Brattleboro is temporarily contracting with Golden Cross Ambulance to help its fire department respond to medical calls as it studies a permanent takeover.
Kevin O’Connor/VTDigger
Brattleboro is temporarily contracting with Golden Cross Ambulance to help its fire department respond to medical calls as it studies a permanent takeover.

Vermont’s combined fire/EMS stations experience soaring ambulance calls, costs

As Brattleboro debates joining the ranks, chiefs statewide warn of spikes in public demand and prices for equipment

BRATTLEBORO — When Steven Locke took his current job, it seemed like a mouthful to say he was chief of the South Burlington Fire and Emergency Medical Services Department. But the 30-year veteran firefighter knows the addition of ambulances brings more than just a longer name.

South Burlington reported 74 fires in 2022, according to city records. But its EMS requests totaled 3,154 in the same period - up 16% from the year before.

That's a challenge when the resulting $950,000 in ambulance insurance reimbursements covered only about 20% of the department's $4.2 million annual budget.

“The increased reliance on the 911 system for pre-hospital medical services is putting a tremendous strain on our existing services,” Locke wrote in South Burlington's most recent annual report. “This is a significant challenge that will tax our services for years to come.”

The South Burlington chief is not alone.

Locke, a board officer for the International Association of Fire Chiefs, worked previously in Burlington and Hartford, two of the six other Vermont municipalities with 5,000 or more people that run combined municipal fire and EMS departments. All report similar spikes in ambulance calls and costs - sparked in large part, they say, by people who don't want to wait in a doctor's office or emergency room.

In Vermont's biggest city, the Burlington Fire Department recorded 116 fires and 2,931 calls about everything from false alarms to cats in trees in 2022, statistics show. But those combined numbers were less than half of its 6,817 EMS requests, up almost 25% from the year before.

For its work, Burlington collected about $1.5 million through ambulance billing - leaving taxpayers to pick up the remaining 90% of its nearly $14 million combined fire and EMS budget.

“The aforementioned significant increase in call volume creates challenges, which are often not seen in the public eye,” Deputy Fire Chief Derek Libby wrote in Burlington's most recent annual report.

In the Windsor County town of Hartford - known for its village of White River Junction - 70% of its 2,637 calls the past year were for EMS, compared with 2% for fires and 28% for everything else. Hartford collected $625,000 in insurance reimbursements, leaving taxpayers to pick up the remaining 80% of its $3.5 million budget.

“We've seen a progressive increase in demand and costs,” said Hartford Fire Chief Scott Cooney, who has worked for the town for 27 years. “EMS is a guaranteed way for someone to gain access to the medical system. Unfortunately, it is the most expensive way. The offsetting revenue doesn't nearly cover it.”

In Brattleboro, municipal leaders are considering whether to join the ranks of other Vermont communities with combined fire/EMS stations. A review of records of the seven largest such facilities - which, in addition to Burlington, Hartford and South Burlington, include Barre City, Montpelier, Springfield and Williston - show rising ambulance demand is causing a growing set of challenges.

“Brattleboro definitely has got its work cut out,” said Barre City Fire Chief Keith Cushman, whose own department responded to 17 fires and 1,752 EMS calls in 2022 - up 16% in a year. “Staffing, hours of training, delays to the supply chain ... it just continues to trend upward. There are so many moving parts to an EMS system. I don't know if I'd want to try to build one now.”

'Very much a demand but no money to be made'

Take staff turnover. The Burlington department has hired a dozen new employees in the past year and has yet to fill its vacant head EMS position. Leaders say it's difficult to recruit and retain candidates for jobs that require specialized training in both firefighting and emergency medical care.

“We must be prepared in all facets of personal interactions and mental health crises,” Battalion Chief Troy Ruggles wrote in Burlington's most recent annual report. “A firefighter who arrives unprepared at an emergency can be faced with life-or-death situations and will find himself or herself under extreme stress to perform.”

Williston, with 35 fires and 1,417 EMS calls in the past year, recently hired nine additional employees (a $785,000 annual expense) after staffers responding to a 2021 emergency could not find on-call replacements, leaving their station empty for almost an hour.

Springfield has been similarly stretched, with 37 fires and 2,420 EMS calls in the past year.

“We struggle with our staffing being inadequate to cover the growing number of calls,” recently retired Fire Chief Russ Thompson wrote in Springfield's most recent annual report. “I don't see the trend of higher emergency call volume slowing.”

Combined stations also report steeper costs and slower delivery of equipment. Barre City, for example, recently ordered a new $337,000 ambulance to replace a 15-year-old backup vehicle.

“That's a $100,000 price increase over just a year or two,” Barre City's Cushman said. “The cost of everything is skyrocketing.”

Burlington, Hartford and South Burlington also have ordered ambulances for as much as $432,259 each, only to learn they won't arrive for up to three years because of nationwide supply chain issues. As a result, all anticipate the final price will ultimately increase.

“We've built in $20,000 for contingencies,” Cushman said. “In the meantime, we've got our fingers crossed that our 2008 ambulance makes it.”

Unlike for fires, combined stations can bill public and private insurance for EMS calls. But none have found that the resulting payments cover rising budgets.

“Most of the patients we transport rely on Medicare or Medicaid, but the federal government reimburses at a very low rate,” South Burlington's Locke said. “That, by and large, is the driving factor on why there's very much a demand but no money to be made.”

Departments, in fact, annually have to decide how much to write off in unpaid ambulance bills. Hartford, for example, just logged a $138,499 loss from unpaid ambulance bills, up from $90,000 to $100,000 in years past.

'Pushed our fragile system ... to the point of crisis'

In Brattleboro, former Town Manager Yoshi Manale painted a different picture a year ago when he projected a municipal EMS takeover would reap “$500,000 to $700,000 net gain in revenue,” just before the selectboard approved a transition plan with little notice or public debate.

An independent feasibility study conducted after Manale abruptly resigned eight weeks later not only debunked the former Brattleboro manager's figures, but also found the town's former provider, the private nonprofit Rescue Inc., was the most economical choice for maintaining current local coverage.

In comparison, the study determined that a proposed Brattleboro Fire Department takeover would increase costs and bolster the town's understaffed system of crisis response.

Brattleboro leaders still have not shared any of the facts or figures that caused them to drop Rescue Inc. But the agenda for Tuesday's selectboard meeting reports they plan to reveal estimated first-year start-up costs for a combined fire/EMS department that total $1.3 million to $1.9 million.

In comparison, Brattleboro had signed a $285,600 annual contract with Rescue Inc. before the selectboard dropped the nearly 60-year agreement last year.

Nationally, ambulance operating costs jumped 22% between 2017 and 2020, according to a recent FAIR Health study of 36 billion claim records, while average Medicare reimbursement increased by just 5%.

“Years of inadequate reimbursement for services rendered, unreliable levels of local, state and federal support, and the pressure of the global pandemic have pushed our fragile system and those who serve our communities to the point of crisis,” the Vermont Emergency Medical Services Advisory Committee wrote in a recent report to the state Legislature.

Of Vermont's 28 cities and towns with 5,000 or more people, 13 run their own ambulances through their fire departments or, in the case of six communities, separate municipal facilities. None report making a profit, with taxpayers subsidizing as much as two-thirds of standalone EMS spending after insurance collection, according to a VTDigger survey.

“The department is concerned with our ability to meet the service demands of our community,” Locke wrote in South Burlington's most recent annual report. “There does not appear to be any reduction of the medical call frequency on the horizon.”

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