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Vt. volunteer service calling for ambulance fee

Under proposal, ambulance service needed by a resident would be billed to their insurance

By Sarah Brubeck
Valley News

Enfield, Vt. — When the Enfield volunteer ambulance arrives and whisks injured or sick residents to the hospital, patients aren’t charged for the service. But in a medical emergency, literally every minute and second counts, especially when it concerns Enfield’s aging population. Now, some in town think things can be speeded up -- and risk reduced -- if they begin charging for full-time ambulance service.

The notion that a town that begins billing those in dire need of ambulance service may strike some as antithetical to how communities are supposed to respond in the event of emergencies. Indeed, when Enfield first raised the possibility of charging for ambulance service almost four years ago, the resident who proposed it was heckled at the Town Meeting.

Things have changed enough, however, that the Enfield Selectboard wants to reintroduce the idea of billing for ambulance service. The current all-volunteer squadron is not equipped or staffed enough to handle the increased needs of the town’s residents.

“There are less and less people willing to volunteer, our population continues to grow and we have a constantly aging population,” said Selectboard Chairman B. Fred Cummings in an email. “It appears as though the time has come to seriously consider it.”

Under the Selectboard’s proposal, ambulance service needed by a resident would be billed to their insurance. Those payments would be used to hire two full-time employees for the dayshift and a third to be on call at night.

Currently, Enfield’s 18-volunteer FAST Squad operates at night and the weekends, since most of the members have full-time jobs. During the day -- and for other times when Enfield can’t respond -- the town contracts for ambulance service with neighboring Lebanon, which handles about half of Enfield’s 375 ambulance calls annually.

The average response time for a Lebanon ambulance in Enfield so far this year has been 13 minutes and 29 seconds, said Lebanon Fire Chief Chris Christopoulos. And if the Lebanon ambulance is dispatched on another call when Enfield requires its service, then the town must call West Lebanon, which takes even longer. Earlier this year, it took the West Lebanon ambulance 25 minutes to respond to a residence on Methodist Hill Road in Enfield.

“If you live out in Enfield Center, and it is in the middle of a snowstorm, your mind would be more at ease if the ambulance were coming from downtown Enfield than from West Lebanon, which could currently occur,” Cummings added.

New Hampshire requires that at least two people respond to an ambulance call. In Lebanon, a call is staffed usually by one paramedic and another responder with basic or intermediate EMT training. The Enfield squad has three paramedics, but Sam Provenza, deputy chief, said he can’t guarantee that one would be available on every call. The Selectboard hopes to make one of the two full-time employees a paramedic.

Enfield would like to invoke soft billing, which would charge residents’ insurance companies, but drop charges if the person doesn’t have insurance or is unable to pay. Town Manager Steven Schneider said he’s expecting the town to generate $130,000 to $140,000 a year through billing.

But Selectman John Kluge said he’s not sure how residents who need an ambulance will react when they receive an invoice.

Voters at the 2008 Town Meeting booed resident Bob Cusick when he presented a warrant article that proposed billing for ambulance services that had always been free.

Back then, Cusick’s proposal lacked widespread support, including from members of the Selectboard and the FAST Squad. When the warrant was voted down, the town had been under the expectation that the people who used the service would never be charged, said Cummings.

That’s because the people who inaugurated ambulance service in Enfield more than 30 years envisioned it would remain a free service, according to a 2008 Valley News article. Cummings said it’s a “balancing act” not to step on the intentions of the “forefathers” while at the same time recognizing the town’s current needs.

But not everyone on the FAST Squad supports the idea of billing, said Provenza, the deputy chief. He said several volunteers believe the service should remain free. But Provenza said the reality is that the squad can’t provide the highest level of service without charging.

“The first thing we need to look at is how will it effect the citizens of the town, and it can only be a benefit for the residents,” said Provenza, who added that the FAST Squad as a whole will support whatever decision the Selectboard makes.

What’s more, Schneider, the town manager, argues that 50 percent of residents that are being helped by Lebanon’s ambulance when Enfield’s is unable to respond, are already being billed.

Christopoulos, the Lebanon fire chief, said their billing rates are aligned with Medicare, and charges can vary depending on the services provided. Basic life support costs $493.26, and advance life support costs $585.75.

Schneider said he doesn’t know what the exact charges will be for Enfield, but he expects they’ll be similar to Lebanon’s.

Cummings said in the email that Enfield is one of the last towns in the Upper Valley to begin billing for service. Canaan has been billing for ambulance services for about seven years, said Mike Eastman. He’s the sole full-time employee for Canaan’s FAST Squad, which is assisted by 10 volunteers.

Enfield already budgets about $80,000 a year toward its ambulance, which pays for the town’s contract with Lebanon and covers the cost of continuing education and licensing for volunteers, maintenance and equipment for the ambulance and medical supplies.

Come Town Meeting, Schneider said, he’s unsure if the ambulance billing will be included in the budget that residents will vote on, or if it will be proposed as a separate warrant article.

“Either way, Town Meeting will have some type of vote,” Schneider said.

As for Cusick, the resident who proposed the warrant in 2008, he said he appreciates the volunteers, but said there’s a limitation to what EMT basic and intermediate personnel can do. Cusick, who has been attending recent Selectboard meetings, wants to see a paramedic on every ambulance run.

“I think that this town, especially with a major roadway going through it and a general aging of the population, you need people who are capable of doing as much for an accident victim as possible,” he said. “It’s a matter of survival.”

The Selectboard plans to continue this conversation at its next selectboard meeting, which is at 6 p.m. Monday.

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