BRATTLEBORO — With a unanimous vote of the Selectboard and after a week of often-emotional discussion and debate, the town has ended a 56-year relationship with Rescue Inc. when its contract expires at the end of June.
After nearly three hours of discussion and debate, the Selectboard voted 5-0 on April 19 to authorize Town Manager Yoshi Manale to enter into a one-year contract for $75,000 with Golden Cross Ambulance of Claremont, N.H.
The plan calls for Golden Cross to assist the town with setting up a fire department-based Emergency Medical Services (EMS) system, starting on July 1.
No member of Rescue was present at the meeting, which followed a week of heated local debate over the town's processes, planning, and motives for a change that was announced suddenly, via press release, from Manale's office on April 11.
Selectboard Chair Ian Goodnow said that, according to the Town Charter, it is the board's duty and responsibility to establish an ambulance service.
“This is a responsibility that cannot be delegated to a town-wide vote or to the town manager,” he said.
Goodnow said the issue was that the town was paying twice for EMS - first to support a full-time fire department that provides much of the on-scene emergency care, and then to pay Rescue Inc. to provide transport services.
Under the proposal, Golden Cross will provide a year of transition and training, as well as two ambulances and personnel, to help the town move to the fire-based EMS model.
That model is not a done deal, Selectboard members said. The board will authorize a study by a third party to see if it is feasible after a year.
Several board members pointed out that Golden Cross has helped other municipalities in similar transition discern whether a municipally run EMS service will be viable.
Board member Tim Wessel called the process “one of the most emotional processes I've been through in my time on the board.” He said his concern is to make sure Brattleboro gets the best care while watching over the taxpayers' money, and he said that he has faith that the fire department and Chief Leonard Howard III can do the job.
Former Selectboard members Kate O'Connor and Dora Bouboulis both criticized the board for the lack of communication and public discussion about the decision to end its relationship with Rescue.
“There was no communication with Rescue from Feb. 9 and the March 25 letter,” said O'Connor. “That's a failure of leadership.”
Bouboulis said she believes the board has made little effort to involve the public in the process.
“I'm not feeling confident in your responses about public participation,” she said. “I don't think you understand what it is.”
Selectboard member Elizabeth McLoughlin said the central issue was the long-simmering tension between Rescue and the Brattleboro Fire Department. Of the 15 towns that Rescue serves, only Brattleboro has a paid full-time department, the rest have volunteer fire and EMS personnel.
“[Rescue's] leadership and business model are served in towns without paid fire departments,” she said. “Rescue had an opportunity to work with us and chose to be difficult, and that is why we are where we are.”
Details from town at first forum
There was more skepticism than anger on April 18 at the first of three hearings to explain why the town will likely be changing how it will deliver emergency medial services (EMS).
Approximately 30 people attending the meeting room at Central Fire Station, with others following along at home via Zoom, got a detailed briefing from Fire Chief Leonard Howard III, Town Manager Yoshi Manale, and Dale Girard, president of Golden Cross Ambulance, about how a fire-department-based EMS would work.
Absent from the discussion was any current member of Rescue Inc. to provide a defense for the EMS service it has provided to Brattleboro since the 1960s.
“As fire chief, it's my duty to make sure the people of Brattleboro are provided with the same level of service they've gotten for the last 57 years,” Howard said, adding that as for what the town plans to do, “I honestly think it will be better.”
Howard said that the department has responded to emergency medical calls since 2000, and on the majority of medical calls that firefighters respond to, they often are the first on the scene.
“It's not something new to them,” said Howard.
Howard said the fire department's personnel - including 18 emergency medical technicians (EMT), six advanced emergency medical technicians (AEMT), and two paramedics - provide emergency care until they hand off the patient to the ambulance crew from Rescue Inc. to be transported to the hospital.
With a fire-based EMS service, Howard said the Brattleboro Fire Department would maintain continuity of care from the scene to the hospital's emergency room.
“The level of care will not change,” said Howard, adding that he expected to have seven firefighters complete an AEMT course by July, and three other firefighters will be starting paramedic training in August.
If the town and Rescue Inc. part ways, the plan is to have Brattleboro sign a one-year agreement with Golden Cross Ambulance of Claremont, N.H., to house and staff two vehicles at Central Fire Station on Elliot Street.
In what is described as an “apprenticeship program,” Golden Cross and Brattleboro Fire personnel would work together over the course of a year.
As outlined by Howard and Girard, Golden Cross personnel would train their Brattleboro counterparts on transport procedures and protocols while the fire department lines up the staff, equipment, and the two ambulances the town would need to buy to run an EMS operation out of Central Fire Station.
Girard said Golden Cross would provide two ambulances to be kept at Central Fire State to deliver 24/7 paramedic coverage during the one-year transition period. Golden Cross would also provide extra coverage during peak call hours, which Howard said were between 8 a.m. and 8 p.m. most days.
This arrangement, Girard said, is similar to a transition plan that Golden Cross recently carried out in Littleton, N.H., as that town did what Brattleboro is now contemplating.
If additional service is needed, Howard said, the town would do as it has for decades, and use the mutual aid system to provide the extra help. In this setup, Rescue Inc. would be one of seven area ambulance services within a 30-mile radius of Brattleboro that would be available to respond to a mutual aid call.
Howard said a fire-based EMS service is not unusual. In Vermont, Burlington, Barre City, Hartford, Montpelier, South Burlington, Springfield, Williston, Windsor, and Woodstock all use this system, as do Keene, Swanzey, and Peterborough, N.H., and Athol, Greenfield, Northampton, Orange, and Turners Falls, Mass.
“This is not something we are inventing,” said Howard, adding that the International Association of Fire Chiefs has come out in support of fire-based EMS as “the most efficient and effective model for the rapid delivery of all emergency medical services.”
Beyond the first year, Howard said, the town is seeking federal grant money to fund three firefighter/advanced life support (ALS) provider positions over a four-year period.
Howard said the fire department doesn't care about the financial implications of the EMS changes.
“The fire department cares about the level of care you receive,” he said. “That's what our mission is.”
He said Rescue currently provides EMS coverage for 15 towns covering 500 square miles with nine ambulances, while Brattleboro will cover one town of 12,000 people in a 32-square-mile area with two ambulances and two fire vehicles that provide first response coverage.
That is why Howard said he is confident that the town can receive the same level of EMS coverage that it is used to seeing.
Questions about cost, service
Heidi Fisher, a registered nurse who has worked in the emergency room, said she was a volunteer for Rescue Inc. for a decade.
Fisher, of Brattleboro, described the fire-based EMS model as a good one but said that the town had twice done cost and service analyses and both times “it came out very, very clearly that, financially, it made absolutely no sense for the town” to take over for Rescue Inc.
She added that “what Rescue charged was far more reasonable than what the town would have to take on” to run its own service, and she asked Manale whether the financial advantages the town was now touting were real.
Manale responded that the town is revisiting the issue to see what had changed, and whether the cost savings it anticipates can be realized.
“If I'm wrong, I'll fully own up to it,” he said, adding that his discussions with similarly sized towns had found that a fire-based EMS model generated enough revenue to cover its costs.
However, Manale said, the town will need a third party to look at all numbers and come up with an accurate analysis.
“I want to make sure of the numbers,” he said.
Former Selectboard member Dora Bouboulis said she was on the board during those analyses, and “we found that, at best, it was a wash” on how much money the town could save.
Bouboulis said she was more concerned that the public was not consulted about the proposed change of direction.
“Everything's backwards here,” she said. “The study should come first. Public input should come first. All these things need to happen, and I haven't heard any of that.”
Resident Pat Greene said she has dealt with Rescue Inc. on several occasions for emergency calls at her home. She said she had no problem with Rescue's service, and pointed out that a trip by ambulance to Brattleboro Memorial Hospital costs about $1,000, which is billed to the insurance providers.
What's the hurry?
Via Zoom, resident Robert Oeser questioned why a 56-year relationship was ending so abruptly, and whether the town had another option.
Manale said that neither he nor Howard were expecting the possibility of severing ties with Rescue Inc. after the town initially offered a one-year contract, rather than the customary three-year deal.
However, in a March 25 letter to the town, Rescue Inc. Chief of Operations Drew Hazelton wrote: “It is my opinion that [fire department personnel] lack the necessary oversight to provide clinically appropriate care to the citizens of Brattleboro. The change would also likely cause unnecessary transport delays and an overall reduction in the entire system's performance.”
Multiple elected officials and town employees have expressed to The Commons that the letter was taken as a threat and that Hazelton's response marked the moment they knew that the relationship could not be salvaged.
“None of us expected that letter,” said Manale, adding that the town's options were limited. “We'd either be stuck with nobody or would have to sign a three-year contract with Rescue. If Golden Cross wasn't available, we'd have to sign a contract with Rescue.”
“Change is hard,” said Howard. While his staff doesn't yet have the transport experience, it does have two decades of experience in responding to medical calls.
“I can guarantee you that we will give you the best care you ever had,” Howard said.