The ‘cold, hard truth’ of emergency medical services

By Grace David | The Center Square

ALLEGHENY COUNTY, PA – The average commonwealth resident expects help to arrive with immediacy after a 911 call ends.

However, the “cold, hard truth” – according Adams Area Fire District Lt. Taylor Goodlin – is that this expectation is not guaranteed.

“I’d love to sit here and tell you we’ll be there no matter what. But, I really can’t. I wouldn’t be able to go to sleep tonight if I told you that because it’s not true,” Goodlin said.

Funding and recruitment are two of the greatest challenges that Pennsylvania’s Emergency Medical Services face.

Recently, the Commonwealth passed legislation to improve the situation, by increasing reimbursement rates and allowing more flexibility for ambulance crews, as previously reported by The Center Square.

While this legislation is on the right track, more assistance is needed. First responders request increased local help from the municipalities they serve.

“Our biggest struggle is our ability to fund our capital needs,” says Chief Chris Dell of the McCandless-Franklin Park Ambulance Authority in Allegheny County. “I don’t see legislation coming along and telling each municipality that you have to fund your ambulance service. Years ago, they did require that every municipality designate an ambulance service–where they stopped short is, it didn’t say you have to fund it.”

Dell explains that billing insurance largely covers everyday expenses. The struggle lies in what he calls “capital expenses” or items like heart monitors, ambulances, stretchers, a new roof or a garage door. These “big ticket items” are necessary for a station to run properly, according to Dell.

The staff at McCandless-Franklin Park explained that there should be a continual cycle where an ambulance is replaced every year. An empty ambulance alone costs $250,000. A stretcher costs $65,000.

“In order for us to treat our patients the best, we want to have the best equipment, and we have to be able to afford those types of things,” says Michael Wholihan from McCandless-Franklin Park.

In addition to the heavy expenses, it can take years to receive a new ambulance, depending on what parts are available. While the technology and medical tools necessary to provide medical services require plenty of funding, EMS agencies also have to pay their crews to be ready at any time.

“All municipalities need to recognize the cost of providing that ambulance service,” says Dell. “They might not call, or they might all call at the exact same time, and we’ve got to handle it all, some way or another. Our being here and ready to respond is very expensive.”

Dell wants municipal leaders to recognize that EMS agencies are struggling–without municipal funding and good management practices, they will not exist.

Recently, a station in Westmoreland County closed its doors after 63 years because it couldn’t fund its operations.

“I’ve seen agencies that are simply running out of money rapidly,” says Dell. “Jeanette EMS in Westmoreland County just recently said, ‘We can’t make payroll. There’s no sense in having teams work today because we can’t afford to pay.’”

Dell says that most FEMA funding goes to fire departments at a disproportionate level. “People think, well, it’s because you can bill for the insurance. But they don’t pay the full weight of what it costs for us to do business,” he explains.

Sometimes, when patients directly receive the invoice to pay for ambulance services from insurance companies, the ambulances never get paid. One way to get the money, according to Dell, is to set up a direct agreement with an insurance company.

“I set a lower rate, and then the checks will come directly to us,” he said.

While the McCandless-Franklin Park Ambulance Authority requests municipal funding, the Adams Area Fire District is 100% municipally funded in Butler County – just 20 minutes away. Its station was recently renovated in 2017.

“We are fortunate enough here that we don’t fundraise at all,” says Goodlin. “Unfortunately, we don’t get enough funds from the municipalities to pay people to be here. We have enough to keep trucks running keep our equipment updated and the lights on, but that’s pretty much about

Many firefighters in the area serve at multiple stations. Adams Area is 100% volunteer, often leaving only one firefighter in the station during the average 9 a.m.-5 p.m. workday.

Goodlin says the municipalities that his station serves have been very generous with the allocation of their taxes to the fire department.

An average engine costs about $890,000 and the average cost to outfit a firefighter is $10,000, and the station can cover it. But Goodlin believes that it is going to take paying for “career firefighters” to keep the service running.

“The ultimate answer is to hire people to do the job,” he said.

The Adams Area Fire District serves a fast-growing community just north of Pittsburgh, so Goodlin expects the number of calls per day to only go up.

“I hope to see a sharp increase in paying personnel to be able to respond to calls at any given notice,” he said.
The lieutenant is very appreciative of the support that the Adams Area Fire District receives, but not all places are as fortunate.

“I come from a place where … we did all sorts of fundraisers just to make ends meet,” Goodlin said. “And in some cases, that still wasn’t enough to bring our equipment up to today’s standards.”

According to Mark Pierson, a volunteer at McCandless-Franklin Park who has served in emergency medical services for 47 years, recruitment is a greater issue in northern rural areas than it is in southern areas closer to the suburbs.

A lack of personnel is not a struggle for McCandless-Franklin Park, nestled in the northern suburbs of Pittsburgh.

“We definitely have volunteers, we definitely have part-time, and we definitely have full-time,” said Wholihan. “And then you have a lot of those that are going through schooling that want some hands-on experience.”

Many ambulance agencies find personnel in students who want to learn in the field, from nearby technical schools, high schools and universities.

To solve similar emergency medical services struggles, nearby states like West Virginia have consolidated their agencies by regionalizing.

While Pennsylvania hasn’t taken this step yet, Allegheny County has gone from 128 to 40 stations, according to Dell. This is often due to local consolidation or shut down, like Jeanette EMS. McCanldess-Franklin Park consolidated between 1977 and 1979 and now serves five municipalities.

“That consolidation has been good,” said Dell. “Because unfortunately, we’re also a volume-driven event, we require the crews to be on calls and be able to bill insurance for the lights to stay on.”

Funding and recruitment needs vary from station to station across the state, but both are equally necessary to provide the immediate and quality services required to keep Pennsylvanians healthy and safe.