24/7 Regional E.M.S.?

Mixed reaction to ambulance coalition’s plan
Carrie Ann Salvi

With an average of 4,500 emergency medical calls to answer each year in the Town of East Hampton and ongoing struggles with volunteer recruitment, retention, and response times, the emergency medical service community is getting creative about how to ensure help gets to patients faster. 

The East End Ambulance Coalition, made up of representatives from all six agencies that serve the town, is proposing an East End Responder Program that would be spread over all six districts as a single territory. Under the program, which has gotten mixed response from the various agencies — advanced life support providers would respond to the scene of emergencies 24 hours a day, seven days a week, in what are known as “fly cars.” An ambulance and volunteer emergency medical technicians would also need to respond, but medical attention could already be started on scene.

Advanced life support providers offer an increased level of care, particularly during major trauma or heart attacks. In contrast to basic emergency medical technicians, they can intubate a patient, start intravenous therapy, and administer narcotics, such as pain medication and drugs that help stop seizures.

Philip Cammann, a paramedic who volunteers with the Bridgehampton Fire Department and a member of the subcommittee that has been working on the proposal for the past 15 months, said that the program would be a shared resource instead of a proprietary one. Paid providers who work in one-person shifts in Montauk, Amagansett, and East Hampton — all of which have instituted their own paid programs over the past year — cannot leave their districts if a neighboring one needs help, unless a patient is in cardiac arrest. But, under a longstanding mutual aid program, volunteers can.

Leaders of the districts that oversee ambulance services are not convinced that a regional approach to immediate medical service is necessary.

The proposal calls for three first responders on duty during the off season and six during the peak season. Each first responder would have a primary area in which to answer calls as they are dispatched. When one is tied up on a call, the others would shift over to help cover the other areas, similar to how police set up sector cars.

In order to set up a program that runs across district lines, the committee wants to form a new tax district that would also be set up as a union-free, not-for-profit agency serving from Montauk to the western edges of the Bridgehampton Fire District in Water Mill and the Sag Harbor Fire District in Noyac. Ambulance agencies in Southampton, Hampton Bays, Flanders, and Westhampton are set up as not-for-profits that contract with the Town of Southampton to provide services.

Based on preliminary figures, including initial expenses for vehicles and equipment and an estimated payroll of $1.4 million, the program would cost approximately $2.5 million annually. For a house with a valuation at $1 million, the cost would be $137.30 per year.

By comparison, the Montauk Fire District, which has one paid provider on duty 24 hours a day during the summer and 12 hours a day during the off-season, budgeted about $150,000 for its program per year.

“Our feeling is it takes the financial responsibility of each individual area and spreads it over everyone,” Mary Ellen McGuire, a member of the committee who represents the East Hampton Volunteer Ambulance Association, told the East Hampton Village Board on Friday.

The committee has discussed the proposal with both East Hampton Town Supervisor Larry Cantwell and Southampton Town Supervisor Anna Throne-Holst, who said they would cooperate in helping form the district if the various boards requested it. “I’m not going to form an overriding ambulance district unless every fire district wants it,” Mr. Cantwell said recently.

The committee has been visiting the various governing bodies this month. “We’re trying to get everybody on board conceptually so we can then sit down with the town boards so we can work out details,” Mr. Cammann told the village board.

The proposal has so far failed to pass muster with the majority of the boards. East Hampton Village, which oversees the East Hampton ambulance, and the boards of the Springs and Amagansett Fire Districts said they are not interested, at least right now.

“I applaud the concept,” East Hampton Village Mayor Paul F. Rickenbach Jr. said at the meeting Friday, but added, “I don’t think we’re ready to get on board.”

“I hope we’re not deflating your initiative, but there’s too many questions we have to take into consideration,” the mayor said. Later, he described the plan as “rather far-reaching,” but said he would not rule it out entirely. “It may be something I forecast happening at some point in the future, but I’m not 100 percent certain it’s something we need to do right now,” particularly because just this spring, the village hired advanced life support providers who act as first responders.

The cost of a paid first responder may prove to be the biggest hurdle.

Pat Glennon, the chairman of the Springs Fire District, where the budget is just over $1 million per year, said that while the board did not take a formal vote, members unanimously agreed they were not in favor of the proposal. The cost, he said, would be too much to bear in a hamlet where taxes are already higher than in other parts of the town and homeowners largely working class. “You’ve got to remember, Springs is basically the poor person’s town, if you will,” he said. The added expense “might be the difference between some elderly man or woman not getting their medication.”

Springs, he said, does not necessarily need 24-hour coverage. Without a large business district, most volunteers work elsewhere and cannot respond back during the day, but are available in the evenings. The Springs ambulance answered a little over 600 calls last year, 400 to 450 of which were in its district. While it has 12 E.M.T.s, only 4 of them are A.L.S. providers, including Mr. Glennon, who has been a critical care technician for 15 years and an E.M.T. for nearly 25.

“If we consistently turn around and say ‘more taxes, more taxes,’ what are we actually doing to the residents of our community?” he asked. “Can you put a price on it? No. At the same time, if you had to, how much is it going to actually save?”

Mr. Glennon said the board is open to other solutions, and is hoping to explore the potential for sharing Amagansett’s paid provider or paying him or her to respond to Springs as necessary.

In Amagansett, however, Daniel Shields, the chairman of the board of fire commissioners, said it is too soon to say whether that is feasible. “Honestly, at this point, we’re trying to take care of our own. I don’t know how we can share one person.”

While Amagansett’s Board of Fire Commissioners also is not interested in the regional first responder program, Mr. Shields highly recommends a partially-paid system in light of the success he has seen in Amagansett. The E.M.S. response times have dramatically decreased since the program’s inception.

Before the program was instituted April 1, the average time from when the call was dispatched to when the first contact was made with the patient was 13 minutes. From April 1 to May 15, when paid first responders were only on call 12 hours a day, the average time from dispatch to the first patient contact decreased to 9.1 minutes. In the brief period from May 15 to June 1, when paid responders have been on the 24-hour-a-day summer schedule, that time dropped to 5.1 minutes.

Similarly, the average time it took an ambulance — still manned only by volunteers — to respond on scene also improved. The average time from when the call was dispatched to when an ambulance arrived dropped from 14.9 minutes before the program to 9.1 minutes after May 15.

Other districts are more keen on the idea of a regional approach. The Sag Harbor Village Board passed a resolution earlier this month to show its interest. Mayor Brian Gilbride said the time has come for agencies to transition toward a paid system. “I never thought it would come in my lifetime. I come from a time when we had a waiting list for fire and ambulance [volunteers], five or six years,” he said.

The village even put off hiring an E.M.T. for the newly created position of ambulance administrator for the Sag Harbor Volunteer Ambulance Corps, which runs 1,300 to 1,400 calls each year. “I think the first responder program, if it gets legs, we won’t need a full-timer,” he said. “It’s a work in progress. We’ll see how this unfolds.”

Ray Topping, the chairman of the Bridgehampton Board of Fire Commissioners, said it is too soon to tell what direction his district will move in. The board recently starting considering hiring a paid provider of its own. “I think everybody is having difficulty getting crews together. We’re having trouble now getting personnel to a fire scene. It keeps me up at night thinking about it,” he said. “We’re open to everything.”

The Montauk Fire Commissioners were expected to discuss the issue yesterday.

After the meeting with the East Hampton Village Board on Friday, Mr. Cammann said he was disappointed more districts were not thinking regionally and that his committee is steadfast in its position that this is the right approach.

“It’s what the rank and file voted to do. A unified system has proven to be the best,” he said. “As long as the community comes first, what works for them works for us.”

With reporting by
Christopher Walsh