The Town of Lyons was in trouble. According to Town Supervisor Jim Brady at a recent Town Board meeting, they wrote off a two year loss by the Lyons Ambulance Service $615,586. Those fees represent an ongoing loss for unpaid ambulance services.
The loss is not a new phenomena. Many municipal ambulance services throughout Wayne County and New York State are in the same situation.
Decades ago many rural ambulance services were performed by local funeral home directors, who had the vehicles necessary for the scoop and transport of medical victims. Few, if any medical procedures were available.
Sophistication and medical services improved over the decades and communities initially survived on volunteers to fill the job, much like community fire departments.
As medical services improved over time, patient care became paramount. Ambulance services required certification. Certification meant medical training. The days of scoop and transport were over.
Yes, a volunteer could drive and assist another crew member, but that crew member needed to be well-versed in medical procedures. Initially that training required the medical crew member to become an ALS (Advanced Life Support). This required advanced classroom training and time dedication.
The next requirements for licensing on municipal ambulance services came in the form of a crew member becoming an EMT (Emergency Medical Technician). Again, this next level of professionalism came at a cost of not only time, but money.
Volunteering became less and less desirable or practical as medical training advanced.
Private, professional ambulance services found it necessary to increase wages for ambulance crews. What was once a rural community volunteer service was/is being squeezed out with the reality of advancements.
Added to the actual cost of an ambulance crew, came the realization that a well-outfitted ambulance, with all the life saving equipment and supplies, could run up to $300,000.
Medicare, is the U.S. health insurance program for people age 65 and older and some people under 65 with certain disabilities or conditions.
Medicaid is a joint federal and state program that gives health coverage to some people with limited income and resources.
These two programs have limited coverage for ambulance services, have maximum fees for services and require paperwork and time before ambulance services are reimbursed.
The next problem for ambulance services comes in the uncollectible category. Patient required fees often go unpaid, as in the case in Lyons. This only adds to the deficit municipality services incur.
In past years it was common for ALS and even EMT level ambulance staff to be paid as little as $12-$15 per hour. In these times, hardly a living wage, in a time where fast food workers were earning the same, or more.
In the past few years, wages have increased to $15, or more, but still not in line for the time and training required by now professional ambulance crews.
Ambulance calls are not a 8 to 5 reality. An ambulance crew must have 24 hour service, or rely on mutual call service with nearby municipal, or private firms.
Relying on ‘mutual aid’ calls cuts down response times that may be critical to treating, or saving a victim of a medical emergency.
Finger Lakes Ambulance Service has a fleet of 9 Advanced Life Support ambulances, one of which is equipped and staffed as a Mobile Intensive Care Unit. They are certified to provide Emergency Medical Services within a 20 mile radius of Clifton Springs, NY by the New York State Department of Health. The private service has supplied back-up to municipal services, in the past, but on a limited basis with response time and availability.
The private service upped its pay for crews to $22 to $30+, depending on the level of training. The Lyons ambulance service topped out at $18 per hour.
Wayne County municipalities saw the problem coming years ago and united several ambulance services on the western region of the county into Western Wayne Ambulance, serving the Towns of Marion and Walworth. Located in Walworth,
the service not only provides 24/7 coverage for the towns, but also provides mutual aid to nearby towns.
“I think it has been a really good thing. We can’t get volunteers anymore and they (Western Wayne Ambulance) get there in reasonable times,” said Marion Town Supervisor Jody Bender.
The County, several years ago, began using the non-transporting EMS vehicle, also known as a fly-car. The response vehicle, quick response service vehicle, or fast response vehicle, is a vehicle that responds to and provides emergency medical services without the ability to transport patients. It has been a critical addition in saving lives of patients throughout Wayne County.
A Wayne County Advisory Committee on ambulance service has taken steps to provide a future plan for county- wide services.
A new ambulance building is proposed to be built behind the Wayne County Nursing Home in the County Complex on Route 31 in Lyons. Another building is in the works for the Sodus area of Route 88 and 104, with plans to address the eastern towns as well with contracts with current ambu- lance and fire company buildings for nominal rent for the time being.
The county run services will replace most of the current individual municipal ambulance coverage, but will come at a cost. So far the County has spent $1.5 million on the plans.
County Administrator Rick House stated that county surplus funds are being tapped for the plans, but more will be spent in activating the service. Ongoing costs will have to be addressed as the county plan becomes reality as taxpayers pay the piper in the future.
Not all towns and municipal services are onboard with the County plans, or the County Advisory Committee.
Macedon, much like the Town of Ontario, have seen rapid growth over the past decade. The Route 31 and Route 104 corridors have provided the towns with additional tax dollars to address ambulance problems and responses.
Macedon has developed a 24/7 plan with two fully equipped vehicles and well-paid staff. They also rely on the Western Wayne Ambulance for mutual aid when either both ambulances are in service, or there is another down time in service.
Macedon Town Supervisor, Kim Leonard stated: “The Wayne County-Wide Ambulance Project recently approved will be a major ticket item to the taxpayers of Wayne County. It is the responsibility of this Wayne County Board of Supervisors to ensure Public Safety to everyone in our County, to improve ambulance response times, and to have qualified EMS personnel committed and ready to serve. With this comes the task of having a plan in place to use our resources wisely while creating this Ambulance Transport Service.”
According to Ontario Town Supervisor, Frank Robusto, the OVS (Ontario Volunteer Service), with a mixture of two paid staff and volunteers has been doing fine financially. "Their response times have been above par,” said Robusto. “You don’t want to replace a vibrant service like we have in Ontario”, he added.
The Newark-Wayne Hospital has rung in on the problem as well. Transports of patients to other facilities recently required the hospital to go as far as Pennsylvania to find a transport.
Regardless of municipal ambulance needs and successes, all realize the scramble for well-paid crews, equipment and reimbursement problems, a long term solution is needed for Wayne County and throughout the state.
Rick House stated that other counties are watching how Wayne County is working out a county-wide plan for the future.