With concern for the performance and administrative burdens borne by Harvard’s volunteer ambulance service, a just-released audit recommends that the town hire a full-time emergency medical services coordinator and make other changes that, if implemented, would likely hasten an end to the organization’s self-funding business model.
The study also recommends that the town add money to the fiscal 2018 Fire Department budget to hire a firefighter who could take responsibility for certain inspections currently done by Fire Chief Rick Sicard, freeing him to perform state-required annual inspections of commercial buildings in town and to devote more time to fire prevention and firefighter training.
The two recommendations were the most dramatic among a list of 23 proposed in a 75-page audit commissioned by the selectmen and prepared by consultants at the Edward J. Collins Jr. Center for Public Management at UMass Boston. The $12,400 “Management and Operations Analysis,” approved by the 2016 Annual Town Meeting in April, was presented Tuesday night to a joint meeting of the Board of Selectmen and the Finance Committee, with members of the fire and ambulance crews in the audience. Harvard’s police force is tentatively scheduled for a similar audit in fiscal 2018.
The study gave high marks to the dedication and professional skills of the volunteers in both organizations but found that the ambulance service faced significant “challenges.”
“One of the not-so-great parts of my job” is its focus on the “weaknesses” of municipal departments, UMass consultant Sarah Concannon told the selectmen. The study, she said, is “a look at potential improvements, not a celebration of great things.”
Nevertheless, she concluded, the town should be able to operate both services as volunteer organizations staffed by on-call firefighters and EMTs if it implements a number of the study’s recommendations.
Response times, morale differ
In its deep dive into the operations of the two departments, the study gives particular attention to response times, a key measure of performance, and to the attitudes of volunteer firefighters and EMTs toward their management and colleagues. A National Fire Prevention Association standard (NFTA 1720) states that a town of Harvard’s density should be able to get equipment manned by six firefighters “on scene” in 14 minutes 80 percent of the time. The study found that Harvard had met or exceeded that standard for fire calls over the past four years.
The Harvard ambulance service has adopted a target response time of 10 minutes, the total time it should take to get a crew and ambulance on scene for a medical emergency. But the study found that ambulance crews have met that target only 48 percent of the time over the past three and one-half years. However, in cases when the service was able to get an EMT to the scene before the ambulance arrived, an approach known as direct-to-scene, the ambulance service was able to meet its response target 68 percent of the time. Concannon said the squad should strive to meet its targets 80 to 90 percent of the time. By training EMT volunteers to go directly to a medical emergency scene and by encouraging EMTs to spend their on-call time at the station, it should be possible, she said, to improve performance. On-call stipends, which are new this year, have not had much impact, according to the study.
The study also found significant differences between the morale of the fire and ambulance personnel. While morale was high among the 23 members of the fire department, the study found, it was low for the 80-member ambulance service. Asked to respond to the statement, “Morale is high in the service,” firefighters gave it a rating of 3.95 out of 5, compared to a 2.91 rating by EMTs, which indicates “disagreement with the statement,” according to the report.”
High turnover
The study found that average turnover among EMTs was high—approximately 25 percent over the past 5 years—compared to the much lower average of 9 percent among firefighters. EMTs must be on call a certain number of days each month, but many perform highly technical administrative duties as well. And the study found that a high number of calls is being covered by a small percentage of members: Nine members responded to at least 40 calls over the past 12 months, while two responded to more than 100.
The entire UMass report is available on the town website and covers substantially more ground than can be covered in this summary. It is now up to the selectmen, with input from the Finance Committee and ultimately the town, to decide next steps. The Fire Department has asked to add a full-time firefighter to its staff in fiscal 2018, and the ambulance service has asked to add a full-time EMS coordinator as well as a part-time EMT administrator. Both departments have said that their new hires would be required to be fully certified as EMTs, able to respond to medical emergencies as part of an ambulance crew. Honoring both requests would add a minimum of $100,000 to the town operating budget, not including benefits or the potential need for a second fire vehicle for inspections.
While the study states that by making the recommended improvements both services can be sustained as volunteer organizations, the addition of paid staff to the ambulance service will likely require subsidies from the town to cover the additional expense. For years the service has paid for its operations out of insurance reimbursements. In past years, the service has been left with a surplus that could be set aside for future purchase of a new ambulance. However, with the addition of call stipends this year, estimated to cost the service $60,000, much of the surplus has already been depleted.
