Following a hard lesson in the perils of jaywalking, I was about 10 the last time I was in the back of an ambulance. Being given a tour of one by the folks at Southern Berkshire Ambulance Squad (SBAS) while not being scolded by my mother was a decidedly better experience.
My supposition in visiting SBAS’ offices was that the lack of magnetic resonance imaging (MRI) capabilities at Fairview Hospital was negatively impacting SBAS’ ability to serve its six-town region (Alford, Great Barrington, Egremont, Monterey, Mt. Washington, and Sheffield). The thought being that having to transport patients to Pittsfield and Springfield for MRIs diverts local resources to our detriment. After chatting with the folks at SBAS, I learned there are several factors impacting SBAS’ ability to serve South County, but Fairview Hospital’s lack of an MRI happens not to be one of them.
Due to dismal economics, running an ambulance service is not for the faint of heart. In 2024, SBAS’ average cost per transport is $960, for which it gets reimbursed $614.66. With nearly two thousand transports so far in 2024, that is a deficit of about $700,000. Accountants would call that chronic fiscal pain.
Costs consistently exceeding revenue by about one-third is an unsustainable long-term business model (and not a particularly good short-term one either). Another oddity of the ambulance business model: if the SBAS comes to your home, checks you out, and you decline transport to the hospital, SBAS receives no reimbursement. One more oddity: if the ambulance comes to a deceased’s home, SBAS is not reimbursed. With Monty Python in mind, I (jokingly) suggested that the SBAS take the I’m-not-dead-yet patient to the hospital to facilitate reimbursement if not resuscitation, to which I was given a stern lesson in the ethics of medical care. (People can be touchy. I was just spit balling potential revenue opportunities.)
Starting in the 1960s and for four decades, SBAS had been a volunteer ambulance service of well-meaning but not highly trained medical professionals. Today’s SBAS, with its mix of highly trained paramedics (fun fact: Paramedics can do 98 percent of what an Emergency Department physician can do, at least according to paramedics) and EMTs, looks nothing like the folks who transported patients to the hospital in decades past.
The ambulances of today are not the medical taxis of yesteryear. State law requires hundreds of hours of training, largely closing the door on well-meaning volunteer ambulance services. Lifesaving care is now provided during transport that may well make the difference in a patient’s outcome.
If you live in SBAS’ region, you are fortunate that you are likely to be cared for by a highly trained paramedic—that is, if you are lucky enough to have one of SBAS’s paramedic-staffed ambulances arrive. The rub is that, due to staffing shortages, SBAS can generally only staff one vehicle at a time with a paramedic. If that one vehicle needs to transport a patient to Pittsfield, Springfield, or Albany for acute specialty care not locally available, the paramedic may be out of our area for up to three hours. During that period, the Sheriff’s Department will dispatch, on a mutual aid basis, an EMT-staffed ambulance from one of the smaller surrounding communities.
The folks in the mutual aid ambulance will no doubt be caring, well meaning, and fully EMT trained in accord with state law, but they will not be able to provide paramedic services. At the risk of sounding overly dramatic, with only one fully staffed paramedic/EMT ambulance in our area at any one time, we are playing Russian Roulette with our ambulance services. I am not saying that the outcome will assuredly be dreadful if a paramedic is not able to arrive at your door, but it is reasonable that a poorer outcome is not out of the question.
Given our community’s aging population, it is easy to conclude that we should assist SBAS in its quest to have two paramedic-staffed ambulances ready at all times. Let me put it this way: As much as I would like Fairview Hospital to have an MRI, having paramedic-staffed ambulances more consistently available is a more critical local health concern. MRIs are valuable but can only do so much; as you may have heard, paramedics can do 98 percent of what an Emergency Department physician can do (according to paramedics).
Appreciating the dismal economics of running SBAS, in 2024, the six towns in SBAS’ region contributed $475,000 to defray costs, but that still leaves an unhealthy operating deficit and a growing list of current needs. To be honest, until my visit to SBAS, it had never occurred to me that an ambulance service was a worthy cause for a charitable contribution consideration. I now know better.
SBAS is currently fundraising not only to cover its current operating deficit of about $150,000 but also to buy additional critical equipment for its ambulances and facilities. SBAS board member John Halbreich recently donated $75,000 (thank you, John!) for the purchase of three LUCAS chest-compression devices used during cardiac arrest transports, reported here. Other critical devices remain on SBAS’ needs list, as follows:
- Two ventilators, approximately $20,000 each;
- Four video laryngoscopes, approximately $6,000 each;
- An ambulance, approximately $477,000 (three years to be fitted and delivered);
- A paramedic intercept/supervisor vehicle, approximately $125,000;
- Ambulance computer upgrades, approximately $30,000; and
- Ambulance headquarters upgrades (it is nearly as old as Monument Mountain), approximately $150,000.
I visited SBAS seeking to stir the pot regarding Fairview Hospital’s lack of an MRI (which, it turns out, is in the works once its electrical distribution is upgraded). I left SBAS with a deep appreciation for how lucky our communities are to have highly trained paramedics and EMTs coming to our door when in need—that is, when that ambulance is not diverted for another’s care. SBAS needs equipment; it needs to keep the lights on; and it needs funding to raise wages to enable staffing for an additional paramedic-staffed ambulance. Convinced these are critical needs, we gave, and you might consider giving too.
There are many organizations in need in South County. Because we just expect an ambulance to show up when needed, SBAS is perhaps less obviously in need, but it is not less worthy.
Survey Monkey Question
Here is a link to the following Survey Monkey poll: “Should our communities provide funding to Southern Berkshire Ambulance to enable an additional paramedic-staffed ambulance at all times?”
Survey Monkey Results
Here is the result of the following recent survey question: “Given its integral relationship to the region, is it reasonable for concerned citizens to request Simon’s Rock grant them time to formulate a workable reuse plan providing for the purchase of the property?”
As of publication, 84.85 percent of respondents said “yes.”
Days Great Barrington has wrongfully withheld Community Access Fees: 279
