EMS shortage is acute-Town Seeks Answer To Increased Need

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Problem seems similar to the one in the WC

EMS shortage is acute 

Towns seek answer to increasing need 

By Susan Tuz

THE NEWS-TIMES Danbury 

When a Bridgewater Volunteer Ambulance crew responded to the scene of a car crash on Route 133 about four weeks ago, the driver was already out of the vehicle and walking around. Soon after, though, he collapsed. His heart had stopped.

Luckily, Brookfield Volunteer Ambulance arrived on the scene with a paramedic who worked on the victim during the ride to Danbury Hospital. The man recovered.

"If it had been 10 or even five years ago, we would have had services for him, instead of seeing him alive today," said Brookfield First Selectman Jerry Murphy.

 

Murphy gives part of the credit to a contract the town signed with an emergency medical services company out of Waterbury. The company, called Ventich, supplies Brookfield with a paramedic 24 hours a day, every day of the year. It also provides Emergency Medical Technicians to supplement the work of residents who volunteer for the ambulance service.

But the deal with Ventich also allows Brookfield to avoid problems that several neighboring towns are facing as calls for emergency service increase and the number of available volunteers, especially during daytime hours, declines.

''We're getting a lot of cardiac saves that we may not have had five years ago," said Allen Owen, EMS captain for Brookfield.

In Ridgefield, Bethel and Newtown, on the other hand, ambulance calls are up and — too often, officials say — there are not enough people to provide a quick response.

Ridgefield's fire chief, Lou Yarrish, has requested more personnel to increase his paid fire and emergency medical services staff.

Bethel First Selectman Alice Hutchinson has established an EMS Advisory Committee to search for answers in her town.

Bill Weimal of the Newtown Ambulance Association said he hopes his town has found an answer by offering incentive pay for new volunteers.

The problem is not in the quality of emergency medical training in these towns. Ridgefield received an Outstanding Service Award from Danbury Hospital in 2003 for its EMS staff.

Bethel, with its three ambulances, has a certified EMS staff of more than 45 serving its Bethel and Stony Hill fire stations.

These men and women "break their backs to serve their town," said Dan Spinella, Bethel's EMS captain.

But the town is growing and volunteers who once worked where they lived are now employed out of town, leaving a skeleton force to respond to calls during the day.

Although a paramedic from Danbury will respond to Bethel calls, Spinella said, it takes longer to get help to a victim.

"I think that we have to evaluate our situation," said Hutchinson, the Bethel first selectman. "With our population of 18,000, if we don't look at possibilities down the road, we'll be caught unawares as our town grows to 20,000 and 25,000. We're already having response time complaints during the day."

The town is resisting a paid emergency medical force at this time, but has an aggressive recruitment program underway for new volunteers. Bethel fire station has six new people in an EMT course.

"I've been in the department for 18 years and have seen a big change in the number of calls coming in" and the number of volunteers available on day shifts, Spinella said. "Will we have to go to a paid force? I can't say."

Adding to the problem, the three towns have seen an increase in extended-care facilities, with numerous calls for emergency services coming from those facilities during the day.

"We've got Ashlar Nursing Home, Lockwood Lodge and Homestead assisted-care facilities in our town," said Newtown First Selectman Herb Rosenthal. "One of our problems is more calls coming from Garner Correctional Facility, which is located here."

The pressures have some in Newtown also wondering whether a the all-volunteer force will have to be changed to partly volunteer, partly paid.

"Our problem was that we had college kids on (as volunteers) during the summer and they've gone back to school," said Weimal of the Newtown Ambulance Association. "Then a number of our long-standing volunteers changed jobs and weren't available days. This seems to be a cycle we go through. We had this situation two or three years ago. I can't say what will happen in five years, but for now, I don't see a professional paid force happening tomorrow."

Newtown is on a pace to take 1,900 calls this year, up from 1,500 calls three years ago, Weimal said.

Calls are also up in Ridgefield. In 2003, there were 1,765 EMS calls. By the end of October this year, 1,667 calls had already come in, a 13 percent increase in the monthly rate.

First Selectman Rudy Marconi pointed out the fire department recently hired more workers for desk work, which frees others for training and emergency calls. Ridgefield has also hired certified paramedics and paid for firefighting training for them. And the town is getting a new ambulance in December, assuring that two ambulances will always be in service in the town.

Marconi predicted that will be the extent of increases in the near future.

When calls for emergency services in Brookfield escalated, volunteers were stretched thin, especially with a growing number working out of town.

That's when Brookfield hired Ventich.

"Six years ago, our call volumes were at about 600 annually," said Owen, Brookfield's EMS captain. "Then Brookfield Commons came in and we shot up to 900 calls annually in 24 months. With that happening, our daytime calls were increasing and our daytime resources were starting to burn out. We had to come up with a way to relieve the pressure on our volunteers."

New Fairfield also hired outside help to provide emergency services.

First Selectman Peggy Katkocin said that just two years ago her town of 14,000 was facing the same problem as surrounding towns: daytime call volume was exceeding manpower. Even with three ambulances at three locations, there were not enough volunteers to man them.

New Fairfield hired BSI emergency medical services, which operates through Danbury Hospital, for almost $300,000 a year.

The town is reimbursed for most of the BSI bill, Katkocin said, by billing insurance companies of customers using the ambulance services.

Today, there is a paramedic on site with an EMT back-up. After 6 p.m., the on-call paramedic is a BSI employee who lives in New Fairfield. He works with the volunteer EMTs.

"We were all a little tentative, concerned about bringing a paid EMT and paramedics in," Katkocin said. "But none of the problems we anticipated occurred. When I leave office one of things I'll feel best about is the improved quality of life and level of emergency care we brought to our town."

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Paid EMT Shifts Expected As Soon As Next Week

By John Voket

Newtown Volunteer Ambulance Emergency Medical Technicians who are most familiar with the town's roadways and population will be the first to access proposed paid day shift opportunities, possibly as early as next Monday, the outgoing chief of the Ambulance Corps told The Bee Tuesday. 

Ambulance Corps Chief Ken Appley, who is voluntarily ending his tenure November 30, said he believes the emergency stopgap paid shift measure, combined with new recruitment programs and a newfound level of cooperation and communication between the volunteer corps and its fiduciary Ambulance Association, will help solve intermittent weekday response concerns.

In recent weeks, several issues involving the 80-plus member corps and the association's nearly $1 million public nonprofit corporation that funds town ambulance services have come to the fore. 

Those issues include First Selectman Herb Rosenthal's increasing concerns in recent months as the ranks of ambulance volunteers were stretched thin responding to numerous daytime calls. The intermittent shortages of available responders, primarily Monday through Friday from 6 am to 6 pm, were causing delayed response times and forcing the town to lean heavily on neighboring community ambulance companies for mutual aid.

Last week, Mr Rosenthal called for the corps and association to work together to solve the response time problems or he would be forced to step in and try to address the issue himself. By statute, the first selectman is responsible for, and has authority over, the community's ambulance service above all other volunteer agencies or their leadership.

According to Chief Appley, late last week the corps and association leaders were able to strike a tentative agreement aimed at solving the response issue. He said as soon as next Monday any willing volunteer would be able to apply to standby at the ambulance garage during 6 am to 6 pm weekday shifts, and they will be compensated for their time through the association.

"It means a staff EMT, who is also a local corps member, will head out to the scene the moment that call comes through," he said.

Short of recruiting a new group of volunteers who would cover crucial day shifts for free, he feels the local access to paid shifts is the most viable short-term solution.

"We'll start the paid program for local EMTs and we'll have a backup plan in place that involves hiring an outside service if this program doesn't work out," Chief Appley said. "We're hoping to start [the paid shifts] next week. We're getting the necessary paperwork squared away."

Newtown has the busiest volunteer ambulance service in the region, responding to more than 1,900 calls in the past 12 months. But as calls for mutual aid to help cover the rapidly escalating call volume increased, it was evident the ambulance service would have to tap less traditional means of getting their ambulances out to the scenes of calls more quickly.

That issue was in the process of being addressed through a compensation plan for corps volunteers.

But after commissioning a proposal to outline a paid shift program for the volunteers, the association's board abruptly changed direction on the idea, seeming to favor the idea of hiring an outside vendor to provide out-of-town personnel to staff the daytime shifts.

During the association's annual meeting earlier this month, former association chairman Malcolm McLachlan told corps members he was advised by an out-of-state legal expert that it would be illegal to pay local EMTs to work for the same organization for which they volunteered. Since that time, a choice of viable options emerged that would allow local volunteers who know the community best to receive compensation to staff critical shifts through an outside staffing service.

Since that story appeared, it was widely circulated among the local EMS community that Mr McLachlan had resigned from the association's Board of Trustees, a fact he confirmed to The Bee Wednesday morning.

Mr Appley said that through additional research by corps leaders, he learned that the corps could initiate temporary stopgap measures to ensure optimum response time, including legally paying volunteers to staff critical shifts.

"We'll put a six-month maximum on this stopgap program while we work on increasing the volunteer membership base to enhance our availability during the week," he said. Besides reaching out to local EMTs who are not currently affiliated with the group, Chief Appley said the corps plans to launch an aggressive campaign to get more community members involved with the service.

He said the corps is also considering establishing a junior ambulance group or explorerlike post to help initiate younger people to the fast-paced and vital community service.

"With the cutoff for members at 18 years old, we barely get them trained before we lose them [to college or other paying jobs]," he said. "If we can recruit and train younger volunteers, we can hold onto them longer."

He said any resident interested in becoming an EMT and a Newtown Ambulance volunteer can contact the corps headquarters at 270-4380. The local ambulance group holds EMT training about twice each year, but neighboring departments, hospitals, and local colleges also offer EMT certification.

"Obviously all the monetary donations to the association help, but it's the EMTs that are out there day and night doing the work," he said. "In that respect, the volunteers [who donate their time] are significantly more valuable to the community right now."

Once the temporary paid day shift is in place, Chief Appley said a volunteer will be on standby at the ambulance garage weekdays from 6 am to 6 pm. The moment a call comes through, that volunteer will head to the location in the ambulance while other available volunteers will go straight to the scene in their own vehicles, meeting up with the rig at the call.

In addition to the ambulance, a paid paramedic intercept is also on 24-hour call in Newtown. But since that paramedic is shared by Newtown, Bethel, and Redding, there is less of a chance that responder would arrive at the scene of a call before local ambulance crews.

Another source close to the ambulance corps told The Bee that by signing an agreement acknowledging they would not be responsible for the minimum 30-hours per month volunteer requirement, it would allow the association to pay volunteers for specific shifts under the stopgap measure.

Chief Appley said, however, that it is the corps' aim to try and get enough volunteers recruited to eliminate the stopgap measure before it expires in May 2005.

"We're going to be looking at the response time every week, and reporting on whether or not it's successful at each month's association meeting," he said. "We just want the community to know that the ambulance corps volunteers are working as quickly as possible to address our response times, and that we are all fully committed to bringing them the best service available. But with nineteen hundred calls in the past year, it's been a tough situation for everyone."