Berkshire County — With emergency medical services (EMS) shrinking and response times growing across the Berkshires, a band of stakeholders—representatives from 14 towns, two ambulance service providers, and a regional partner—are forging forward with a solution.
Spearheaded by Heather Barbieri, the grant-funded Southern Berkshire Emergency Medical Services Task Force is a “direct continuation” of the path begun in 2018 under the leadership of former State Rep. William “Smitty” Pignatelli (D – 3rd Berkshire District). Barbieri, who was a member of his original group, also serves as Fairview Hospital’s director of emergency management.
In those seven years since the Task Force was created, the problem has only worsened, she said, recalling the urgency in Pignatelli’s voice during the newer sessions: “we need to do something and we need to do something now.”
Although the Task Force experienced starts and stops, especially during the COVID pandemic, the group restarted in earnest last year with a new $180,000 grant and assistance from the Collins Center for Public Management, a state agency that boasts proven success in building regional EMS groups in other areas.
With their goal of developing a similar model in the southern Berkshires, Task Force members recently added a website to keep residents informed of their public meetings and other actions undertaken to ease the public-safety crisis. The site will also be used for public education and is anticipated to soon include the group’s history, plans for action, and study data.
“We appreciate feedback, we appreciate input, we appreciate interest, we appreciate different points of view,” Barbieri said. Most of the meetings are available through Zoom, and she is asking for the public “to be engaged” once more sessions start, sharing their stories of success and detailing where EMS improvement is needed.
That website, with group agendas and minutes, can be found here. A citizen speaking segment will be added to meetings to provide an opportunity for public expression.
However, there is a lot more work going on behind the scenes.
Understanding the issue
Seven years ago, the Task Force operated under an initial grant that funded a study, with the resulting data identifying high priority issues reflecting the dire need for emergency services reform from volunteer to paid and trained staff.
“That was one of the top findings, is that the volunteer EMS world just was not sustainable,” said Barbieri, citing the vast number of mandatory introductory and maintenance training hours required of emergency medical technicians (EMTs).
Then there is the response time to a call that can take an EMT away from home or work for hours.
“If you’re sitting at home having dinner and those tones go off, you might have to leave your house for three hours,” Barbieri said. “That increase of time commitment is just huge when it’s someone who has a full-time job and now has a part-time job just doing the training to keep up with Massachusetts standards.”
Just how long does one response call take? For example, according to Barbieri, Sandisfield’s ambulance received an EMS call prompting a drive to Berkshire Rehabilitation & Skilled Care Center at the end of April. Although Sandisfield Ambulance responded, the team found the patient needed a higher level of care, a paramedic level of care, and called Southern Berkshire Volunteer Ambulance Squad (SBVAS), also known as Southern Berkshire Ambulance (SBA), to assist, but not before loading the patient into the ambulance as well as getting the pertinent nursing reports and paperwork. If that patient in the scenario isn’t a candidate for Fairview Hospital, the ambulance makes the longer drive to Berkshire Medical Center (BMC) where the patient and reports are unloaded, the ambulance cleaned, restocked for service, and then driven back to Sandisfield, with the vehicle tallying a total of three hours in use.
“People don’t stop having heart attacks, strokes, and car accidents in those three hours because the ambulance is out of service,” Barbieri said. In the example given, not only is the Sandisfield ambulance out of service but also the SBVAS ambulance, amounting to what she called “a huge time commitment.”
Barbieri counted a maximum of 10 ambulances in southern Berkshire County. SBA has one to three ambulances available when fully staffed, which isn’t always the case. New Marlborough, Otis, Sandisfield, Richmond, Lee, Lenox, and Becket each have one ambulance, with Becket consistently staffed with a paid team. Based in Pittsfield, County Ambulance can help with longer transfers or transfers involving patients who need a higher level of care.
Although SBA’s three vehicles sound like a lot, it isn’t when patient transfers made by the ambulance team are considered. For another example, a patient may be taken from Fairview Hospital to Baystate Medical Center in Springfield or transported from the hospital to a nursing home, or from home to dialysis, Barbieri said. “That certainly keeps an ambulance busy,” she said.
EMS, Essential Services, and a push forward through legislation
Although many southern Berkshire residents and officials are finally getting the message and acknowledging the need for a revised EMS protocol, insurance companies who are on the line to reimburse ambulances and EMS providers for their fees don’t see the issue in the same way and haven’t kept up with the cost of that care, Barbieri said.
An ambulance needs to be able to respond around the clock, 24 hours a day, every day, she said, but if that service is only used 12 hours out of the day, the service must still be available to respond during the remaining 12 hours. “So, it’s that cost of readiness that’s the biggest challenge because insurance, obviously, doesn’t pay for that,” Barbieri explained. “They only pay from Point A pickup to Point B dropoff.”
Additionally, insurance reimbursement, when received, “clearly doesn’t” cover the full cost of the service, she said.
Unlike police and fire services that fall within annual municipal budgets, EMS doesn’t fall within the definition of an “essential service” by the Commonwealth.
“That’s a big piece of it,” Barbieri said. “If [EMS was] considered an ‘essential service,’ [it] would be funded through the town, like police and fire are. The police officer doesn’t have to submit a bill to an insurance company. It’s not the same. So, EMS has to be ready to provide the service whether they get paid or not, where police and fire are funded by the town.”
But taxpayers expect the same level of service from EMS workers as with services deemed “essential.”
Enter State Rep. Leigh Davis (D – 3rd Berkshire District).
In office only a few months as Pignatelli’s successor, Davis has already filed five bills aimed at improving EMS funding and workforce, as well as modernizing the model in the Commonwealth.
HD.2230, if passed, would designate EMS as an “essential service.”
“EMS is at a breaking point,” Davis said. “Essentially, EMS is our community’s insurance policy. EMS responds when primary care is unavailable, urgent care is inaccessible, or crisis strikes. Right now, EMS is often misunderstood, it’s unfunded, and it’s stretched beyond its limits, especially here in rural Massachusetts.”
Once in office, Davis became the Task Force’s advocate in the State House “to convince the legislature that [EMS] is a problem and it’s not just in rural Massachusetts—it’s all of the Commonwealth.”
Seeing that neighboring states have already declared EMS to be an “essential service,” she filed HD.2225, addressing workforce challenges and expanding EMS licensure so personnel can move between state boundaries.
Notwithstanding her “overarching” goal being to declare EMS as “an essential service,” she put forth another bill as a Plan B, establishing a statewide EMS commission (H.4076) to provide broader oversight and innovation. To chip away at some of the issues with EMS providers, Davis filed HD.2224, a pilot that would deter the problems of insurance reimbursement for ambulance costs, including some crews who are only reimbursed for costs if the patient is transported to a hospital.
“Regionalization [of EMS] is not a cost-saving model,” Davis said. “What we’re trying to do is to make sure it’s sustainable.”
Communities need to determine what level of service is expected and how much they are willing to do to gain that service threshold, she said.
“The writing on the wall is clear that we definitely need systemic reforms to safeguard the future of EMS,” Davis said. “These bake sales, ham roasts, and spaghetti dinners—this isn’t going to fix the problem. From my point, as a legislator, I feel it is my duty to do all that I can. EMS is a mobile emergency room and not just transport. We really need to address the fact that the costs of readiness, having staff and equipment available 24/7, this is not funded.”
Training is key
One of the issues to enhance the EMT program is the advancement of EMS training, including hosting additional classes needed to fill the gap between the volunteers of the past and the number of certified EMTs, Barbieri said. During COVID, that training didn’t happen, and a lot of volunteers retired, without being replaced by new staff, she said.
Last year, however, EMT training classes started up, Barbieri said, by way of a state Workforce Development grant and the efforts of Berkshire Community College and local ambulance systems including Northern Berkshire EMS, County Ambulance, and Southern Berkshire Ambulance. Northern Berkshire EMS will host another class later this year.
“So we’ve been able to have some classes to start refreshing that pot of EMTs,” Barbieri said. “That was a collaboration that happened because of Smitty’s leadership.”
Davis introduced HD.2227 to promote EMS careers by offering cardiopulmonary resuscitation (CPR) training in high schools through grants.
She also acknowledged “ambulance deserts” exist in the rural parts of the state, areas where ambulances can’t quickly respond or, sometimes, not at all.
Since it regenerated, the Task Force has been collecting data on ambulance calls, Barbieri said, with an eye toward giving that information to Berkshire Regional Planning Commission, who will compile the data into a Geographic Information System, mapping the locations from where the ambulance calls are coming.
“If they’re all coming from a place where there’s not an ambulance, what’s the answer?” she said. “How do we get an ambulance closer?”
Despite the winding road to get to this point in the group’s progress, Barbieri is confident the Task Force will attain its goal, a new EMS protocol, before their new grant expires in June 2026. “Our goal is to meet that deliverable, to have that plan available to implement by June of 2026,” she said, adding that an extension is possible. “It sounds like a big thing, doesn’t it?”
