By Abigail Ham
The Keene Sentinel
With another local ambulance provider considering closing, Cheshire EMS Chief Mark Kreamer says the county-run service is prepared to fill this and any other gaps that may emerge as area providers cope with industry pressures.
Cheshire EMS launched in Swanzey in 2022 in part due to concerns about coverage gaps left by the closing of the private, Keene-based DiLuzio Ambulance.
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More recently, Winchester announced last month it’s in talks with Cheshire EMS to potentially become the town’s primary provider.
Despite initial tension with local ambulance services concerned about competitive pressure from Cheshire EMS, Kreamer reiterated that the goal of the county service isn’t to become the only provider in the area. Instead, he said, it is to be able to fill gaps as they show up to ensure that when anyone in Cheshire County needs an ambulance, there can be one on the way.
Cheshire EMS is the primary provider of ambulance services in seven towns and has backup or transport contracts with 19.
The agency’s leadership often has conversations about future “what-ifs”, Kreamer said, and is prepared to adapt the service’s model to fit the needs of different towns should they find themselves in need of coverage.
For some, that means looking into basing an ambulance in the town full-time. For others, it means responding from Cheshire EMS’ station in Swanzey . And for the most far-flung towns in the county, it means providing training to local EMS to make sure they’re prepared to give care until a Cheshire EMS ambulance can get to the scene.
Compared to some other ambulance services in the region, Kreamer said Cheshire EMS has had relatively good luck with staffing and retention and has a waitlist of applicants.
The service currently employs 54 people, 11 per shift plus three officers, according to Kreamer.
Having more resources than some smaller services means Cheshire EMS can be prepared to respond to the “ebbs and flows” of towns’ needs, according to the Cheshire EMS chief.
Winchester looking for a change
At a Winchester selectboard meeting Nov. 19, the town’s leaders said they were “exploring an opportunity to have Cheshire County ambulance department be the sole provider of ambulance services for the town of Winchester, as they have largely been doing for the past year or so,” minutes say.
They’ve made no final decision, the board said, and don’t have a timeline for a possible transition. If the plan does move ahead, however, the town would no longer staff its own ambulance service, the board said.
The eight active members of Winchester Ambulance currently cover about half of EMS calls in the town, with Cheshire EMS covering the remainder, according to a statement from the town-based service on Facebook the following day.
“It is no secret that our ambulance has faced challenges in terms of staffing and responding to emergencies, but we are eager to turn this around,” Winchester Ambulance said in the statement.
The service’s current model, which went into effect in 2019, is behind the times, it said. The staff members are paid hourly Monday through Friday to staff the station from 6 a.m. to 6 p.m.
After 6 p.m. and on weekends, staff is paid $1 per hour to be on call from home or to be at the station if they do not live in town.
For every call answered during those hours, each crew member is paid a flat rate, ranging from $25 to $45.
To keep the service functional, that model needs to change, the statement said.
“We have a talented and committed group of providers who have consistently shown up to serve our community when able to and we are eager to build on their dedication. We are passionate about continuing to serve our community, and we believe that with your support, we can create a brighter future for our ambulance service.”
For Cheshire EMS, simply responding into Winchester from the existing Swanzey station may not be practical for the 800-ish calls a year it would expect to take, Kreamer said. The service’s current average response time to Winchester is about 18 minutes.
That’s why basing an ambulance in Winchester is likely the way Cheshire EMS would want to move forward. But that’s all dependent on ongoing talks with the town, Kreamer said.
Industry-wide trends
If Winchester Ambulance does close, it would be the latest casualty of forces experts say are making it more difficult for municipal and nonprofit EMS providers to survive.
A 2023 report from the N.H. Ambulance Association pointed to ambulance service closings, including the shuttering of DiLuzio Ambulance in Keene, as casualties of the COVID-19 pandemic. But it warned those closings could become much more common.
“While the COVID-19 pandemic exacerbated the situation, the strains on the EMS network have been building for years and stem from increasingly unworkable dynamics,” the report’s authors wrote.
A survey of first responders done for the report found that many EMS calls, especially in rural counties, are never reimbursed because the residents are uninsured or covered by Medicaid, which, like Medicare and private insurance, covers little if any of the actual cost of EMS personnel and equipment.
Low reimbursement rates have ripple effects, including labor shortages, because medical professionals can get a bigger paycheck putting their skills to work in another setting.
In that report, nearly half of municipal or nonprofit EMS personnel said they believe there is a fairly large or major problem with 911 ambulance service in New Hampshire.
Kreamer sees Cheshire EMS’ role in the county as a fail-safe for when gaps appear in other services, to ensure no one’s left without coverage just because it’s difficult to keep an ambulance service fiscally afloat.
“The words ‘take over’ are not in our vernacular,’” he said. “... We’re looking to help.”
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