By Andy McKeever
LANESBOROUGH, Mass. — A bill to change the staffing requirements of an ambulance service could be a game changer for struggling volunteer services.
But, the state Department of Public Health has opposed the bill in previous legislative sessions.
State Sen. Adam Hinds and state Rep. Paul Mark have sponsored a bill that would alleviate the requirement that two emergency medical technicians be on every basic life support transports. The change would allow for first responders, who are slightly less trained, to be drivers during those calls while a certified EMT handles patient care in the back.
“There are a number of communities in the district that bump up against this state law that requires two EMTs,” Hinds said on Monday. “It is very difficult for a volunteer ambulance service to do that … This is essentially a pretty basic shift.”
But that seemingly small change hasn’t been easy.
The bill dates back to 2011 and came at the request of Hinsdale, which was looking for ways to improve its volunteer service. It was filed by former state Sen. Benjamin Downing and Mark. The first version was sent for a study in 2012. The pair re-filed it the next session, this time joined by Reps. William Pignatelli and Gailanne Cariddi, and it again fell short of passing.
“The same issue was happening in Charlemont and they got on board with advocating for it,” Mark said on Tuesday. “It’s become more of a Charlemont and Hawley issue [more than Hinsdale] now.”
Last year, the bill got even further through the process but the Department of Public Health publicly opposed it. The opposition led to a recrafting of the bill limiting it to towns with a population of 3,000 people or less or with a density of fewer than 500 residents per square mile. But even then it didn’t pass.
Mark refutes DPH’s concerns saying it is in the best interest of those living miles away from a hospital to receive care quickly.
“DPH put out a statement that they didn’t feel it was safe,” Mark said. “But what is not safe for some of these people to wait 45 minutes to get to the nearest hospital.”
Earlier this year DPH spokesman Tom Lyons told New England Public Radio, “Day-to-day staffing for basic life support ambulances with two emergency medical technicians is the standard of care for all ambulance services in the state, and we believe this is in the best interest of our residents and anyone in Massachusetts who may need an ambulance. … We are always available to work on strategies with communities to meet this standard of care.”
Hinds has now picked up where Downing left off on the bill, re-filing the same version as the previous three sessions — without the restrictions on town sizes — alongside Mark. The bill allows class I, II or V ambulances to use first responders on the basic life support calls as drivers. If passed, it would be a huge help in keeping rural volunteer services in business, many of which are barely holding on.
The Lanesborough Ambulance Squad is one of those volunteer services that could benefit from the change. The service has been facing financial struggles in recent years and part of that is because of an inability to get volunteers to answer calls, thus lowering the revenues received from making the transports.
Deputy EMS Chief JD Hebert says many times there has been only one of the six or seven who are active in the department available to handle a call. However, there are another 30 or so volunteer firefighters who are trained first responders but because of the license requirements can’t fill in to drive the rig.
“There are a lot of times when we only have one available. Being a volunteer service we are challenged,” Hebert said.
Hebert said there are four levels of emergency medical service certifications — first responders, EMT-Basic, Advanced EMT, and paramedic. Some commercial services are able to get a waiver to have an EMT-Basic be the driver and a paramedic in the back on advanced life support calls, he said. The volunteer service handles basic life support calls and he doesn’t see why those training level requirements couldn’t be similar for a basic life support.
“If you take that same concept to a basic in the back and a trained first-responder in front, why wouldn’t that work?” Hebert said.
Lanesborough officials have tried to recruit town employees to become emergency medical technicians to help handle more calls during the day but the training is extensive and officials found only one volunteer willing to become certified. Fire Chief Charlie Durfee has repeatedly said that not many people are lining up to become certified EMTs.
The Ambulance Squad used to be able to support itself but regulations and unpaid bills have been making it increasing difficult to make the ends meet.
Hebert said the staffing requirement change would have to be “under strict guidelines and controls” but would be a huge help to the volunteer services.
If the Legislature again compromises on regulating it to population sizes, Lanesborough would fall 91 people short of being under the 3,000 mark, according to the 2010 Census, but would still be eligible because of the population density.
More recently in Lanesborough, the squad’s future has been questioned when County Ambulance submitted a proposal to become the primary response for all of the calls at no charge to the taxpayers. There is a chance Lanesborough shuts down its ambulance service.
And the same story is true for many rural services throughout Western Massachusetts, some much farther from their nearest hospital.
The threat of shutting down looms over Charlemont, which is trying to save its 70-year-old service, and Hawley. Village Ambulance in Williamstown, a good 30 minutes or more from Berkshire Medical Center, is the latest to face the possibility of a shut down because of financial challenges.
“Charlemont and Hawley could lose their accreditation this year. They’ve been trying to find ways to address this,” Mark said.
Charlemont Ambulance Service had previously received temporary permission from the state to use a first-responder as a driver with an EMT in the back. But, the temporary waiver doesn’t provide much certainty as town officials seek to develop long-term plans.
A second bill proposed is to allow Charlemont to charge a 3 percent recreation tax on commercial outdoor facilities such as ski resorts and whitewater rafting. But that, too, had been objected to by the Department of Revenue and failed the last session. Mark and Hinds have re-filed that bill as well.
Squads all over Western Massachusetts have been struggling. Volunteer ambulances are particularly important to small rural towns where the distances between population centers are vast compared to the eastern portion of the state.
Mark added that the rural towns not only have greater distances to cover but also smaller tax bases to support switching to full-time services, which can cost hundreds of thousands of dollars per year.
“In these small towns, it is very difficult for them to afford more employees,” Mark said.
Mark says this time around the lawmakers at least have a better understanding of where the Department of Public Health is coming from. He hopes to improve communication and bring those officials out to the rural towns to show them exactly the difficulties facing the towns.
For Hinds, the seemingly small but important piece of legislation is just one example of regulations that don’t help rural Western Massachusetts he’d like to change. He said he’s been getting involved with the rural caucus and is hoping to find more ways to help the small towns throughout the district.
“My hope is we can take a practical approach to this,” Hinds said. “There are a number of state regulations that don’t apply to small towns. This is just one example.”