Coverage shortfalls have Swanzey and Winchester EMS officials on edge

BY MEGHAN FOLEY SENTINEL STAFF

Christopher J. and Maryan G. Platz of Winchester Ambulance know they have a problem.

Fire Chief Norman W. Skantze in neighboring Swanzey knows he does, too.

While the towns differ in how their emergency medical services are delivered, they share a common struggle to have enough personnel to respond to calls — especially during the day.

Winchester has its own ambulance service manned by paid on-call personnel. Swanzey contracts with R.J. DiLuzio Ambulance Service LLC in Keene.

The Swanzey Fire Department is a first-response agency, meaning it has some paid on-call members who are trained at some level to help a person having a medical emergency.

Winchester contracts with DiLuzio for backup, and if it needs a paramedic-level emergency medical technician to help with a call. Swanzey doesn’t have a plan B if its sole provider, which also contracts with other towns, isn’t able to come through.

To date it hasn’t come to that, Skantze said, but he worries about the future, especially knowing that ambulance services aren’t part of the region’s mutual aid system, which covers only fire departments.

Mutual aid means fire departments will help one another during an emergency at no cost. It’s expected that the department providing the assistance will someday be on the receiving end.

Southwestern N.H. District Fire Mutual Aid has long dispatched ambulances for its member towns, according to Chief Philip J. Tirrell. But there are no agreements in place through the agency that require ambulances to respond to towns they don’t cover as backup, he said.

In the past, when DiLuzio couldn’t respond to a call, Keene would be contacted to provide backup, Skantze said. If Keene couldn’t come, the next in line would be ambulances from Winchester, Troy or Marl-Harris in Marlborough, Skantze said.

However, Marl-Harris no longer operates as an ambulance service, and Troy and Winchester are struggling to respond to their own calls, he said.

Meanwhile, Keene officials are now evaluating the fire department’s ability to back up ambulance coverage to towns that don’t have contracts with the city’s ambulance service.

“It puts us in a difficult place — if DiLuzio, who currently meets the needs of the community, continues to attract more customers and answer more calls,” Skantze said.

Skantze is one of many local fire and EMS officials concerned that emergency medical services in the region are reaching a breaking point. Some services are struggling to stay afloat with fewer volunteers and funding, while others that can make the calls are feeling the strain.

Thinning ranks

At one time during the past 25 to 30 years, Winchester Ambulance had so many members there would be fights to get on the schedule to do runs, Chris Platz, a captain with the agency, remembers.

Now the department, which serves about 4,340 residents, is down to six active members, and has been missing about 30 percent of its calls during the past year, he said.

“Some of it has to do with a lack of volunteers. The other reason is there is not much industry in town, and people who might be interested in joining the ambulance service aren’t coming to Winchester to work,” Chris’ wife, Maryan, a lieutenant with Winchester Ambulance, said.

In addition, emergency medical services is a challenging field to work in, and one that’s hard to make a living from, she said. It’s also “a young person’s game” because of the physical demand, she noted.

“It’s not anybody’s fault, but the job as a rule doesn’t pay enough. With a few exceptions, you’re going to be working more than 40 hours a week to pay your bills,” she said.

Still, Maryan Platz said she loves being an emergency medical technician.

“It gets in your blood,” she said.

Winchester Ambulance has received 400 to 500 emergency medical calls annually for the past five or six years, Chris Platz said.

That’s much more than the 100 to 150 calls per year members responded to when he joined the agency in 1990.

With the increase in call volume and decrease in volunteers, Winchester Ambulance is at a point where it can’t continue to operate as it has been.

Emergency medical services are no longer about putting somebody in an ambulance, getting to the hospital as fast as possible, and hoping that person lives: An ambulance has become essentially a mobile emergency room, Chris Platz said.

“More lives are being saved now than ever before because of the advances in pre-hospital care,” Zachary J. Ford, a lieutenant with Winchester Ambulance, said.

The challenge, he noted, is getting people to realize that, and that Winchester Ambulance and other emergency medical responders can’t do their job without enough staffing and community support.

“The bottom line is people expect us to show up at their worst times, and we have a budget lower than the library. To me, that is telling,” he said.

The budget for Winchester Ambulance — a town department that operates under the fire department — this fiscal year is $84,152. The library’s budget is $108,350.

The Platzes are in the very early stages of a plan they hope will revitalize Winchester Ambulance and keep it running for years to come.

But they expect it’s going to be a tough sell to town officials and residents, especially since they want to hire people part time to cover shifts during the day. That involves spending money.

About 20 percent of Winchester Ambulance’s calls come between 9 a.m. and 1 p.m. during the week, according to Ford.

But having people available to respond to emergency medical calls during weekdays is a big struggle, and Winchester Ambulance often must turn to DiLuzio Ambulance for help, Maryan Platz said.

The EMTs who are in town often are working during the day or just not available, Maryan Platz said.

By state law, the service must have two people on an ambulance to take a patient to the hospital. But Winchester Ambulance likes to have three because it can be helpful to have another person caring for a patient en route, Maryan Platz said.

While Ford and the Platzes live in Winchester, other Winchester Ambulance EMTs are from Hinsdale, Richmond and Swanzey. They all have to report to the fire station to get an ambulance before going to the site of a medical emergency.

“So there is already a delay there,” Maryan Platz said.

With a day crew, people would be at the station and could respond more quickly, she said.

Besides meeting with Winchester selectmen, she said ambulance personnel plan to reach out to successful business owners in town for guidance in funding the part-time positions.

“We now have to look at the business aspect, and that is something new for us,” she explained. “We need to think about how we are going to fund this, and how we are going to do it in a way that doesn’t put too much more burden on taxpayers.”

They also plan to meet with other ambulance services in the region that have hired people to cover day shifts to learn how they do it, and when they realized they needed to go that route.

Swanzey’s dilemma

The town of Swanzey is 45 square miles with about 7,230 residents, dozens of businesses, a regional middle and high school, two elementary schools, a 16-bed assisted living facility, three state highways and an airport run by the city of Keene.

From 2011 to 2015, the total number of fire, rescue and medical calls received by the fire department increased by 185, or 22.7 percent, with 2012 seeing the lowest volume at 816, and 2015 seeing the highest at 1,001.

Over the same time period, EMS calls received by the agency increased by 98, or 17.6 percent, with 2012 being the lowest at 557, and 2015 being the highest at 655.

The 40 members of the fire department are paid per call with the exception of the fire chief and fire inspector, who are full-time paid employees, and the EMS coordinator and deputy chief, who each work 16 hours per week. Of those 40 men and women, about 20 are licensed in some level of emergency medical care, Fire Chief Skantze said.

But as the need for emergency medical services rises in town and elsewhere, the ability of volunteers and on-call staff to provide them has decreased, he said.

Last year, the fire department responded to 898 calls, 600 of them emergency medical calls.

Before switching to DiLuzio in the late 1990s, Swanzey received its ambulance service from the Keene Fire Department.

Besides Swanzey, DiLuzio primarily covers Gilsum, Harrisville, Marlborough and Richmond.

Swanzey’s agreement with DiLuzio, which was signed by selectmen in 2016, says the agency will provide ambulance coverage 24 hours a day, but “there may be times when the emergency medical service system’s requirements or unforeseen operational issues may be such as to make a response impossible due to the limited resources of (DiLuzio Ambulance).”

If that happens, “a mutual aid ambulance may be dispatched,” according to the contract, which expires in 2019.

The Swanzey Fire Department is a first-response agency to EMS calls in most cases, in advance of the ambulance service, Skantze said.

“In doing so we can provide patient-care skills, and then work directly with the ambulance on scene, which will often transport the patient to the hospital,” he said.

But sometimes the setup doesn’t work.

“You have to keep in mind that providers who are on-call for the town also have work, family and other obligations that compete with the demands of the increasing call volume,” he said.

As in Winchester, emergency medical calls made during the day are the toughest to cover, Skantze said.

“Many employers have been very supportive with releasing our firefighters for major incidents. However, it is getting more difficult for employers to allow their employees to leave work for the more routine EMS and fire calls during the daytime hours,” he said.

In addition, emergency medical services have made great strides in recent decades, and the service levels that Swanzey, DiLuzio and other providers offer are higher than they were 10 or 20 years ago, according to Skantze. That requires additional training of emergency medical responders, and additional costs, he said.

Skantze believes Swanzey should consider having a fire department-based ambulance service because of the increasing demand and the immediate need.

Such a service would permit the town to generate revenue by billing patients or health insurance companies, as long as the patient goes in the department’s ambulance to a hospital, according to Skantze. That would help offset expenses, and allow the fire department to do a better job of providing emergency medical services to the community, he said.

The fire department, which provides some emergency medical care, can’t collect from insurance companies or patients because it doesn’t have an ambulance transport service.

However, what the future holds for emergency medical services in Swanzey and across the region doesn’t necessarily come down to what is best for the towns, but what’s best for the patients, Skantze said.

“I think the problem has been creeping up on us, and looking back, we’ve just kept adjusting,” he said. “But how much longer can you keep adjusting before you need a major solution?”

Meghan Foley can be reached at 352-1234, extension 1436, or mfoley@keenesentinel.com. Follow her on Twitter @MFoleyKS.