Berkshire County — Berkshire communities have been sounding the alarm about the declining ability for each town’s emergency medical services (EMS) programs to individually operate effectively given the area’s decrease in volunteers who have traditionally staffed those departments combined with the high cost of housing for workers, growing response times, and mounting paperwork. State Representative William “Smitty” Pignatelli (D – 3rd Berkshire District) is trying to amplify that bell with a committee he formed this past spring, with its town administrators, Select Board members, government department leads, and healthcare staffers tasked with finding a way to move toward regionalizing those critical services.
On November 7, the outgoing legislator pulled in Massachusetts Department of Public Health Commissioner Robert Goldstein to the committee’s monthly session so state leaders could hear the concerns of those serving on the Berkshires’ front lines, trying to use available resources to fill an ever-increasing void in EMS staffing, education, and organization. “The Berkshires, I’ve always said, we’re getting older, we’re getting smaller, we’re getting sicker, and I think volunteerism is going away,” Pignatelli said.
With those trends, he asked whether the region’s small towns can “truly afford” to pay full-time, 24/7 EMS and fire department staff, focusing currently on the EMS portion of that dilemma. “I’ve traveled all around the state,” Goldstein said. “I’ve talked to a lot of different groups of medical services and providers. The issues you’re facing here are both unique to what’s happening in the Berkshires and also shared with what we’re seeing in small towns, large towns, big cities all across the Commonwealth.”
According to Goldstein, those same challenges to medical services are affecting folks in the Cape Cod area as well as Boston.
For Goldstein, the solution lies in a unified approach to emergency-services management from both the executive and legislative sides of government to enable “small towns in rural areas [to] get what they need.” He challenged the director of the Office of Emergency Medical Services and her supervisor, the director of the Bureau for Healthcare Safety and Quality, “to work collaboratively with people across the state to identify what we think is the ideal emergency medical system for Massachusetts.”
“I want you to know that I’m listening today,” Goldstein said. “We want to take action. We have the political will to take action. And, also, action in government is slow, at times, so please bear with us as we try to accumulate what we learn from you here in the Berkshires and what we’re learning from folks in central [Massachusetts] and what we’re learning from folks in southeastern [Massachusetts] out on the Cape, and what we’re trying to bring to Beacon Hill as we try to move forward with the necessary changes to the system.”
Goldstein’s address can be found here.
Local officials speak out
Waivers—orders developed during the pandemic that defray possible ambulance staffing shortages by loosening requirements for the vehicle to include two certified emergency medical technicians (EMTs)—have become more limited and may, in fact, disappear completely. With only four services available to transfer Berkshire County patients, that is a problem. “That concerns me deeply because many of my colleagues don’t have two people around during the day [for transport],” said Lee Fire Chief Ryan Brown, adding that his town fortunately doesn’t need a waiver as its model is sufficient. “That’s going to drastically hurt EMS.”
Pignatelli questioned whether a waiver could be applied to the entire Berkshires region, easing the need for each department, or licensee, to individually request the provision.
Goldstein pushed back and said a blanket waiver is difficult because the capabilities of one town within an area are very different from the capabilities of another town. “If we were to just waive the whole region, we might not be able to make sure that we maintain standards,” he said. “The intent of a waiver process is to say, ‘If we are to waive this regulation, can we still maintain the quality and safety for [the community]?’”
For Michael Woronka, president and CEO of Pittsfield-based Action Ambulance Service, getting more EMTs through the pipeline is challenging due to the lack of qualified instructors for training.
Leigh Davis, who won Pignatelli’s seat during the November 5 election (those results are unofficial until the secretary of state certifies them), suggested that pipeline should begin in high school. Her son was training to be an EMT as a Monument Mountain High School senior, but travel requirements presented an issue. At the University of Massachusetts, he found it hard to keep up with that training but has since become certified. “I think the whole pipeline is something we really, really need to get going, and having something in the schools is super important,” Davis said. She said she has found a lot of interest in the local high schools in pursuing a career as an EMT.
As vice chair of the Great Barrington Selectboard, Davis said her town pays $205,000 annually to subsidize its ambulance service, a cost that can’t be sustained. Davis told The Berkshire Edge that emergency medical services will be among her top priorities when she takes office in January. “I will be working with [Pignatelli] and other legislators throughout the Commonwealth,” Davis said, adding that she has already spoken with State Representative Lindsay Sabadosa (D – 1st Hampshire District) who said she is experiencing similar issues in her district. “I think a lot of it is partnerships and learning from each other, being aware of what’s happening in other states, particularly New York, and crafting legislation that will help this region.”
Other participants voiced concern over the burdensome paperwork required by the Commonwealth for EMTs, with Woronka commenting that duty often requires as many as “280 clicks” on the computer to close out a transport patient’s data, not including the additional time required to complete a patient’s medical chart.
Described by Brown as the department’s “island in the storm,” regional offices within the state’s Office of Emergency Medical Services have seen funding cuts, leaving no entity for his office to turn to for guidance. Goldstein replied that he recently met with five regional coordinators who expressed similar thoughts.
“I recognize that more money would help this problem; unfortunately, more money doesn’t exist,” Goldstein said, adding that the budget is limited to legislative and gubernatorial appropriations. He suggested better cooperation between the regions and advocated that the burden on those regional offices should be lessened, nixing the requirement that those regional offices be staffed five days a week in person as opposed to remotely. “We need to make it easier for the regional offices to operate and decrease their overhead so that the money they are getting—they can use it to appropriately support all of you,” Goldstein said.
A long time coming
The issue facing this group isn’t new. Some of the assembled committee members had worked on a path forward with Pignatelli and others in 2019, but that effort went nowhere after a study was conducted. Then the pandemic hit, and the issue has since worsened. “We’re trying to reinvent this whole conversation again,” Pignatelli said. “We can’t wait five more years. We’re trying to offer some solutions that would be short term, or immediate, while we are collectively trying to find the long-term, permanent plan.”
Taking the lead
Great Barrington officials have taken the lead on a $180,500 grant that stemmed from Pignatelli’s committee and was filed October 10 by Town Manager Mark Pruhenski on behalf of 12 Berkshire towns: Alford, Becket, Egremont, Great Barrington, Lee, Lenox, Monterey, Mount Washington, New Marlborough, Otis, Sheffield, and Stockbridge. Non-municipal community partners including Action Ambulance, Berkshire Health Systems, and Southern Berkshire Ambulance were also named. A copy of that grant application can be found here.
The grant’s purpose is to fund a consultant to “study the feasibility of developing a regional-service delivery model for emergency medical services.”
“Leaders in southern Berkshire County recognize that the challenges that spawned the first study are still very much affecting EMS providers’ ability to provide fast, reliable, professional emergency medical response to much of the region,” the grant states.
Two years ago, Stockbridge officials tried to get ahead of the curve, identifying what the municipality’s future might look like in terms of emergency services based on the number of firefighters serving the town and its demographics. “In order to do something to protect the town over the next couple of decades—not right now [as] we have an awesome fire company—but it’s really looking down the road, where do we need to be?” Town Administrator Michael Canales said of the discussions that ensued.
So, Stockbridge officials first spoke with those in Lee, then West Stockbridge and Richmond to move a shared approach forward. “We need to be all talking instead of just waiting for somebody else to do it,” Canales said. “We figured we need to step up and say we’re going to take the lead. We’re going to start doing this. Smitty did a great job of saying, ‘This is a bigger issue than just a couple of towns, this is everybody.’ So, his influence was able to bring the entire region together.”
Recognizing the inability for western Massachusetts emergency services departments to function with only volunteers, Canales pointed to a few decades ago when Stockbridge boasted three operational fire departments and 90 firefighters. Currently, he said that staffing number has decreased by more than two-thirds, with those departments consolidating. “It’s just trying to keep an eye on the future, making sure that we’re ahead of it, trying to be proactive instead of reactive,” Canales said.
Before the meeting broke, Pignatelli implored Goldstein to leave the Lenox Town Hall enlightened by the gravity of the situation. “Your takeaway here is I want you to have a better understanding of the sense of urgency that I think the Boston folks need to have,” he said to Goldstein. “This is going to be a problem, and it’s only going to get worse.”
