Two Golden Cross ambulances are parked in front of the Central Fire Station on Elliot Street in Brattleboro.
Kevin O’Connor/
Two Golden Cross ambulances are parked in front of the Central Fire Station on Elliot Street in Brattleboro.

Brattleboro honing in on costs to provide EMS on its own

Final public forum expected in September before Selectboard chooses a future path

BRATTLEBORO — Although costs are becoming more sharply focused as the town continues to explore supplying fire and emergency services in future, there's still much more to know.

The Selectboard heard a fourth informational report regarding what is being called the Fire/EMS Transition Project at its July 25 meeting, which focused on what a fully municipal service model or contracted services model might look like.

"We have a long way to go," said Selectboard member Peter Case, pointing out again that the board is simply receiving information to consider.

After parting ways with longtime provider Rescue Inc. in 2022, the Selectboard directed the administration on March 21 to pursue parallel tracks of information gathering, cost analysis, and risk assessment necessary to develop a preferred alternative model for fire and emergency medical service delivery.

The board has set the goal of choosing a clear path in September, following a final public forum on the issue, when options and costs have been thoroughly researched and presented.

The parallel tracks include a contracted EMS service provider and a municipal EMS service.

If the town continues on the path toward municipal emergency services, the timetable will let the town incorporate costs into the fiscal year 2025 general fund budget and to prepare for the currently projected July 1, 2024 start-up date.

At its May 2 meeting, the Selectboard approved a project plan for the Fire-EMS Transition at which there was an opportunity for public input. Two weeks later, the Selectboard received more information about public engagement for the project. That was also when the public was able to provide feedback about the draft Request for Information (RFI) and solicitation strategy proposed for use on the contracted EMS track.

A June 16 forum was the third chance for public input. Since June, said Town Manager John Potter, a section of the town website dedicated to the project ( has been updated and has seen a 72% uptick in public viewing.

People with thoughts, questions, or concerns related to the Fire-EMS Transition Project have sent 52 emails to date to an address established for the public to weigh in ([email protected]).

These comments will be summarized for the Selectboard prior to deliberation.

Fully municipal EMS operating model and costs

Two key components are being considered for a potential municipal EMS model: the ability to respond to multiple simultaneous emergencies and being fiscally responsible with the least impact on the general fund, said Assistant Town Manager Patrick Moreland at the July 25 meeting.

In March, the Selectboard agreed that the town should be able to respond to two medical emergencies and send as many as six firefighters to a working fire at the same time, thus necessitating a minimum platoon size of 10 EMS/fire providers and an EMS supervisor.

The supervisory position, said Moreland, is "key."

The supervisor would serve as primary liaison to Brattleboro Memorial Hospital and to EMS District 13, while also maintaining proper staff training and overseeing a quality control and improvement program.

The proposed model would require seven new firefighters, one of whom would as supervisor be paid the same rate as a captain at $89,185 annually.

All staffing, benefits, and overtime for the seven additional staff would result in an additional cost of $717,307 for fiscal year '25. Other operational costs were estimated at about $235,978.

For the first nine months of the year - Golden Cross, the Claremont, New Hampshire–based EMS firm that is working with the Brattleboro Fire Department to provide EMS services on an interim basis - has received $627,845 in reimbursement.

Given a known collection lag time of about three months, Moreland and town staff members who are working the numbers estimate $837,127 will be collected in total for the year. They estimate annual revenue could reach $942,160, if the town were to bill more, either through an in-house billing system or a third party.

Moreland said it is possible that billing could occur without a "new cost to the general fund."

He also noted that a complete picture includes fuel costs, medical supply costs, workers' compensation insurance, vehicle insurance, equipment replacement down the road, and other tangential costs.

The impact of moving forward without the services of Golden Cross, he said, could be about $110,000 and might provide "somewhere between a small savings and a modest savings."

Moreland emphasized again that he was "absolutely not" suggesting that running a town EMS is profitable.

"It just isn't," he said, while noting exploring other sources of revenue, such as non-transport fees and subscription offerings, would be "worthwhile" potential policy changes to consider.

"We all need to remember that the town will pay these cost increases no matter how EMS is delivered - whether in-house or contracted by a third party," Moreland said.

He noted that when combined expenses of $828,171 are deducted from the additional expected $942,160 in revenue, the net impact to the General Fund for a fully municipal EMS program in fiscal year 2025 is calculated to be reduced by $113,875. In future years, expenses are likely to rise, he said.

Two firms respond to RFI

Two responses to the June 1 request for information have been returned to the town. The purpose of the RFI was to begin to identify EMS providers that may be interested in serving Brattleboro.

The RFI was provided to a list of 82 EMS providers, along with notification to the state heath/EMS departments in Vermont, New Hampshire, Massachusetts, and New York. Notice was sent to a variety of EMS trade journals, posted on the town website, and published as a public notice in the newspaper of record.

Those responding were not identified at the July 25 meeting, and the town will officially make the RFI responses public once the procurement process has been completed. Redacted submissions were made available to the Selectboard in the supporting documents for the meeting and posted on the town website.

The Commons has independently learned that the two firms responding are Rescue Inc. and AmCare Medical Systems, Inc., of St. Albans.

A draft request for proposal (RFP) from potential third-party EMS contractors has been prepared based on feedback from the RFI. It is available on the town website. Proposals will be considered from single firms or joint ventures.

Potter said in his report that the town will entertain any of a range of EMS approaches, "including ones that provide dedicated ambulances or ones where ambulances are shared with other municipalities, as well as approaches that rely on Brattleboro Fire Department personnel and equipment to provide some level of emergency response or that do not."

The RFP, approved by the board July 25, was expected to be released this week. Proposals, of which Potter said the board hopes to receive several, are due Aug. 29.

This year in the department

Prior to the Transition Project information dispersal, Assistant Fire Chief and Town Health Officer Charles W. "Chuck" Keir III gave an update of department activity with statistics from July 1, 2022 to July 3 of this year.

The department has made 4,500 emergency responses, in addition to their work at fires, vehicle crashes, etc., he said, adding that 3,051 calls required EMS responses.

The average time was 27 minutes, 45 seconds. Two ambulances were needed for 480 calls and three were needed 58 times. Mutual aid was required twice. The service transported 2,044 patients.

He also praised department personnel.

"Our staff has endured countless policy and procedure changes," Keir said. "They have increased EMS licensure, have sat through hundreds and hundreds of hours of training."

He also said that partnering with Golden Cross this year caused the department to have "endured some hardship there and some growth as we learned to live with another organization within our walls."

Noting a recent report in VTDigger that, since June 2022, 16 people have left the department, Fire Chief Leonard Howard III explained what was behind that number.

Five left for another fire/EMS agency, he said. Three left for personal reasons, one was "a voluntary resignation," one retired, and five others "opted out or couldn't fulfill" their probationary periods, he added.

The last was a part-time fire inspector whose post has already been filled, Howard said, projecting that a full staff of 28 will be in place by Aug. 3.

This News item by Virginia Ray was written for The Commons.

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