By Shawne Wickham
The New Hampshire Union Leade
EXETER, N.H. — Seacoast-area fire departments have been sounding the alarm after Exeter Hospital notified them it was abruptly ending a program that sends paramedics to medical emergencies when advanced critical care is needed.
Now the Attorney General’s Office has stepped in.
For more than three decades, Exeter Hospital’s Advanced Life Support (ALS) Program has served surrounding communities by dispatching paramedics in an “intercept” vehicle to critical medical emergencies such as car crashes and cardiac arrests.
Paramedics are the highest level of first responders licensed by the state Bureau of Emergency Medical Services. While larger communities typically have their own paramedics, the intercept program has provided that level of care for smaller communities.
But towns that contract with Exeter Hospital were notified on Sept. 10 that the ALS intercept program would end on Sept 20. Hospital officials said they made the decision to end the program and lay off its paramedics as a cost-cutting measure.
The short notice of the termination, along with concerns expressed by local communities, prompted the AG’s office to get involved.
Representatives from that agency held an emergency meeting Thursday night with management from Exeter Hospital and Beth Israel Lahey Health, the hospital’s parent company. And on Friday, Attorney General John Formella announced: “Today, our office received assurances from Exeter Hospital that it will continue its ALS Program through at least December 20, 2024 .”
“As a healthcare charitable trust, Exeter Hospital must operate in a manner that protects the public,” Formella said in a statement. " Exeter Hospital’s announcement that it would be discontinuing the ALS Program within 10 days provided wholly insufficient notice to the communities that rely upon it.”
Formella said hospital officials “will engage in a collaborative effort with state and local officials to discuss the concerns raised this week.”
In 2023, the Attorney General’s Office approved the merger of Exeter Health Resources, which includes Exeter Hospital, with Beth Israel Lahey Health. The AG’s office originally opposed the merger, alleging that it would reduce competition in the healthcare market, but the state reached a negotiated settlement that included certain conditions to protect consumers.
On Friday, hospital spokesperson Sonya Vartabedian said in a statement: “After working with the Attorney General’s Office, we have reached an agreement to extend the closure date of the Paramedic Intercept Program. This program has served as a resource for many communities, and we will work with the impacted departments, state and local officials during the transition period.”
Top-level emergency care
Paramedics are licensed to perform certain medical procedures that emergency medical responders (EMRs) and emergency medical technicians (EMTs) are not, such as intubation and administering IV medications, according to Justin Romanello, chief of the Bureau of Emergency Medical Services.
“With paramedics, you have the most tools in your toolbox,” he said.
Romanello’s agency licenses just under 6,000 emergency responders statewide, including about 1,400 paramedics, 1,500 advanced EMTs, 2,700 EMTs and 250 EMRs, Romenello said.
Every level has a role in stabilizing a patient and getting them to a hospital as quickly as possible, he said. “And that’s important because there are very few things that we can do pre-hospital to fix a problem, and ultimately ... a patient needs to get to the hospital to truly be fixed,” he said.
Smaller towns typically don’t have the call volume to have paramedics on staff, Romanello said. But ideally, every community should have access to that level of care through its mutual aid agreements with other towns or contracts with ALS providers, he said.
“I am confident that anywhere in this state could activate and get that resource coming,” he said. “How long they wait certainly depends on the limitations of where they are in the state.”
And that’s where a parademic intercept team can make a difference, going directly to a patient’s home or crash scene, or meeting the ambulance en route to a hospital.
Cheshire Medical Center in Keene, Frisbie Memorial Hospital in Rochester and Huggins Hospital in Wolfeboro operate intercept programs for communities in their service areas.
‘Complete devastation’
Kourtney Wiegand, a night charge nurse at Exeter Hospital, said the decision to end the ALS program — and lay off 14 paramedics and their manager — puts patients’ lives at risk.
In her eight years at Exeter Hospital, she said, “I’ve had so many different patients that would not have been alive if it weren’t for them.”
Wiegand said news of the program’s termination shocked hospital staff. “Everybody was crying,” she said. “It was complete devastation.”
“Our paramedics are so incredible, and so talented and skilled,” she said. “They go out in the community and they start the critical care out there. These patients are so much more stabilized by the time they get to us, and it makes a huge difference.”
Her biggest fear? “That people are going to die,” she said.
Some local fire department officials have voiced concern on social media since they learned of the program’s termination.
“To say our department is devastated by the news is an understatement,” Kingston Fire Department posted. “Through the years they have saved so many lives and now to think of medical calls without this next level of care is just unfathomable,” the department wrote, calling on area residents to join its Save Exeter ALS Campaign online.
Stratham’s selectboard issued a statement calling the hospital’s action “an abrupt and shocking decision that concerns a critical service to the community.”
Some officials have sought to temper the anxiety exploding on social media.
‘Am I freaking out? No.’
Closure of the Exeter ALS program is “certainly a loss of a resource,” EMS Chief Romanello said, but he stressed, “All the communities are still covered by an ambulance, a transport mechanism, and by outstanding, qualified EMS providers.”
Exeter Fire Department issued a statement calling the hospital’s ALS program “a valuable life-saving service,” though it noted that Exeter’s use of the service was “very limited” because the fire department has its own paramedics.
Hampton Falls Fire Chief Jay Lord also wanted to reassure his community. “We’ve got great partners that can help out, and it’s horrible that this service went away, but the community doesn’t need to have any change in expectation of what’s going to happen to them,” he said.
Lord said Hampton Falls is within 10 to 20 minutes of emergency departments in Seabrook, Exeter and Portsmouth. “We’re also very fortunate in that we’ve got mutual aid partners in Seabrook, Hampton and Exeter that staff at that (paramedic) level,” he said.
The fire chief plans to meet with his counterparts in those three towns on Tuesday to discuss options. And he expects to present a plan to his town select board the next morning.
“Am I concerned? Yes,” Lord said. “Am I freaking out? No. But I’m paying attention and we’re coming up with a plan.”
Kensington Fire Department called the termination of the ALS intercept program “a major blow” to the town and the other communities that rely on it for mutual aid. More than 40% of Kensington’s medical calls typically rely on Exeter ALS, officials said in a social media post.
“We want to reassure the community that we will continue to provide our community with professional EMS and ambulance transport services,” they said. “While we wait to learn more, we are working with our mutual aid partners to make contingency plans.”
But they warned, “While our crews can request paramedics from surrounding towns like Exeter, Amesbury, (Mass.) and Seabrook, we expect that those towns are going to face an overwhelming level of demand in the aftermath of this change, and average response time for paramedic arrival will increase.”
The Kensington department also expressed sympathy for the paramedics being laid off as a result of the hospital’s decision. “They have saved countless lives and served our community, often to little recognition or thanks,” they wrote. “Thank you, Exeter ALS.”
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