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With new chief on board, N.H. county preps to launch EMS service

Originally, the county had planned to take over an existing private ambulance service, but decided to launch their own after the deal fell through



Ryan Spencer
The Keene Sentinel, N.H.

SWANZEY, N.H. — Construction crews worked busily, painting, drilling and hammering away, as a generator whirled Friday at 53 Monadnock Highway ( Route 12), the future site of Cheshire County’s new EMS service.

Michael Spain, the chief hired last month to lead Cheshire EMS, exuded an air of excitement as he toured a partially-constructed, six-bay garage that will house county ambulances by the end of the year, if all goes according to plan. Across the parking lot, an existing structure was being renovated to accommodate administrative offices, bunk rooms and kitchen space for the personnel that will soon staff the 24/7 EMS operation.

Read more: N.H. EMS startup to get federal funds for training, equipment

Talks about establishing a regional EMS service began years ago, as county officials became aware that local departments and ambulances services were struggling with staffing issues, county officials have said. After months of behind-the-scenes discussions, county officials announced plans for Cheshire EMS last fall, originally pitching the project as a public takeover of the private DiLuzio Ambulance Service. But when those plans fell through this spring, county officials moved forward with plans to launch their own EMS service.

“The reason I wanted this job was a challenge,” Spain said during an interview earlier that day at the county offices in Keene. “I’m a person who enjoys challenges and creating things.”

Joined by County Administrator Chris Coates and County Commissioner Jack Wozmak, Spain discussed his plans for leading the county department — which in the past year has gone from little more than plans on paper to an operation with a homebase, a chief and two ambulances already waiting in the wings.

Describing himself as a strategic planner, Spain — who said he and his wife have found Cheshire County to be a welcoming community in the four weeks since he moved from the Chicago area to start the job — laid out a “fluid roadmap” for the start-up of the EMS service.

The operation will begin with interfacility transports — moving patients between area healthcare facilities — potentially as soon as the end of this year, before beginning to respond to 911 calls once towns in the region establish contracts with the service, Spain and the other county officials said. In the years to come, Cheshire EMS could expand to include “satellite stations” in other towns in the county to provide quicker response times to those communities, the new chief said.

The county expects to have a paramedic intercept vehicle — which can respond to assist EMTs when a paramedic is needed on site — running early on in the operation, Spain said. And, by the end of next year, Cheshire EMS should consist of seven ambulances, the paramedic intercept vehicle, and at least one wheelchair transport vehicle, he said.

“Really what our goal is is we’re going to have your back,” said Spain, who has been a licensed EMS provider since 1974 and has held his Nationally Certified Paramedic license since 1980. “If you need us, we’ll come.”

The county has begun a search for a deputy chief to assist with leading the county department and has readied job descriptions for paramedics, Advanced EMTs, EMTs and wheelchair transporters, Spain said.

The new chief said he will lead Cheshire EMS — which county officials have said will employ between 30 to 35 people — with a hands-off approach that is flexible and responsive to the needs of personnel but lays out clear expectations. This is the same leadership style he has employed throughout his career, Spain said.

Before moving to New Hampshire, Spain served as a clinic paramedic at DuPage Medical Group and as an engineer/acting battalion chief for the Elk Grove (Ill.) Fire Department, where he oversaw 35 personnel, including firefighters, officers and paramedics, according to a news release from the county at the time of his hiring. He also has been a fire chief, the director of paramedic services for Sartori Hospital in Cedar Falls, Iowa, and the EMS director for Silver Cross Hospital in Joliet, Ill., among other positions.

Construction of the EMS facility in Swanzey — which will also include a residence to house traveling nurses visiting the region — is expected to wrap up by mid-November, County Commissioner Wozmak said. He noted that supply-chain issues have delayed delivery of crucial parts, such as overhead doors for the garage.

Towns will have to decide for themselves whether they want to go with the county-run ambulance service, run their own EMS operation, or contract with other providers such as DiLuzio Ambulance Service, he said.

“We’ll be meeting with the towns now that Mike is on board, keeping them in the loop on the timeline of things,” Wozmak said. “We’ll just be walking down the road together with them on whatever decisions they make about who they want to provide their 911 needs.”

The purchase of ambulances and supplies as well as the $1.1 million project in Swanzey — $395,000 for the purchase of the property in March and $705,000 in construction costs — has been funded entirely through federal funds from the American Rescue Plan Act, County Administrator Coates said. He said county officials have worked closely with the state’s congressional delegation in Washington, D.C., to make their needs known and find funding.

Once Cheshire EMS is up and running, it will operate as an enterprise fund, Wozmak said, covering its operating costs with revenues generated by insurance receipts and by user-fees paid by towns that choose to contract with the service. The paramedic intercept will be available to any town that needs it, he said, and will charge towns based on usage.

“The idea of the enterprise fund is it doesn’t fall on the backs of property tax payers directly,” Wozmak said. "... It is basically paid for by the users, and paid for by the users means that if a town wants to subscribe to the 911 service, we’ll come up with a rate — a dollar amount — that covers the expenses associated with providing coverage to the town.”

With a full-time professional staff, who will be eligible for benefits and retirement plans, and access to federal grants, Cheshire EMS will be better able to address staffing shortages and be more sustainable than volunteer-based operations run by many towns’ fire departments, he said.

“I think that, over time, towns will realize that they don’t have to make expensive, individual, town-based decisions to start up a service when we’ve already got it,” Wozmak said. “We’ve got federal money to pay for the vehicles, the building and the stuff, and all they need to do is call us up and have a contract conversation. So while they certainly can go out and buy their own ambulance, ultimately, I don’t know why they would.”

He said the county will be having conversations with towns ahead of their annual meetings in the spring, when voters would approve any contracts with Cheshire EMS as part of their budgets.

Noting that in emergency situations, such as when CPR is required, a speedy response can save lives, Spain said the ultimate object of Cheshire EMS is to be able to respond at a moment’s notice with professional, well-trained staff.

“Our goal is to be there as expeditiously as possible for a better outcome,” he said. “So we’re really putting together a relationship not only with the area fire departments and EMS, but we’re putting together a relationship with the citizens.”


(c)2022 The Keene Sentinel (Keene, N.H.)