“If we don’t have funding, the lights go off, and the impact of that on the towns we currently serve would be catastrophic. Given the per capita income of the population of Southern Berkshire County (particularly of those who retire to the region and are most likely to need these services), it’s a sad statement that this situation exists”—James Santos, president of Southern Berkshire Ambulance Squad’s board of directors
An alarming shortage on the horizon
According to 2021 data from the National Rural Health Association, more than a third of all rural Emergency Medical Services (EMS) providers in the U.S. are in danger of closing. Put another way, 57 million Americans face a critical and immediate EMS shortage—including you, dear reader. Adams Ambulance Service announced last week that it will cease its 50-year service on December 31 due to a $200,000 deficit it highlighted in September. Southern Berkshire Ambulance Squad (SBAS) currently has a $350,000 deficit.
Two stark realities heighten the need for ambulance services in our region: lower average household incomes (linked to a higher incidence of severe, life-threatening illnesses and a heavy reliance on EMS care) and a rapidly rising aging population. According to the most recent Berkshire Census data (from October 2023), the median age for Southern Berkshire County has increased to 52.7; this is 10 percent higher than Berkshire County overall (which has the second largest 65-plus population in the state). Add to that the scarcity of hospitals and longer traveling distances to those hospitals, and you have a critical need for ambulance services.
How did we get here?
There are approximately 19,000 locally run EMS providers across the country, but no agency to oversee them, and no two states view them the same way. The median annual wage for EMS providers in May 2020 (at the height of the pandemic, when people relied on them more than ever) was just over $36,000 (according to the U.S. Bureau of Labor Statistics)—well below police and fire department wages. Their injury rate was three times the national average, and they were ten times more likely to have suicidal thoughts (according to the Journal of Emergency Medical Services). A survey of EMS organizations conducted by AAA in 2020 found that nearly a third of the workforce left their ambulance company in the first 12 months. Was this purely COVID-driven? Yes and no.
To understand the state of emergency services today, one must look back to 1973, when Congress (facing budget cuts under the Nixon administration) enacted the EMS Systems Act, shifting services to the states. Early on, these services remained solid—fueled by strong volunteerism, pride in serving, and a tight bond among EMTs. Over the years, however, the number of volunteers declined and was further depleted following the stress and strain of the pandemic years.
Moreover, by not explicitly deeming emergency medical services “essential,” the act created a funding desert that no other emergency services face. It also left it to state governments to decide whether or not to provide or fund them, such that EMS services are still classified as “nonessential services” in 39 states today—including Massachusetts.
The Commonwealth, in turn, shifts this responsibility to the municipal level. “The state government feels this is more of a town issue,” says James Santos, president of Southern Berkshire Ambulance Squad’s Board of Directors, “perhaps because most areas east of here are more densely populated, giving them easier access to a nearby hospital, higher call volume, and a higher tax base to fund these services.”
Allison Knox, intermittent emergency management specialist with the U.S. Administration of Strategic Preparedness and Response, writes: “The very thought that EMS is not essential is a mind-boggling concept for many volunteer and professional EMTs and paramedics, who are keenly aware of the vital role that emergency medicine plays in every U.S. community.” Yet, due to the budget demands small, rural towns currently face, they often choose to classify them as “nonessential” as well.
You may wonder, What about all the money they get from the insurance industry? The reality is that healthcare reimbursements (particularly from Medicare or Medicaid) do not nearly cover the cost of EMS care. And, because EMS agencies are only reimbursed for services when they transport a patient to a hospital, a single provider may (for example) get 1,000 calls a year but only be able to charge for 750 of them.
Southern Berkshire Ambulance emerges to fill a glaring void
Southern Berkshire Ambulance Squad (SBAS) has served towns in Southern Berkshire County since 1968. Per its website, it was established to provide “comprehensive mobile integrated healthcare and emergency medical services in Southern Berkshire County, for both 911 calls and interfacility transports from Fairview Hospital.”
Before its inception, Fairview Hospital was responsible for ambulance service in Southern Berkshire County—but a 40-minute wait time (due to an inadequate dispatch system) in responding to a severe car accident in November 1967 exposed the glaring need for change.
The Southern Berkshire Volunteer Ambulance Squad was organized the following March and incorporated that April. The American Legion donated the first ambulance, the Lions Club donated radios, and Fairview Hospital granted $10,000 for constructing a garage and meeting room at 31 Lewis Avenue (on hospital property).
Growing needs require advanced training and equipment
Over time, the all-volunteer squad became more highly trained. By the end of 1975, 85 percent of the members were nationally registered EMTs, and in 1980, they became an Advanced Life Support (ALS) service. Automatic External Defibrillators (AEDs) and training were introduced in the early 1980s, followed by helicopter intercept protocols in 1987. Through community donations, the squad expanded in the 90s from a garage with a single room to the larger facility that exists today.
In 2014, they voted to become a nonprofit organization and a paramedic, all-paid (workforce) service based on area needs. They also added a third ambulance and increased staffing from one 24/7 crew to two crews. Today, SBAS has 12 full-time paramedics, six advanced EMTs, and 26 basic EMTs providing ambulance coverage 24/7/365. It has 12 full-time and 27 part-time (paid) and volunteer members, three Type III and one Type II ambulances, and one support vehicle.
SBAS currently serves six towns—Alford, Egremont, Great Barrington, Monterey, Mount Washington, and Sheffield—Massachusetts’s largest geographic coverage area. In addition, it has mutual aid agreements with six neighboring municipalities. Call volume averages 3,000 per year, with 911 calls (transporting people from their homes to the hospital) as the first priority, followed by transfers (when a hospital asks EMS to transport a patient to another facility).
As with other medical jobs, the technical knowledge required to use the equipment and the time spent writing reports has become more daunting. “We need to fill out an incredible amount of forms to get reimbursed. It takes 30 to 45 minutes to complete the run report, but it’s your entire documentation of that call. If that call comes into question three years from now, that documentation is your memory, so you have to be very meticulous,” explains SBAS chief paramedic Kevin Wall.
A bold vision of service, training, and outreach
SBAS’s vision is “to be a leader for innovative, clinically sophisticated, and cost-effective delivery of comprehensive mobile integrated healthcare and emergency medical services in our service territory” by recruiting, training, and retaining quality EMS leadership and service personnel. “Initially, when we transitioned, we thought we could become self-sustainable, but when you go from all volunteer to all professional, it’s a challenge,” Santos states.
In addition to emergency services, they provide training for those outside the organization and existing paramedics and EMTs (including CPR, AED, First Aid, continuing education, EMT training, and recertification). “There’s a lot of mandatory continuing education,” Santos adds. “We pay for some, but that still leaves a lot that staff need to cover on their own.”
Community service and outreach are other important aspects of their presence—including standby services for countless local events, pro bono health screenings, and special events like the SBAS “Trunk or Treat” for kids every Halloween.
Mounting challenges to staff and funding those services
“We’re a well-run organization, with layers of complexity, and it takes competence, knowledge, and expertise to maintain it,” Wall says. To achieve its vision, SBAS is facing an overwhelming number of challenges.
“Since the pandemic, we’ve lost more than a third of the EMS workforce in America,” Santos states. “Given that shortage, we need to provide better pay and benefits to attract staff and keep them from leaving to become nurses (where they can earn 50-75 percent more).” In addition, with more complex equipment and health concerns, higher training is no longer a bonus but a necessity.
The second biggest challenge (which goes hand in hand) is getting more funding. “There are probably not any calls that we get full payment on here in the Berkshires, with an aging and rural population. For anyone on Medicaid or Medicare, we’re lucky to get pennies on the dollar,” he acknowledges. Although the average cost of responding to a call is $1,000, they will likely be reimbursed $450.
“The cost of readiness is high,” Wall confirms. “But the reality of being prepared for calls 24 hours a day, seven days a week, is that you have three or four people onsite waiting for a call.” If that sounds like inefficiency, think back to why SBAS was started and imagine waiting 40 minutes (or even 20) for a dispatch service to assemble a volunteer crew today to treat you or a loved one. “If we want to take care of the community and save lives, there’s a price involved,” he stresses.
Unblocking the airways to resuscitate the service
“We would love to do more transfers, but we’d need a third truck and more staff,” Wall continues. “The ultimate goal is three rigs on the road, with the third truck and staff used for transfers to help us recover our losses.”
Other potential income sources include donations from fundraising campaigns (which they only have the finances to run once a year, ironically), grants (which board member John Halbreich researches and writes), and funding from the towns they serve.
“In Berkshire County, there are several ambulance companies that are in dire straits right now, and those that still exist have resources that are woefully inadequate for the number of people who now live here full- or part-time,” board member Doug Robbins points out. “In super rural areas like ours, it’s not only individuals that rely on us,” Santos adds. “Fairview Hospital, a critical access hospital, also relies on us to transfer their patients to other facilities.”
“The towns in our scope have enjoyed free services for 50 years,” Santos points out, “but that is no longer possible.” So they have been making their case to area select boards—a necessary reality when towns are not obligated to contract with an ambulance service. As Shaw Israel Izikson, managing editor of The Berkshire Edge, reported in March, SBAS requested an annual subsidy of $151,294 from the town of Great Barrington, along with subsidies from the other towns it currently serves ($27,275 from Alford, $45,144 from Egremont, $51,669 from Monterey, $65,825 from Sheffield, and $8,792 from Mount Washington) to cover its projected 2023 costs of $2.1 million. Board treasurer Joseph Krejci noted that the organization is currently operating with a $350,000 deficit.
Patient costs—the bottom line
“It would cost roughly 10 to 15 cents a day for the average resident, or $36 to $55 per year if each town added an expense item to their annual budget,” Santos estimates. Contrast that with the additional wait time if they weren’t here or the cost of just one ER visit, and you’ll quickly appreciate the value of what we have enjoyed till now.
Beyond the day-to-day reality of individual health crises lies the terrifying terrain of new safety threats. Santos recalls several past crises where EMS support was critical—evacuating the Timberlane Heights Nursing Home, sending crews out to five plane crashes, navigating the nation’s first school shooting at Simon’s Rock in the early 90s, and responding to multiple calls during the Memorial Day tornado of 1995 (which killed three and injured 24). And national headlines and statistics indicate that disasters like these are becoming more of a reality each year.
“The ultimate boon would be finding a few large donors to start an endowment,” Robbins suggests. While rural income levels may not support that level of giving, it is an easier proposition for many second homeowners who retire here full-time. A quick perusal of area gala donors and revenue totals provides astounding confirmation that the deep pockets exist—the challenge is making something as unglamorous as covering the cost of an oxygen tank or defibrillator as enticing as sponsoring a concert or theater camp.
Few would want to give up summer staples like going to BIFF, Shakespeare & Company, or Tanglewood, but those (admittedly important) cultural organizations aren’t going to save your spouse during a heart attack or your child during an anaphylactic reaction. The actual cost is not whatever dollar amount is proposed for your town but the cost of not supporting the only ambulance service available when you need it next.
SBAS mailed its annual fundraising letter to 9,000 households last week. You may have already tossed it in the recycling pile, but by clicking on this link, you can still make your tax-deductible donation to this year’s campaign.
Respond as if your life depended on it—and they’ll promise to keep being there to do the same.
Here’s a cost breakdown of providing emergency medical services:
- Advanced airway/breathing equipment, including video laryngoscope for intubation—$1,000
- Auto-loading stretcher—$70,000
- CPR machine—$25,000 each
- Epipens—$500 each
- Heart monitor/defibrillator $50,000
- IV infusion pumps—$2,50 each
- Laptop to input all the information—$1,700
- Pediatric medical supplies—$500 each
- Portable oxygen tanks—$150 each
- Type II ambulance—$150,000
- Fully equipped truck and staff ready to assist, no matter the emergency—Priceless
