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The EMS Crisis We Are Facing Today

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Peter Melan
June 20, 2019


EMS is still near and dear to my heart. I continue to maintain my EMT certification and miss the days of working on ambulances in my younger years. With time constraints and other responsibilities, I have remained involved by volunteering on advisory committees, spoken at national conferences and local organizations and offered assistance to anyone in the field.

I had the pleasure of being chosen to speak at the National Collegiate EMS Foundation conference back in February of this year where a group of 60 students attended a session on Recruitment and Retention. I was also honored to speak at the Northampton County Ambulance Association breakfast a few weeks back that included a wide variety of attendees ranging from state officials to hospital representatives. Borough and township managers were in the audience along with actual street-level providers.

My presentation was designed factual information surrounding the crisis EMS is currently facing. I had compiled data from the Pennsylvania Bureau of EMS that showed a staggering decline of providers throughout the Commonwealth. Although participating on a statewide commission to help rewrite legislation was productive, it yielded minimal results, especially with regards to funding and insurance reimbursements.

An ambulance is a necessity that most municipalities overlook due to a variety of reasons. One reason is that any elected officials and administrators may not fully understand the importance of having an ambulance respond in a constituent’s time of need. It has become somewhat of a free-rider problem where ambulance companies have ceased operations and the sponsoring municipality decides to contract with another service without providing additional funding. This is an inherent problem that we as leaders must immediately realize and correct.

I truly believe that the crisis in EMS will continue to worsen as time goes by and a lack of support will grow. During the breakfast, I was asked pointed questions about how I envisioned a resolution to the problem, and I responded by saying the state would be unable to provide any remedy—Any substantive fix must come from local or county-level officials.

The problem in EMS is exacerbated by a growing lack of people who are not entering the industry and the struggle to retain those who are currently serving. Wages for an EMT average $14/hour. For a paramedic, the average hourly rate is $19/hour. There is very little room for growth, as opposed to working in other healthcare environments. The smaller agencies that remain are simply unable to compete with larger or municipal-based services. This results in providers having to work at several jobs in order to have a sustainable lifestyle, creating a safety issue not only for the provider but for the patient who relies on that EMT to render care.

As you read this article, consider an ambulance who not only provides 911 service but also has to supplement its revenue by offering non-emergent patient transport. This means that an ambulance crew will prepare a patient and provide transportation to and from their doctor appointment. Many of these transports are geared towards residents of extended care facilities such as a nursing home, or patients who could be confined to their homes. The crew will arrange for picking up the patient, which results in that ambulance being taken out of service. This creates a void in the system—if a 911 call is made for a life-threatening emergency and this vehicle was the only unit available in that municipality, a mutual aid request to a neighboring ambulance is made resulting in an extended response time. The additional time could be critical in severe cases such as a patient severely injured in a car accident or someone suffering a heart attack. Minutes and seconds matter in these situations.

To resolve the problem described, it is incumbent for elected officials to gain a thorough understanding of EMS and the benefits provided to a community. Merely relying on an ambulance that is not devoted to your municipality is dangerous and further stretches an already strained industry.

There are creative ways that ambulances could be funded that have very little impact on a budget. The first and most obvious is to offer some type of incentive to constituents who are already certified and are able to immediately make an impact on staffing. Another solution, albeit not popular, is some type of EMS tax where the collected revenue is specifically earmarked for the designated service. Developer impact fees may be considered if the municipality is seeing a growing amount of development and the elected officials are open to improving the overall safety of their constituents without any impact on their budget.

This article should serve as a reminder that as elected officials and administrators continue to provide our constituents with the highest quality of services, we should be mindful of how critical an ambulance is when a loved one is in a desperate time of need. No official ever wants to hear a complaint that the ambulance finally arrived after 30 minutes and that person who needed a hospital could not wait any longer and passed away.


Author: Peter Melan is an at-large councilperson in the City of Easton, PA and the chair of public safety. He is in his first year of graduate studies in Public Administration at Ohio University. Peter is known for his creativity in solving problems using non-traditional methods, and for his experience in project management and data analytics.

 

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