A recent news article on the Lake George Emergency Squad cited Town Supervisor Dennis Dickinson asking squad captain Chris Hawley at a recent budget workshop what would happen if the town flat-out rejected the squad’s request for $251,000 for 2014 — an increase of $111,000 over 2013.
Hawley is quoted as saying the squad would discontinue operation and the town could hire Empire Ambulance.
Maybe a paid, professional EMS enterprise would be the way to go. Empire already was awarded a “Certificate of Need” for all of Warren County. When North Warren EMS once closed its doors temporarily, Empire sent crews to cover, at a cost, until adequate volunteer staff could be found, and to give the squad time to reorganize.
North Warren EMS uses E5 Staffing, a private venture, to fill the gaps in coverage not provided by volunteers. As the state upgrades the EMS system to the national standards, area EMTs are witnessing changes — some for the better, some for the worse. The bottom line is, what has happened to the volunteer?
First, let’s look at what it takes to be a volunteer EMT. The EMT Course has three components: Didactic (120 hours) which includes practical, hands-on skills training; the Clinical/field ride-along (minimum 24 hours total of observation with a minimum of 10 patient contacts), and final testing (4-8 hours). Through lectures, interactive presentations, skills labs and simulations, individuals acquire knowledge and skills so they can properly care for patients. The cost of this training is $700 for the original course and $335 for a refresher sessions — plus the cost of books. After courses are completed, squads can get reimbursed for the cost of the class only — and squads, of course must pay for students who don’t finish the course, or those who don’t end up serving the agency.
That’s not all. For further training, there is an Advanced EMT course also taught at a nearby squad at the cost of $950. The highest level of EMT is a Paramedic, a two-year college course currently not offered in Warren County.
Tuition costs vary from $3,000 to $13,000 or more. Often after completion of the paramedic course, the students are hired by EMS companies for better wages than many EMS agencies in Warren County can offer.
It’s a job that you must love to do, being called out all hours of the night or day, with shifts being 12 to 24 hours, with most starting with poor hourly wages, primarily part-time work with no health insurance provided.
So what has happened to the volunteer? As more and more volunteer EMS agencies start to pay staff less and less, volunteers ask themselves why they would give up 12 hours to volunteer for a shift, when the person on duty beside them is getting paid.
There’s also the question of “soft billing” and how much patients end up getting charged for services.
Both Empire and Lake George EMS pay staff, both are paramedic-certified ambulances, both bill, but with Empire responding, patients must pay for services. Lake George EMS and many other volunteer squads in the region aggressively bill insurance companies, but don’t pursue payments from uninsured patients after sending out a few bills.
Cost verses benefit: Some agencies in Warren County staff 24/7 during the summer months when the average call volume requires the coverage, then rely on mutual aid off-season. As a taxpayer and full-time resident, I wonder why I am not as important as the part-time residents and tourists.
Ideally, when an emergency responder shows up at your home to provide service, he or she is local and knows your name, your medical issues and other vital information, because they have provided service beforehand.
Unfortunately, federal labor law is a major obstacle: individuals are prohibited from providing both paid and volunteer services in the same capacity to the same public agency or other employer, so most squads don’t hire their own volunteers. Some use staffing agencies such as E5 or Keena Staffing as a way to outsource their employment.
Warren County has talked of a county-wide Advanced Life Support (ALS) system — with paid paramedics in first response vehicles responding, which would relieve some of the cost burden of the local EMS squads.
In this arrangement, the local EMS agency would be providing the ambulance for transport. This has been met with lots of opposition from some of the area squads, but something needs to change. More people are calling for ambulances, insurance is paying less and less for services, and EMTs are being required to provide more care in the field than ever. The days of “get there give oxygen and get them to the nearest hospital” are out. Now we can start IVs, give medication, conduct electrocardiograms and provide many lifesaving services, many required by our medical directors.
This all adds up to an increase in the bottom line. The system is a very broken; one that needs to be scrutinized. The EMS system should be examined to see if the volunteer is a plausible option or just another antiquated idea.
Nathan Thomas, Emergency Medical Technician