Predicting “greater expectations” for the services it provides to the town, Harvard Ambulance Service leaders are rethinking the all-volunteer model it has operated under for 43 years in favor of adding paid staff, starting with a full-time EMT/administrator at $52,000 a year.
The selectmen supported the proposal when the HAS presented its annual budget in a “big picture” format last week. Present for the briefing were HAS Directors Steve Beckman and Jason Cotting, data analyst Will Stevenson, and HR Coordinator Bonnie Sweeney.
Facts and figures they brought to the table included the following:
- Consisting of an all-volunteer staff of certified EMTs and drivers, HAS operates on an annual budget of about $150,000 and so far has been self-funding, through insurance billing and sources other than taxpayer funding.
- HAS fields 300 to 350 emergency calls per year with “unmatched response times,” according to HAS statistics.
- The service must be able to summon a crew on a 24/7 basis, 365 days a year, Beckman told the board, and there are “greater state regulations now.”
- Functioning under a state mandate “equal to that of police and fire departments,” ambulance service first responders provide emergency care in addition to ambulance transport, he said. And as the quality of lifesaving equipment improves, so do expectations for first responders.
Citing “heightened administrative accountability,” Beckman said the town’s aging population has created a substantial uptick in ambulance calls in recent years, particularly from senior residential facilities such as Foxglove and Bowers Brook. “We’re looking to expand the existing model to deal with the trend,” he said.
Beckman said HAS travels outside the area as well as locally, transporting patients to UMass Medical Center in Worcester, Emerson Hospital in Concord, Clinton Hospital, and Lowell General, in addition to Nashoba Valley Medical Center in Ayer. “We contract out for ALS [advanced life support] services,” he said.
Sketching out a profit-and-loss statement over four years, he said HAS expects to have $200,000 set aside for the purchase of a $350,000 ambulance in 2018.
Write-offs sap budget
On average, an ambulance call costs $591, but a number of those calls are “write-offs” for which HAS won’t be paid, and the service is not authorized to bill Medicaid. “We don’t collect from MassHealth or charge town residents who don’t have insurance,” Beckman said.
HAS is one of the last vestiges of the all-volunteer service model, Beckman said. But it’s a challenge to stay that way and continue to be self-funding as well. He acknowledged that the model is probably not sustainable going forward.
He also said the amount of time volunteers put in is key to staying on track, but that the current level of available, trained personnel can’t be considered consistent for planning purposes, and in fact is about maxed out now. “Our volunteers contribute about 400 hours per year,” Beckman said. “It’s squeezing the rock.”
Consensus among selectmen and the HAS group was that eventually the HAS would likely look more like the Fire Department with a roster of both paid and call EMTs.
The selectmen noted that the idea has been floated before.
Another problem to be addressed was the lack of a “real facility” to house the staff, Selectman Leo Blair said. The current ambulance headquarters, a room off the garage in the Public Safety Building, is neither warm nor comfortable, the HAS members agreed.
“It’s harder to recruit, collect, and there’s a need for paid staff,” Blair said, summing up priority needs. “Could you be on the way out of business?” It’s a question worth asking, he added. “Not to understand that it’s possible is a sure way to fail.”
The HAS members said they believe there would be a role for them, even with changes.
Selectman Ken Swanton agreed, citing other towns with “blended” volunteer and paid staff models. “Maybe we should take a look” he suggested.
“I’d caution against a Band-aid approach,” Chairman Ron Ricci added. “Let’s look at keeping the service together and figure out staffing needs from there.”
“The point is you may be asking for too little,” Blair said.
