Last Call for Volunteer Ambulance Companies a Continuing Trend in Pa.

March 15--Tom Lewis has volunteered with local fire and ambulance departments since he was 18.

Now 44 and the captain of the Jackson Township Volunteer Ambulance Association, Lewis' more than a quarter century of voluntary service is about to come to an abrupt halt -- at least for now.

The ambulance association, in its 45th anniversary year, gave township officials 90 days' notice in February that it will officially dissolve in May. In the meantime, Back Mountain Regional Fire and EMS takes their calls.

"We tried everything we could think of," Lewis said of the dissolution. "It was a hard pill to swallow."

The Jackson Township Volunteer Ambulance Association is one of three local ambulance companies to shut its doors since the beginning of 2015.

And, by the end of the year, there might be more.

"It's definitely a trend," said Andy Zahorsky, data and technical support manager for the Luzerne County 911 Center. "Volunteers are a dying breed," and it's not going to end any time soon, he said.

By the end of February, Jackson Township Volunteer Ambulance Association, Wyoming Hose Co. No. 1's Medic 27 advanced life support unit and the Kingston Township Ambulance & Rescue Association had all officially stopped responding to calls.

In addition, members of the Duryea Ambulance Rescue Service Association decided to close down in May 2013 and gave formal notice of dissolution this January.

Most municipalities in the region use professional or paid advanced life support providers staffed by paramedics, which respond to emergency medical conditions such as heart attacks and severe injuries. But basic life support units, often associated with fire departments and which respond to non-life-threatening situations such as falls and minor accidents, were traditionally volunteers with emergency medical technician training.

Zahorsky said Luzerne County has probably lost more volunteer ambulance companies in the past two years than the entire eight he has been in his job, and he "wouldn't be surprised to see two or three more by the end of the year."

There are different reasons for their closing, Zahorsky said.

Some of the ambulance companies combined to form regionalized departments; others "just died," he said. Internal politics can play a role. Some ambulance companies are on life support, fighting to survive before they collapse, he said.

Zahorsky said Luzerne County 911 submits a no-crew list to its governing body, Emergency Medical Services of Northeastern Pennsylvania, outlining which ambulance companies don't respond after being called out by a dispatcher. These are units that either went nine minutes without responding or told 911 they didn't have anyone to go on the call.

The report from October to December 2014 was 21 pages long.

"That's a lot," Zahorsky noted.

He pointed out that all calls were answered; an advanced life support crew is usually on its way within minutes.

Municipalities are ultimately responsible for selecting their emergency responders, which the state requires them to do.

Zahorsky said it is not true that 911 hates volunteers -- "But we hate when nobody responds."

If ambulances don't get out, it looks like 911 is to blame, he said. There may be departments that are better-equipped and closer, but the dispatchers don't pick who responds.

"There are departments out there we're really struggling with, and it's a matter of seeing the writing on the wall," he said. "They're in trouble. The alarm has been sounding, but they keep hitting the snooze button and saying, 'Oh, we're OK.'"

Lack of volunteers

Fire departments' chronic shortage of volunteers has been well documented. But ambulance companies face the same challenges in keeping their numbers up.

In Jackson Township's case, that's what proved fatal to the ambulance association.

Lewis said the department has had manpower issues for the past few years. It tried membership drives, to no avail, he said.

Jackson Township supervisor Chairman John Wilkes Jr., who is on the executive board of the Pennsylvania State Association of Township Supervisors, says the loss of fire and ambulance volunteers is a problem throughout the state -- and the country.

The state needs to come up with initiatives such as tax breaks, higher education and college funding or paying for insurance, he believes. The state should also subsidize the required training, which Wilkes calls an "unfunded mandate."

Fire and ambulance companies do get state grants, but Wilkes said that's not enough.

"The grants are welcomed, and very, very, very well appreciated," he said. "But we don't have the personnel to man the equipment we get with the grants."

As one incentive to recruit and train volunteers, state senators Lisa Baker, R-Lehman Township, and Sean Wiley, D-Erie, reintroduced proposed legislation to give volunteers tax credits. The senators debuted the bill in April 2014.

Senate Bill 299, if passed, would grant municipalities the ability to waive local earned income tax for volunteer first responders and also volunteers at nonprofit emergency medical service agencies. The municipalities would have the power to determine the amount of the tax credit and set guidelines, such as how many calls a volunteer must answer each year and what level of training he or she has to have.

Baker and Wiley stated that the bill is expected to be part of a larger package of incentives to fill the rapidly declining ranks of volunteers: Over the past 30 years, numbers have dropped from 300,000 to 50,000 statewide. They attribute the decrease mainly to the prevalence of two-income families, the demands of incessant fundraising, local leadership conflicts, and the stagnant economy.

In an emailed statement, Baker said she has asked the state Department of Health to look at the ambulance department closure issue.

"The numbers coming back show a net loss of 81 agencies in a little less than a year, with 139 closures and 58 startups. Some of these changes reflect mergers and consolidations, but obviously there are outright closures such as we have seen locally," she stated.

Baker intends to push for public hearings on concerns and issues affecting ambulance units.

Lack of funding

Finances are another major factor -- that's what caused the demise of the Duryea and Wyoming departments.

Wyoming Mayor Bob Boyer said volunteers realized the ambulance couldn't afford to run: The call volume wasn't there.

An ambulance is like an "emergency room on wheels," very expensive to run and staff, and small towns can't afford it, he said.

Lewis said it can cost well over $1 million to start up an advanced life support unit.

A basic emergency medical technician training course costs $600 at Luzerne County Community College; a complete degree can cost around $20,000.

Ambulance services will typically pay for EMT training and some supplementary courses, Lewis said, but the state requires more hours of training and it gets more difficult each year. And with family and work responsibilities, many volunteers are unable to put in the time.

Insurance from patients doesn't always pay enough, he said, and sometimes ambulance companies have to resort to using grant money slated for equipment or training to help cover operating costs.

Jenkins Township EMS merged with Pittston City EMS to become Greater Pittston Regional, which is now first due for Wyoming. Lehman Township's ambulance merged with Dallas' to become Back Mountain Regional Fire, EMS and Rescue, which is providing basic life support service as well as advanced life support in Jackson and Kingston townships.

Mark Van Etten, president of Back Mountain Regional, said paid ambulance services don't cost residents or municipalities more than volunteer services.

He said Back Mountain Regional bills the health insurance companies and solicits donations of $30 per household a year. The donations also help cover the fire protection the company provides.

One of the advantages of regionalizing the ambulances is that, individually, Kingston and Jackson townships did not have enough call volume to support a paid crew, Van Etten said.

It's much more expensive to run an advanced life support service than a basic life support service. Paramedics are paid more because they are more educated and there's a smaller pool of them, plus there is the cost of supplies such as drugs and additional equipment, according to Van Etten.

To sustain a staff, an ambulance company needs to go on at least 1,000 to 1,200 calls a year. Van Etten said Back Mountain Regional gets around 68 calls a day, and estimates it will get 3,000 calls in 2015.

Back Mountain Regional has an ambulance with 24-hour-a-day paid staff. Since picking up Jackson and Kingston townships, the ambulance company is expanding the hours of paid staff on its second ambulance from 6 a.m. to 4 p.m. to 6 a.m. to 11 p.m., Van Etten said. Volunteers will still staff the 11 p.m. to 6 a.m. shift, he said.

Van Etten sees the increased state requirements as a good thing, meaning residents are going to have better care, with more advanced people responding.

"We are offering a better product today than we were 10 years ago," he said.

What the future holds

Zahorsky called the county volunteers the "best of the best," and noted that "We've got a lot of really good volunteer departments out there."

On the other hand, there are some ambulance companies -- and fire departments -- that are not going out for their calls, he said.

"It's scary," Zahorsky said. "What people don't want to hear is that is where we're going. Paid departments are taking over."

Wilkes-Barre, Plains, Nanticoke and Hanover Township, to name a few, have paid fire departments, and West Pittston is paying Commonwealth Health to man an ambulance for the borough.

Combining departments, like in the Back Mountain and Pittston areas, is another strategy.

"I think you're going to see it more and more often: Regionalization of small communities, or they will have to close their doors," Lewis said.

Zahorsky believes fire and ambulance companies need to start putting petty differences aside, for the betterment of residents and their municipalities. A person having a heart attack doesn't care what name is on the side of the ambulance.

Lewis said there are no easy answers to the volunteer situation, which he has seen worsen in his two decades in the field.

For the last four years he has worked as a professional paramedic -- and it was his years of volunteering that inspired him in his career choice. When he first started out, he wanted to be a firefighter but his colleagues convinced him to join the ambulance service instead. He took an emergency medical technician course and "I've been hooked ever since then."

When the Jackson Township Volunteer Ambulance Association closes its doors for good, Lewis said he might volunteer with Back Mountain Regional.

"Better for the community than me just sitting at home doing nothing," he said.

"But first I have to get through this closure."

eskrapits@citizensvoice.com, 570-821-2072

Copyright 2015 - The Citizens' Voice, Wilkes-Barre, Pa.