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N.Y. county launches ambulance service in rural towns where gaps exist

Erie County has purchased five ambulances to backup existing services in five towns


Erie County

By Sandra Tan
The Buffalo News

ERIE COUNTY, N.Y. — The lack of volunteer emergency medical technicians and paramedics in Erie County has resulted in such poorly staffed rural ambulance services that mutual aid requests from neighboring towns, once reserved for mass casualties and other major incidents, are now being made for routine calls.

Fire and rescue personnel who have seen their ranks thin from one generation to the next say that’s not sustainable.

“There were times, especially when I was chief, I was scared,” said Geoffrey Hack, supervisor and former fire chief for the Town of Holland, which like many rural communities receives no service from commercial ambulance companies.

To help alleviate the shortage, Erie County government is getting into the ambulance business.

The county has purchased five ambulances, painted in a distinctive blue, orange, white and yellow. The first one, being housed at the Colden Volunteer Fire Company, goes into service on Monday, along with a “fly car” that can transport emergency medical personnel and equipment but can’t transport patients.

The plan is to have county ambulances serve as backup in the towns of Aurora, Wales, Eden, Boston, Colden, Holland, Collins and North Collins.

All five ambulances should be online by the end of the year, said Greg Gill, deputy commissioner of the county’s Emergency Medical Services Division.

The county-sponsored ambulance service is not a cheap proposition.

When County Executive Mark Poloncarz first announced plans to create an ambulance service in April, the county estimated it would cost $4.67 million in startup costs, the construction of an ambulance base office, and first-year operating costs. The service is estimated to cost $2 million per year going forward, though that cost may be partially offset by insurance reimbursements.

Poloncarz said he didn’t want county residents to be at risk of dying because of ambulance service wait times, particularly in sparsely populated rural areas, where travel times are longest and hospitals are farthest away.

Jim DePasquale, Colden town supervisor and assistant chief for the Colden Volunteer Fire Company, said that when the new county ambulance service was starting to take shape, he called the Emergency Services Division and offered to house one of the new ambulances, which worked out well for the county since Colden is more centrally located than some other Southtowns locations.

Right now, he said, his volunteer fire company has fewer than three dozen members, and many are close to retirement. The average age is 55. He has four basic volunteer EMTs but no paramedics, who would have more advanced emergency medical training. Only two EMTs are typically available during the daytime, he said.

“It’s very thin,” he said.

The new county ambulance crew showed up this week to take stock of the first ambulance’s new home in Colden. Equipment to open airways, deliver babies and splint broken and dislocated limbs were stashed in the cabinets.

A simulation manikin was there for training on different techniques for keeping the heart going during cardiac arrest.

Gill said he’s hired eight paramedics and two advanced EMTs, who have more skills and training than basic EMTs. Paramedics, the most skilled members of an ambulance crew, can do things like insert breathing tubes, interpret EKGs and administer medication.

He stressed, however, that the county ambulance service is not designed to disrupt or replace existing ambulance services and mutual aid relationships. It’s meant to be a backup when existing ambulance companies and mutual aid backups are unavailable. The county ambulance service could then respond to a call or intercept and take over a call to free up a local ambulance crew.

The public cannot directly call the county ambulance service.

“We keep calling it a safety net,” Gill said. “In times of high demand, if there are resources that aren’t available, as normal, then we hope to staff it.”

He also said he’s interested to see how many calls the county ambulance service gets before determining whether the county should hire more emergency medical personnel.

“The one thing we don’t want to do is put resources out there that aren’t needed,” he said.

At Thursday’s official announcement in Colden, Poloncarz thanked the Health Department for its role in designing the new ambulance system.

“It takes into account our community’s unique needs, and incorporates the valuable resources that already exist among our local volunteers and ambulance services,” he said.

Some county legislators said other ambulance services, including private companies like American Medical Response, or AMR, have expressed concerns about the county ambulance service drawing away needed personnel and thinning an already shrinking pool of skilled emergency medical personnel in the region, particularly since the county pays better.

They have suggested other government subsidized alternatives that would leverage private ambulance services for greater rural access, instead of the county starting up its own government-funded service.

County leaders have said they are better positioned to stay true to the mission of providing emergency medical services and transportation to areas that would be unprofitable for commercial providers.

“It might have ruffled a feather or two in the commercial service, but on the whole, it’s the right thing to do,” Gill said.

Scott Hultquist, director of the Eden Emergency Squad, which handles about 800 calls a year, has moved to a mixed model that includes some paid paramedics, along with volunteer EMTs. But like many local ambulance services, the ambulance can only provide services within a limited geographic area, like a single town.

The creation of a county ambulance service could eventually open the door to a more regional approach that could create a more coordinated, countywide emergency medical response model down the road, he said. Local town ambulance providers could decide to operate under the county’s broader ambulance certification.

“We can grow that vision even further and make ambulances more available throughout the Northtowns, throughout the Southtowns, throughout the region,” he said.

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