By Evan Brandt
The Mercury
MONTGOMERY COUNTY, Pa. — Montgomery County has kicked off an ambitious effort to study and assess willing Emergency Medical Services providers with an eye toward helping the companies become more sustainable and provide the best service possible going into the future.
One of the many things that became glaringly clear coming out of the COVID-19 crisis was the precarious state of many ambulance companies and EMS providers.
In March of 2022, Bloomberg News reported that “turnover among paramedics and emergency management technicians ranged from 20% to 30% annually in 2020, according to a survey the American Ambulance Association released late in 2021. That means ambulance services can expect to replace their entire staff roughly every four years.”
And that affects response time.
“According to state data, the average response time has also increased in recent years from 15 minutes in 2018 to 17 minutes in 2021,” according to an Oct. 9 report by the CBS Pittsburgh affiliate, KDKA. In more rural parts of the state, it can be as long as an hour, they reported.
” Pennsylvania’s EMS agencies are grossly underfunded and understaffed,” according to the report. “The agencies struggle to adequately pay their EMTs and paramedics while maintaining their equipment. A patchwork quilt of more than 1,200 agencies, they’re responding to 2.5 million calls a year, losing money on each one,” KDKA investigative reporter Andy Sheehan reported.
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Speaking last year to the Pottstown Metropolitan Area Regional Planning Committee, Douglass (Mont.) Supervisors’ Chairman Josh Stouch said most ambulance services are sharing the exact same group of EMTs and paramedics.
“They’re working one shift at Goodwill and then another at Gilbertsville or Trappe ,” said Stouch, who is also a constable and firefighter with Gilbertsville Fire and Rescue .
Last year, Stouch was promoting the exploration of a regional ambulance authority, to streamline operations and overhead and a bill making the rounds in Harrisburg would make that possible, said Lower Providence Township Manager E.J. Mentry .
More recently, some ambulance companies have independently begun pooling their resources and seeking significantly larger contributions from their municipalities.
For example, the proposed 2024 budget for Limerick Township includes the implementation of a new EMS tax to help bolster the local companies that service the fast-growing township.
All of these are factors that will be grappled with by a team of consultants hired by Montgomery County to take a comprehensive look at the county’s EMS services and make recommendations.
The EMS Strategic Plan project budget is $168,000 and is covered by federal Homeland Security Grant Program funding.
Two public meetings held Wednesday marked the effort’s kickoff and as an introduction to the EMS services, which the consultants and county officials hope will cooperate and share their information.
“COVID really brought into focus a reimbursement system that has been in place since the 1960s,” said Jonathan Washko, CEO of Northport, NY -based Washko and Associates, one of the two consulting companies with expertise in this subject that will be working on the study. “And this is not just something we’re seeing in Montgomery County, we’re seeing it everywhere.”
The five-phase study will have many aspects, including financial stability.
“We want to make sure EMS in Montgomery County is not just surviving. We want to make sure it’s sustainable into the future,” said Washko, who himself spent many years as a volunteer on ambulance companies.
“The health care system in this country is a mess, it’s a real train wreck,” said Stephen Wirth, a partner with the Mechanicsburg-based consulting firm of Page, Wolfberg and Wirth, also a former longtime ambulance volunteer.
“And for many people, EMS is their first point of contact with that system,” said Wirth, who was previously involved in an effort to bring stability to EMS services in Erie.
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Both firms have had experience with efforts such as these, but the study and assessment they are undertaking now may be the first one in Pennsylvania, perhaps even the entire country, that looks at these issues across an entire county, particularly a county as well-populated as Montgomery County, said Wirth.
“The size and scope of this project is immense,” said Shannon Gollnick, a member of Wirth’s firm who spent 20 years as a paramedic and now holds a doctorate in management.
For example, the scope of this effort will look not only at recruitment and retention but also at finances, clinical quality, service delivery, disaster response, data systems, facilities, patient care reporting, fleet maintenance, and organizational structure. training and education, supply and logistics and integrating systems.
“But it comes at the right time,” said Gollnick. “The ground beneath us in health care is literally shifting beneath our feet.”
“You are in a unique situation,” said Ryan Stark, another consultant with Wirth’s firm. “You are not at the precipice of disaster so we have an opportunity to be proactive. It’s a unique situation and this could allow you to set the tone of the future in your communities.”
The consultants hope to finish the project and report back with final results next June after sharing a draft of their findings with the county and the companies that participated.
“And this is not going to be some 95-page report where everyone reads the executive summary and then puts it on a shelf,” said Washko. “We want to provide something actionable, that you can use, but the only way we can do that is collaboratively.”
Accomplishing the project’s goals will require cooperation and participation from as many of the county’s EMS providers as possible.
Brian Kuklinski is from the Montgomery County Ambulance Association and was on the advisory board that crafted the scope of the study. He urged ambulance companies to participate fully to make the results as complete and useful as possible.
“We want this to be data-driven,” said Wirth. “This is your study.”
“Many of our providers are struggling to provide services. This is a complex issue and we only get one chance to get this right,” said David Brown, deputy director of EMS at the Montgomery County Department of Public Safety. “The public is relying on all of us.”
In the coming weeks and months, the vendor will be conducting stakeholder surveys and discussions both virtually and in person to assess the needs and expectations of the EMS in communities across Montgomery County. Agencies interested in staying informed and getting involved with the project, can “opt-in” with their contact information using an online form at: https://forms.office.com/r/jgwhdDjYMR.
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