Administration and Leadership

Reflecting on Pennsylvania’s EMS Issues from 2,300 Miles Away

My sister-in-law in Eastern Pennsylvania, sent me this great descriptive article published in the Times News from the six-county EMS region in Eastern Pennsylvania where I was director from 1975–1992.

It presents a great update and facts on age-old issues that volunteer, BLS and low-volume services have. I wish I wrote it.

Most of the issues are decades old and existed when I was the region’s EMS Council Director, but now these issues are catching up with small services and choking them—financially and emotionally—to death.

From 1975–1987, the Commonwealth of Pennsylvania’s EMS law allowed (by interpretation) EMS Regional Offices to designate ALS regions, and we did so.

They were all strategically selected, spaced and medically mentored by my office and a host of expert board members from hospitals, communication centers and EMS agencies, to cover the region equally and strategically 24/7 based on a high ALS call volume basis.

Our regional medical director actually demanded and received staffing plans and skill verifications (e.g., assessments, successful IV starts, intubations) on a monthly basis before he would release the monthly ALS privileges to compliant services and paramedics.

BLS services that wanted paramedics—many so they could bill at the ALS rate—fought us in court, but we prevailed.

I mirrored our region’s ALS unit deplyment on the Washington State MEDIC ONE program and it worked, as that program still does. Medics 1, 3, 5, 7, 9, ALSS, Northern and Southern Berks units covered a majority of the region of 1.2 million people (and 110 BLS area) with high-quality ALS and high call volume-skilled Medics.

Then, years later, long after I moved 2,300 miles away in California for JEMS, an attorney for the Commonwealth of Pennsylvania issued a ruling that interpreted the EMS law in a different light, contending that any BLS service could have paramedics—even if they couldn’t provide 24/7 ALS coverage.

BLS services—some with call volumes less than 1,000 calls annually—were thrilled and started to hire medics—of any quality that they could find in some instances—so they could offer ALS quicker or closer and, of course, bill the higher ALS rate.

They thought that was the panacea, but it wasn’t.

They failed to do their homework or listen to the regional EMS administrators. We were seen as bureaucrats or obstructionists who had stood in their way to get ALS and prosperity.

They didn’t do the math and figure out all that’s detailed in the Times News article.

As a result, it is sad to see the result, as so many great volunteer services have started to close their doors in a predicted domino effect.

They succumbed to all the things we warned them about: low call volume that was married with the poor reimbursement from the federal government and insurance companies; choking expenses exacerbated by increasing payroll/benefit costs and training; overtime expenses; and equipment and vehicle procurement prices that increased as their budgets didn’t and sucked their reserves dry.

The EMS leaders in Eatern Pennsylvania who are cited in this article, John Kloss and Joni Gestl, grew up in BLS and ALS systems and know that consolidation, regionalization and program innovations like mobile integrated healthcare/community paramedicine are solutions for EMS survival—if only the affected agencies will listen to them.

They say you’re never a profit in your own land. I feel that way right now as I write this from 2,300 miles away reflecting on the people and ambulances services I loved, respected and worked for for 20 years, as we developed the regional EMS system footprint, programs and protocols.

I have a heavy heart and pray, not just for the survival of these great—often stubborn—services, but for the ability for them to “see the light,” and work with John Kloss and the Eastern Pennsylvania Regional EMS office to rethink deployment, financing and service delivery.

Like watching someone who’s dying from cancer, I watched from afar as services shut their doors, dying a slow, painful death in the 25 years I have been away from from the Eastern Pennsylvania EMS region.

But, sadly, unlike cancer, we know that many of these deaths were—and still are—preventable.