Lack of funding, personnel create challenges for EMS | Kulick

I have been in EMS (the Emergency Medical Services) a long time. I mean a really long time. I’m beginning my 50th year and believe me, the changes I have seen have been lifesaving and dramatic. Gone are the days when someone called for an ambulance and the phone tree was started to find a couple of people available to drive to the ambulance station, respond to the call, swoop up the patient and drive real fast to the hospital and hope that was good enough to have someone survive.

Recently in testimony in Harrisburg, Heather Sharar, Executive Director of the Ambulance Association of PA, told legislators, “Ambulance transports are more than 'just a ride.' You are receiving a mobile (emergency room). It is not just the gas for the ride to the hospital. It is care. It is medical monitoring, treatment, and observation. It is a lifesaving resource, that unfortunately nobody wants to pay for.”

In the September issue of a publication from the Pennsylvania State Association of Township Supervisors an article appeared: “EMS in Crisis, Townships are on the Front Lines to Preserve Local Agencies.” The article notes that EMS providers across the commonwealth are sounding the alarm over issues that threaten the service as it currently operates. State regulations, a lack of steady funding stream, and dwindling numbers of volunteers and staff consistently rise to the top of the list.

The article cites that the EMS crisis didn’t sprout up overnight and there’s no simple fix. Residents consider it an essential service and expect trained personnel ready to respond when they call 911. Municipalities are on the front lines in the battle to ensure that EMS remains a community service.

The article highlights the two most pressing issues with EMS, no surprise that the same two issues affect virtually every organization: personnel and money. According to a quote from Phillip Beck of East Pennsboro Ambulance service highlights what many of us in EMS have been saying for years: “EMS doesn’t close. You can’t tell your residents, ‘Sorry don’t call 9-1-1. We need a break’.”

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Today, attracting young people or those of any age into EMS often see it as a steppingstone into other careers. Often for a resume for medical school, nursing school or many other careers. Hence, the shortage of trained personnel to serve as 911 EMS providers.

Today the cost of becoming an EMT is upwards of $1,000 and the cost of the necessary book is $600 more. To become a paramedic, the cost can range from $7,000 to $25,000 and takes at least a year’s experience as an EMT and then another six or eight months to a year to complete the course then to take the test for certification. The cost alone is one of the reasons that most agencies only have career personnel.

The costs associated with ambulance services have skyrocketed. As the article points out, from gloves to gurneys (stretchers), it’s expensive. An outfitted ambulance can start at $200,000. A service must still pay for insurance, supplies, buildings as well as the personnel.

A common misconception is that insurance payments will carry the cost of operations. Ambulance services bill clients and their insurance companies for services, which is the main source of income for EMS. Insurance reimbursements and copays often go unaddressed, according to one EMS leader, but those payments account for a large percentage of their budgets.

“Every time an ambulance responds to a 911 call, the average cost is $750, “(An) Average transport bill is $1,185 or more. (The) Average net amount collected from insurance is 38%. If a patient does not have insurance, or refuses to pay their bill, an EMS agency basically has provided a free service,” according to an EMS manager. He also noted Medicare and Medicaid also don’t cover much of the cost per ambulance transport.

In testimony in Harrisburg before the House Veterans Affairs and Emergency Preparedness Committee, Joe Gerdes, director of government relations for PSATS, said that funding is a challenge. He told the committee, “To address funding, new revenue raising options would be helpful and enhance a municipality’s ability to help pay for EMS and other emergency services.”

“For example, PSATS members would like to increase the amount of the ambulance tax they could currently levy under the Second Class Township Code from 0.5 to 1.5 mils. These revenues could only be used to support ambulance companies that service their townships.”

The article continues to address other issues like mandates on training, staffing and other licensure related issues as well as insurance reimbursements. But the most telling lines were the closing ones. “The current EMS crisis only looks to get worse if immediate action is not taken. action that requires all stakeholders to work together to find viable solutions. If not, a call to 9-1-1, rather than being met with “9-1-1 what’s your emergency?” may be met with silence."

Debbie Kulick is an EMT who writes a weekly news column for the Pocono Record.

This article originally appeared on Pocono Record: EMS agencies in Pa. need funding, personnel | Kulick