Image via Shutterstock Pennsylvania EMS
Image via Shutterstock

“We are going to see more ambulance companies go out of business.”

Between 2012 and 2018, nearly one quarter of Pennsylvania’s emergency medical services agencies shut down due to budget cuts and staffing shortages, according to the Pittsburgh Post-Gazette. Now, with the novel coronavirus sweeping the state, the surge in demand for EMS services is highlighting the broken system.

In Montgomery County, an emergency medical technician in Upper Merion Township contracted COVID-19 last month. A majority of the department, including the township’s fire chief, had to be quarantined for 14 days.

“It weighs on your mind at night,” Public Safety Director Thomas Nolan, who doubles as the Montgomery County community’s police chief, told the Pittsburgh newspaper. “I can’t even see the enemy on this one to worry about my people. I worry about it constantly.”

Most EMS agencies that operate outside of Pennsylvania’s major cities are financially supported almost entirely by Medicaid, Medicare, and private insurance reimbursements. Jerry Ozog, executive director of the Pennsylvania Fire and Emergency Services Institute, said that the problem with relying on these reimbursements is that they only represent a small portion of actual costs. Private insurers often send reimbursement checks directly to the patients—many of whom do not pass them along to the emergency service companies.

“We are going to see more ambulance companies go out of business,” he said in an interview with Pittsburgh Post-Gazette. “[The coronavirus] is going to cause them to go into the red. They’re not going to be able to pay their people or to survive.”

Adding to the financial situation is a lack of successful recruitment and retention for EMTs in Pennsylvania. A 2018 legislative study shows the number of EMTs have decreased by more than 6,000 since 2012, and the number of paramedics fell by over 4,000.

The average salary for an emergency technician in Pennsylvania is $20,000 per year, while paramedics make closer to $40,000. Paramedics are trained to administer drugs, set up IV lines, and offer more specialized services compared to EMTs. Ozog believes the salaries are likely responsible for the staffing issues.

A 2018 legislative study shows the number of EMTs have decreased by more than 6,000 since 2012, and the number of paramedics fell by over 4,000.

“To make a life-sustaining wage in this business, paramedics may work for three different ambulance services,” he said. “If somebody gets sick due to the virus, it may put them out of service for a month. And it may put three ambulance services out of commission.”

The EMS crisis is expected to worsen as the novel coronavirus spreads throughout the state, especially with rural agencies. Heather Sharar, executive director of the Ambulance Association of Pennsylvania, believes as the pandemic worsens and the medical needs of vulnerable people continue to rise, the demand for EMT services could take a large financial toll on the industry. 

“If you can’t afford to pay staff and they don’t have anyone to man the ambulance, what are you going to do?” she told the Gazette.

Rural EMS agencies rely heavily on fundraisers to function financially, and now due to the pandemic, many of these fundraisers have been cancelled indefinitely. In Fayette County, the absence of the Hiller Volunteer Fire Company’s weekly fish fry the company has relied on annually means that their reserve fund could soon be completely depleted.

“If we don’t have a fundraiser for three months, bills are not going to be paid and we’ll be in a serious financial crisis,” said Chief Scott Dolan, who also serves as a paramedic. The Hiller Volunteer Fire Company currently has 40 volunteer firefighters—out of those, 20 are trained to respond to ambulance calls. 

EMS agencies across the state are eligible to apply for Small Business Administration loans under the recent federal stimulus package. Currently, there are two state House proposals that set aside emergency funding for fire companies and EMS agencies. 

Ozog believes these legislative measures aren’t enough to sustain these services long-term. He suggests further legislation is needed so that insurance companies send reimbursements directly to ambulance companies, and that taxpayer money should be used to oversee ambulance services. 

“The system will not look the same after this,” Ozog said, “because of the financial fragility of the system we have now.”