Selectboard warned municipal EMS ‘no cash cow’

Start-up costs for range from $1.3 million to $1.9 million for staff, vehicles, and consultants

BRATTLEBORO — If the town were to take on running emergency services (EMS) entirely in-house, those who are exploring options say start-up costs could range from $1.3 to $1.9 million.

“There isn't anyone in the town of Brattleboro who sees this as a cash cow,” said Assistant Town Manager Patrick Moreland at the Selectboard's June 20 meeting. “EMS services are expensive. There will be some revenue, but it's not a cash cow.”

A town-run EMS system is one option on the table after Selectboard members directed town staff to conduct parallel explorations into both in-house and contracted fire and EMS services.

The current plan is to adopt a new approach by September and implement the new system July 1, 2024.

The EMS Transition Project is in process because, in April 2022, the Selectboard suddenly and without public discussion dropped an almost-60-year contract with the private nonprofit Rescue Inc., which most recently charged the town $285,600 annually.

At the time, then–Town Manager Yoshi Manale told the board that town-run EMS services would be less expensive than Rescue's fee and that the town could see up to $700,000 in revenue.

For the time being, the town has contracted with Golden Cross Ambulance of Claremont, New Hampshire. Golden Cross supplies ambulances and some staff members who respond to calls along with town fire department employees.

Golden Cross has invoiced those who use the ambulance service $923,759.40 between July 2022 and May 2023 and has received about 61% of the billings to date.

Fire Chief Len Howard said it's his understanding that “it'll take months” for Golden Cross to actually collect what they've billed and that the billing agency told him it takes five or six months before you know accurately how much of what's been billed has definitively been collected.

Former Selectboard member Dick DeGray said he has “huge concern” about a collection rate running at 61% and doesn't believe the town will have a clear enough picture of the financial implications of contracted services by the planned September decision date.

Regarding the contracted service exploration, a Request for Information (RFI) was published in multiple periodicals and online June 1 to gauge interest. Applications are due to the Municipal Center by Friday, June 30 at 4 p.m.

In-house EMS start-up costs

One question if the town runs its own service is how many ambulances to buy or lease.

Dr. Johndavid M. Storn, emergency medical provider and one of two medical advisors for Vermont's EMS District 13, the catchment area for Windham County, told the board that overall the health care field is seeing myriad challenges.

“Everybody's doing the best they can,” he said. “Everybody's providing good care.”

He also said that more than once a day, two calls come in at the same time, that the town needed two ambulances about 50 times in the past year, and that one time in a total of 2,800 calls Brattleboro could have benefitted from a having a fourth ambulance.

Moreland offered what he called “staff's best guess” regarding start-up expenses, noting that currently the department has three platoons of eight staff members. The working model - after reviewing best practice recommendations - is for the ideal of three platoons of 10 staff members plus an EMS supervisor, he said.

This scenario would require seven staff members to join the force between November 2023 and June 2024.

A supervisor would be hired for eight months at a cost of $84,702 to help hire other staff members and build the program within Brattleboro fire. The six new firefighters would cost $154,713 for 21 months, for a total of about $240,000 in personnel costs.

To make up for the gap between when the town would start billing for services and collecting fees, Moreland estimated about $250,000 would be “front-ended” for the first quarter of fiscal year 2025.

This plan includes $30,000 in billing software and $20,000 for a start-up consultant. The fire department would also need to buy 10 new radios of different types, bringing the staffing and equipment start-up cost to $674,250.

Moreland laid out four possible scenarios regarding ambulances, all including buying three ambulances but of different types. Cab-on-truck-style ambulances cost $400,000 each, and van-style ambulances cost $250,000. All would be fully equipped; however, the cab style requires about two years lead time to purchase.

• The first option is to buy three cab-style vehicles and lease the same during the gap for 15 months at a cost of $50,000. The total cost for this scenario is $1.9 million.

• The second option is to buy two cab-style vehicles and one van-style. That option would cost $1.7 million.

• The third choice would be one cab-style and two van-style ambulances for $1.5 million.

• The final option would be to choose three van-style vehicles for just under $1.3 million.

Options to pay for the system include using about $1.7 million in American Rescue Plan Act (ARPA) money, of which the town currently has $2.7 million, or borrowing. Borrowing would require Representative Town Meeting authorization.

In the least expensive scenario for taxpayers, borrowing would add $175,000 each year over 10 years of payback, including $445,000 in cumulative 10-year interest costs.

Borrowing could also impact other projects, including swimming pool improvements.

And, if the vote to borrow were to be “no,” said Moreland, “we're in a bit of a predicament.”

After being questioned as to whether the town can afford this, Selectboard Chair Ian Goodnow acknowledged many other areas where ARPA money could be spent, including addressing increasing homelessness and needed social services and a potential property tax increase.

“You're totally right,” he said. “We're not quite there […] we've looked at potential revenue, we've looked at start-up expenses, [and] one proposal to pay for the start-up expenses would have no impact to the taxpayer using ARPA funds, but we have not looked at operating costs.”

Goodnow pointed out “the contrast between the potential proposed revenue and the potential operating costs and what that impact would have on the General Fund and on the taxpayer.”

“That's a critical, critical element to that consideration,” he said. “We haven't even gotten that far to begin that discussion. We're halfway through the process as to whether to we're to go down the municipal EMS track or a third party.”

Next steps, and community feedback

The next step of the EMS Transition Project timeline takes place Tuesday, July 25, when board members will address public comment, which board members are encouraging. The board will also review results of the RFI and draft a Request for Proposal (RFP).

To submit feedback, email [email protected] or mail comments to EMS Feedback/Town Manager's Office, Municipal Center, 230 Main St., Brattleboro, VT 05301.

The board plans to discuss the project also at its Aug. 15, Sept. 5, and Sept. 19 meetings, which are open to the public and available via Zoom.

A public forum exploring fire-EMS alternatives is planned for Friday, Sept. 1.

Subscribe to the newsletter for weekly updates