Last E.M.T. Holdouts Go For Paid Systems

Gansett and E.H. to help beleaguered vols
Ten of the 11 advanced life support providers hired by the Amagansett Fire District
Ten of the 11 advanced life support providers hired by the Amagansett Fire District for a new partially paid ambulance service were at a meeting Tuesday. Morgan McGivern

Starting Tuesday, the Amagansett Fire District will institute a paid emergency medical service program, the second in the Town of East Hampton. The East Hampton Village Ambulance Association will follow suit with a similar program beginning May 16, and the Sag Harbor Volunteer Ambulance Corps is in the midst of putting together a budget to create one paid position.

The approximately 35-year-old volunteer E.M.S. system on the South Fork has been criticized in recent years despite volunteers’ attempts to keep up with increased training requirements and answer the soaring demand for services, particularly in the summer months when call volumes double, and even triple in some areas.

As with the Montauk Fire District, which went ahead last spring with a pilot project in response to a lack of volunteers trained in advanced life support, Amagansett and East Hampton will have paid paramedics or critical care technicians, also known as advanced emergency medical technicians, on duty daily.

At the launch of Amagansett’s program, paid personnel will work from 6 a.m. to 6 p.m. Come May 15, there will be coverage 24 hours a day.

East Hampton’s program will only cover 6 a.m. to 6 p.m. year round because of a night squad successfully run by volunteers.

“We feel that it’s beneficial to the community to have the best care we can provide,” Daniel Shields II, the chairman of the Amagansett board of fire commissioners, said. “We owe the taxpayers the best protection we can provide.”

His district has been without advanced life support services since December, when Tom Field, the last active volunteer A.L.S. provider, decided to reduce his involvement. Since then, the district has relied on the assistance of neighboring agencies for response to serious calls in which A.L.S. was necessary, such as major trauma or heart attacks, under longstanding mutual aid agreements.

Meanwhile, the Amagansett commissioners put aside $150,000 in funding and dealt with the logistics of setting up a paid system. The district hired two supervisors: Garret Lake, a critical care technician from Cutchogue who has been working in Montauk, and Jade Fallon, a Hampton Bays volunteer who works in Ridge and Wading River. The 11 providers hired underwent orientation on Tuesday.

Mr. Shields said the district was fortunate that a mutual aid program was in place to make up for the deficit in advanced life support. “It will be nice not to rely on mutual aid if we don’t need to,” he said.

In East Hampton, where there are four volunteers certified in A.L.S., the larger challenge has been call volume. The association relied on 45 members to answer 1,402 calls in 2013. “It’s very hard to keep up with daytime volume in summer,” said Barbara Borsack, the village’s deputy mayor and an emergency medical technician for nearly 25 years.

The village, which oversees the E.M.S. agency that also responds to ambulance calls outside the village, in areas like Northwest Woods and part of Wainscott, is now hiring 24 A.L.S. providers who will alternate 12-hour shifts. As in Amagansett and Montauk, providers work part time.

Critical care technicians get paid $22 per hour and paramedics $25 per hour, according to Becky Molinaro, the village administrator. “On the high end, the personnel will cost approximately $35,000 for the season, which will be split in two fiscal years,” she said. The village’s fiscal year ends July 31.

Village Police Chief Gerard Larsen took the lead because, he said, “I’ve been the biggest complainer. I figure if I’m going to complain, I ought to try and help.”

Chief Larsen became concerned with response times, which also led to calls that tied up village police officers, he said. “The volunteers are overwhelmed. This is something that’s got to happen,” he said of the program, adding that he worked closely with the chief of the ambulance corps, Diane O’Donnell. The Police Department is also providing a vehicle for the paid personnel to drive to calls.

He has gone a step further, too. Four part-time village police officers assigned to bicycle patrol will take the Emergency Vehicle Operators course so that they can drive the association’s ambulance to calls within the village police jurisdiction if a volunteer driver is not available. They will work shifts that ensure there is someone available from 6 a.m. to 10 p.m. “This is the first of its kind,” Chief Larsen said.

“I think this is a big step toward giving our volunteers the help they need to provide the best possible service to our citizens,” Ms. Borsack said. “I’m very excited about this program.”

The move from volunteer-based systems in East Hampton and Amagansett to partially paid ones took six months to put together, but it was years in the making. Volunteer systems across New York State, particularly on Long Island, have struggled to answer an ever-increasing number of calls during the workday, when most volunteers are at their day jobs. Nearly all ambulance companies as far east as Southampton instituted some kind of paid system, at least during the day, several years ago.

“We were the last holdouts,” said Eddie Downes, the president of the Sag Harbor Volunteer Ambulance Corps, who also co-chairs a subcommittee of the East End Ambulance Coalition that is looking at the issue. The Sag Harbor agency decided help was necessary, however, and asked the village to establish a full-time ambulance administrator position, someone who could do paperwork but was also certified as at least an E.M.T. to answer calls during the day. The salary proposed is $42,000, or $63,500 with benefits. The budget process wraps up in April.

The Springs and Bridgehampton Fire Departments have no immediate plans to institute a partially paid system.

Meanwhile, the East End Ambulance Coalition will continue a program that began last summer in which volunteers gave a day each week when they were on standby to respond to calls from 6 a.m. to 6 p.m. within the six fire districts that make up the Town of East Hampton. Mr. Downes said proposals have also been submitted to the East Hampton and Southampton Town supervisors for a paid first responder program for 2015.

The Montauk Fire District formed its own paid program just before the summer of 2013. It was so successful — and was even credited with saving one man’s life — that the commissioners continued it during the off-season. Amagansett fire commissioners sought the advice of those who set up the Montauk program to develop one on the other side of the Napeague stretch.

“The problem is our working people who are volunteers just can’t be there all the time,” Mr. Field said. A county instructor, he has been the backbone of the Amagansett department’s E.M.S. service for many years. “It’s becoming tougher and tougher. Fewer people are volunteering and they can give less and less time than they used to. It left these enormous gaps.”

In fact, after more than 23 years providing advanced life support and answering more than 4,500 calls in his E.M.S. career, he gave up his certification at the end of November, when he decided not to train in new protocols the county required for all A.L.S. providers. He maintains a basic life support certification.

In a recent year, he said, he counted 342 evenings, Saturdays, and Sundays he had spent in E.M.S.-related meetings or classes. “And that had nothing to do with runs or E.M.S. paperwork,” he said, adding that he typically went on 250 calls annually. “I guess you could call that burnout.”

Even with paid providers alleviating some of the pressures, the volunteers are an essential component. “E.M.T.s and drivers are vital to run the calls and leave the first responder in the district to be there for the next call” when it is not necessary for the A.L.S. providers to transport the patient to the hospital, Ms. Borsack said.

Amagansett Fire Chief Duane Denton said the move has the support of his department. “It’s been accepted well by the members. I had a meeting with all of the ambulance company. We need the volunteer side to make this work.”

While the paid personnel are highly trained, Mr. Field insists they cannot treat the patient at a higher level without the help of E.M.T.s. “The E.M.T. is so vitally important. An A.E.M.T. who works alone is a lonely sucker. It’s an E.M.T. who allows him to do his or her work because they are doing the little mundane things that need to be done.”

Amagansett’s E.M.S. service has been made up of only volunteers since the ambulance company’s inception in 1974 — East Hampton’s since 1975. As necessary as Mr. Field considers the institution of a partially paid system to be (and eventually, he believes, a fully paid system), he said it is bittersweet. “I absolutely hate the idea that we can’t do anymore volunteer. . . . To me it’s a tremendous loss of something that had gone for so many years, and yet, as much as it hurts, it’s understandable. It had to happen. It’s going to happen everywhere, it’s just a matter of time."