It’s a problem in Coventry, a little town of 12,000 in eastern Connecticut.
It’s a problem in New Britain, a small city in central Connecticut where 73,000 people live.
And it’s a problem in Stamford, the state’s second-largest city with a population of 137,000 in the southwestern corner.
In each municipality, Emergency Medical Services need urgent care.
Citizens expect that when they call 911 for an ambulance, one will come, and quickly. But that isn’t always happening in many places in Connecticut.
Staff shortages and revenue scarcities are creating EMS “deserts” just as demand is rising, those in the profession say. The problems are statewide but particularly acute in small towns, where ambulance response times can be 40 minutes.
John Elsesser is the Coventry town manager and past president of the Connecticut Council of Small Towns. Circumstances have converged to set EMS at a critical stage, Elsesser said.
“We use a lot of volunteers for EMS, but the number of volunteers has been diminishing. It took a real big hit during COVID,” Elsesser said. “People didn’t want to take the chance of bringing the virus back to their families.”
To staff its two ambulances, Coventry hired an agency that brought in emergency medical technicians. Coventry used federal COVID-19 relief money to pay the agency, Elsesser said.
“The response time was cut in half, so more lives were saved,” he said. “But that money has gone away.”
Now the situation is worse. There are few volunteers but the number of calls for service “has gone up tremendously – we have an aging population,” Elsesser said. “That’s compounded by the fact that local hospitals are not operating emergency rooms any more, so ambulances have to drive to Manchester and Hartford.”
The hospital in Manchester is 12 miles from Coventry, he said. The trip from Coventry to Hartford is 20 miles.
Then there’s the finances.
“We bill for services but a lot of the costs are capped by Medicare for seniors,” Elsesser said. “The state has Medicaid for people on state assistance, but Medicaid pays half of what Medicare pays. It costs the town $400 to $500 for every Medicaid call.”
Last year, town officials tried to put $500,000 in the budget for EMS service. It went to referendum and Coventry residents voted it down. It went to referendum again and was rejected again, Elsesser said.
“We have a state license for ambulance service and we have to meet certain standards and response times, but we don’t have the volunteers,” he said. “Other towns are facing the same thing. Some gave up and said they just won’t have ambulance service. We’re not going to do that.”
Elsesser joined a push by the council, which represents 118 small towns – nearly 70 percent of Connecticut’s 169 municipalities – to support a bill sponsored by State Sen. Saud Anwar, a South Windsor Democrat and physician. Senate Democrats brought the bill before the Public Health Committee this week.
The bill would raise Medicaid reimbursement rates for EMS to equal Medicare rates.
Beyond that, the bill would increase salaries for emergency medical technicians and the more highly skilled paramedics; offer tuition reimbursement for training programs; and create a database to track EMS response times.
If the bill passes, it will be a big help, but it won’t solve the problems with EMS, said Bruce Baxter, chief executive officer of New Britain Emergency Medical Services and president of the Connecticut Emergency Medical Services Chiefs Association.
“EMS is in a crisis all across the nation – a crisis of not being funded as fire departments and police departments are funded, even though we provide a service that’s just as critical,” Baxter said. “Paramedics bring the hospital emergency department to you. They use the same technology, tools, and monitoring systems that patients get in the emergency department. Lives are being saved in the street.”
The federal government writes the rules for Medicare, but the state sets the fees EMS may charge Medicaid patients, Baxter said. In New Britain, about 49 percent of EMS patients are Medicaid beneficiaries, he said, so the organization loses money on nearly half of its calls.
“It’s no longer acceptable for Medicaid to be the low payer,” Baxter said.
There’s another problem, he said.
“EMS is different from other aspects of health care; we get reimbursed only when we transport a patient to a health-care facility,” Baxter said. “We respond to motor vehicle accidents and falls and other reports of injury, but if we get there and the person doesn’t need to go to the hospital, we can’t bill.”
As revenue falls short, ambulances, which cost upwards of $250,000, are aging, and expensive high-tech equipment needs replacing, Baxter said.
“We’re dipping into our earnings,” he said. “You usually do that as an investment tool, but this is to keep the system afloat.”
New Britain service, like in Stamford, is a nonprofit organization, Baxter said. But Stamford EMS “is lucky because they get a significant subsidy from the city to help their nonprofit agency stay afloat,” he said.
Stamford gave its EMS $2.1 million in fiscal 2022-23, the city budget shows.
Stamford Emergency Medical Services Chief Edward Browne said call volume is up with the city’s population boom of the last decade, and the organization relies on kindnesses.
“We do fundraising for the equipment we have to buy and maintain, and we have a robust volunteer program that we depend on,” Browne said. “The increasing cost of equipment and fuel, and attracting and retaining personnel is a big challenge. The pandemic has done a number on our industry. Medicaid reimbursement has been low for many, many years. Bringing it up to Medicare level would definitely help.”
A 2022 survey by the American Ambulance Association showed that the nation’s EMS agencies are experiencing full turnover of staff every three to four years, and more than a third of new hires leave during their first year.
The survey found that 11 percent of full-time emergency medical technician positions in the U.S. were unfilled, and 39 percent of part-time positions.
It was higher for paramedics – 30 percent of full-time positions were open and a whopping 55 percent of part-time positions, according to the survey.
The survey of 119 EMS organizations representing 12,000 employees cited a report by the Health Resources and Services Administration that estimated the country will need another 40,000 EMS workers by 2030.
“This will necessitate an extensive understanding of the nature and reasons for turnover in EMS-related occupations,” the survey concluded.
“We’re all struggling,” Elsesser said. “It’s hard to talk about it because you don’t want to admit you can’t solve the problem. But it’s beyond our control. We need help. Otherwise the whole system will collapse, and that’s not good for anybody.”