isn’t feeling a worker pinch,” Shawn Baird, president of the American Ambulance Association, told Bloomberg.
The same is true locally.
“Some paramedics don’t get paid as much as people who work in fast-food restaurants,” said Mike Risell, chief of fire and emergency services for Upper Providence Township. “A paramedic or EMT should not have to work shifts at two or three difference ambulance companies each day to make ends meet, especially when you consider all the credits and training required.”
Speaking Wednesday to the Pottstown Metropolitan Area Regional Planning Committee, Josh Stouch said most ambulance services are sharing the exact same group of EMTs and paramedics.
“They’re working one shift at Goodwill and then another at Gilbertsville or Trappe,” he said.
In addition to being the chairman of the Douglass (Montgomery County) Board of Supervisors, Stouch is also a firefighter with Gilbertsville Fire and Rescue and a constable with a deep and long-standing interest in emergency services.
Wednesday night Stouch spoke about the looming crisis in ambulance and emergency medical services and a possible way to address it — a regional ambulance authority.
As the region’s population continues to grow, the burden on local ambulance companies will only increase as available personnel stagnates or decreases, Stouch said.
“This is important to take a look at knowing the amount of development coming into the region,” he said.
In addition to manpower shortages, EMS services are also expensive to maintain. Unlike a volunteer fire company, which has an equipment cost, but often sit empty until a fire call comes in, ambulance stations need to be staffed 24 hours a day, 365 days a year.
Running such a station can cost between $600,000 to $800,000 per year — a high cost to shoulder on a town-by-town basis, Stouch said.
Instead, many municipalities assign an independent provider.
For example, Goodwill Ambulance in Pottstown services North Coventry, East Coventry, Pottstown, Lower Pottsgrove, West Pottsgrove and part of Upper Pottsgrove. Gilbertsville Ambulance services part of Upper Pottsgrove, as well as Douglass Township (Montgomery) and New Hanover and into Berks County.
Upper Providence Township is currently served by three ambulance companies — Friendship Ambulance in Royersford, Trappe Ambulance and the Audubon station of Lower Providence EMS. Officials there, concerned about response times and a growing population, considered forming a township ambulance company but ultimately rejected it, largely due to the cost.
Instead, they adopted a five-year plan in 2018 to subsidize advanced life support service, which means a paramedic and associated equipment is available said Risell. The plan also adjusted the response areas and funded the construction of a new firehouse and ambulance facility on Black Rock Road.
That facility is expected to be ready for full occupancy in August, but what is essentially a satellite station of Friendship Ambulance is already housed there, Risell explained.
“It’s located in a very central part of the township,” he said.
In addition to basic life support, “BLS” in emergency services parlance, which means an emergency medical technician, or EMT is present, there is the more comprehensive advanced life support or ALS, which requires the presence of a paramedic and the associated advanced equipment.
The cost of providing advanced life support services is high, Stouch said.
Most people can expect an ambulance to arrive within about seven minutes of being called, said Stouch. But someone in need of advanced life support could have to wait for as long as 20 minutes. “I think a lot of people moving into this area don’t realize that,” he said.
“You may never need it, but if you do need it, you expect it to be there,” Tom Troutman, chairman of the regional planning committee, said of advanced life support service.
To help support these essential emergency services, Upper Providence Township also provides an annual contribution to all three ambulance companies, Risell said.
But that does not mean every municipality pays for the service out of its budget.
Most services allow people to pay an annual membership fee to help support the organization. For many ambulance companies, a primary source of income is payment for services from insurance companies or, if they have no insurance, by the patient, not all of whom can pay.
Risell said changes brought about by the American Care Act reduced the services ambulance companies can charge for and also have not fixed a loophole by which some insurance companies pay the patient rather than the ambulance company for costs. And those patients do not always pass along the payment to the ambulance service.
Wednesday, Stouch proposed exploring the idea of creating a regional ambulance authority to address some of these issues. An authority could have a large service area comprised of several towns and would operate independently of municipal governments and fire companies.
It is different from regional fire companies, he said, which were formed by a merger of existing fire companies that still do not charge for their services.
As he sees it, the authority would be autonomous like a water and sewer authority. It would be empowered to levy a fee on each household in the participating municipalities, similar to a fire tax, and thus not being a drain on township budgets, It would also spread the cost among as many people, all potential patients, as possible.
“It could be something revolutionary for the county,” he said, noting he has received “lots of positive feedback from emergency management coordinators in the area.”
Outside Pittsburgh, 15 to 20 small boroughs joined in a municipal ambulance authority, Stouch told the planners.
In 1972, the Valley Ambulance Authority was established outside Pittsburgh. According to its website, it “provides EMS and medical transportation services to Moon Township, Coraopolis Borough, Crescent Township and Neville Island.
“VAA also provides service to certain parts of the Pittsburgh International Airport. The governing body of each member municipality appoints representatives to the Board of Directors, who oversee the operations of Valley Ambulance Authority.”
“In 1974, Quaker Valley Ambulance Authority was organized as the second municipal ambulance authority in the United States, providing EMS and medical transportation services to Aleppo Township, Bell Acres Borough, Edgeworth Borough, Glenfield Borough, Leet Township, Leetsdale Borough, Haysville Borough, Glen Osborne Borough, Sewickley Borough, Sewickley Heights and Sewickley Hills,” according to the website.
Similar to its cousin, the board of directors of the Quaker Valley Ambulance Authority is comprised of one appointed representative from each municipality, providing each community with an equal vote — regardless of its population or size. “In 1974, Quaker Valley Ambulance Authority entered into a joint operating agreement with Valley Ambulance Authority to share facilities, personnel, administrative costs and operational expenses.”
Risell said he is familiar with the operation in western Pennsylvania “and from what I understand, it works pretty well. The concept is certainly sound and it certainly deserves exploration.”
Emergency medical services are already stretched to the breaking point, he said.
“If we don’t start looking at alternatives now, we could be in real trouble,” Risell said.
Although the regional ambulance authority idea does not have to do specifically with planning, meeting with the Pottstown Metropolitan Area Regional Planning Committee Wednesday seemed like a good way to reach out to all the affected municipalities at the same time, said Douglass Township Manager Peter Hiryak when introducing Stouch.
Hiryak noted that the regional planning group is already the umbrella under which the regional recreation committee that services seven of those eight municipalities operates, so fielding such a discussion is not outside the group’s field of interest.
The regional planners agreed in a unanimous vote to fulfill Stouch’s request and have a letter sent to the emergency management supervisor in each of their municipalities to contact Stouch about forming a committee to explore the issue.
“The pieces are all there, we just need to assemble them,” Stouch said.
