Rocky road to emergency medical service
This is the second of a two-part series. The first part appeared in Sunday's edition.ww
Emergency medicine is a high stress and often low paying job, but to make matters worse for emergency medical services, fewer people are coming out of school to enter the work force.
Many that do make it through training have no intention of ever stepping foot in an ambulance, said Jeff Kelly, chief of Cranberry Township EMS. They use EMT or paramedic training as a steppingstone to other health care careers, like nursing or physician's assistant school.
Kiley Cribbs, coordinator for EMS and police training at Butler County Community College, said changes in the amount of training required for EMS jobs and increasing costs for education have likely resulted in a decrease in enrollment and an increase in the attrition rate in their EMT program.
To become an EMT a person must take a semester-long class, which totals about 175 to 200 hours of instruction. BC3 has EMT classes each semester on its main campus at a rate of $700 per course. Cribbs said that price includes many study tools that will help students on their certification exams.
Paramedic training lasts about two years and students earn an associate degree at BC3, Cribbs said. Other paramedic programs are certificate programs, she said. Paramedics and EMTs also must pass a national exam through the National Registry of Emergency Medical Services.
The training to become an EMT is more rigorous than it was 20 years ago, Cribbs said. What paramedics did then, EMTs are required to do now.
“On the flip side, the providers we are putting out are truly very knowledgeable and skilled in those departments,” Cribbs aid.
Cribbs said some people start the EMT program and can't keep up with the workload. Instructors try to put an emphasis on the time commitment required, to prepare students before they enter the program.
“It really takes a lot of discipline on the student's end to be successful in the class,” Cribbs said.
BC3 is launching a hybrid online and traditional learning EMT course in the fall to accommodate students who need more flexibility with the schedule. The hybrid program will include interactive video-based lecturing that can be accessed any time and hands-on classes every other weekend, Cribbs said.
Kathy Neiper, a paramedic with Portersville Muddy Creek EMS, said she thinks the amount of initial training and the continuing education required is difficult for people to handle with how busy life is these days.
“It's almost like a full-time job to become a paramedic,” she said.
It's also just a tough job for anyone, the EMS officials said.
“It's high stress,” Cribbs said. “You're out in the elements. You work holidays and weekends. When you get called by 911, it's not like you can say, 'No, I'm not going to go.'”
That's why they're competing with other industries now for prehospital providers, Kelly said. Oil and gas companies, urgent care facilities, movie sets and the aeromedical field all need EMTs and paramedics, and those jobs often pay better and have more stable hours, he said.
Solutions
With all these issues, it can seem like an uphill battle for a service that most people deem to be a necessity.
But local agencies are finding ways to stay sustainable.
At Portersville EMS they focus on keeping expenses down however they can, including doing building and equipment maintenance in-house whenever possible. They also rely on fundraising to get by, Neiper said.
The agency hosted a concert last fall that was successful and hopes to host and grow that event this year.
“We're trying to look for big fundraisers to fill the gap,” Neiper said.To keep a steady cash flow, ambulance services can answer non-emergency transport calls from hospitals to other health care facilities.“It's another way to generate revenue,” said Denny Bacher, president of Butler Ambulance Service.Bacher said the overhead costs on non-emergency transport calls are less than emergency calls, and the reimbursements are more reliable.This is because the patient is responsible for emergency transports after insurance is billed. With non-emergency transport, the hospital that requested the transport is the payer of last resort, said Kelly, of Cranberry EMS.However, EMS providers must be careful to balance scheduling non-emergency transports and being available for emergency calls, Kelly said.Butler Ambulance Service also has a wheelchair van transport business for people who are wheelchair-bound and unable to get around on their own, Bacher said, and that helps the bottom line. Most of the patients who use this service pay out of pocket.The cost for wheelchair transport is $40 one way in a 10-mile radius, so a typical trip is about $80, said Alicia Haas, billing manager with Butler Ambulance Service.To supplement their income and help out residents, most EMS offer subscription or membership services where the member pays a small annual fee. The membership then either gives them reduced out-of-pocket costs or no out-of-pocket costs for emergency transports. Cranberry's fee for a family is $60. Butler's is $50.
Neiper said Portersville EMS cuts the bill in half for any subscriber who has a bill after insurance has paid. In Cranberry, the EMS agency forgives any out-of-pocket costs for a subscriber who uses the ambulance in an emergency, Kelly said.It's a good deal for everyone, although their subscription rate is relatively low, Kelly said, with around 20 percent of households in their coverage area being subscribers.Efficiency is key at Cranberry EMS, said Ted Fessides, deputy chief of administration, where they review data to drive their decision-making. The agency looks at finances, clinical and operational data quarterly, Kelly said, and grades themselves on their performance.They also use surveys to find out patient outcomes and see how they performed.“We put ourselves in a position to learn from our shortcomings and get better,” Kelly said.Making and keeping relationships with municipal governments and offering a variety of public health programs to the community is also crucial, Kelly said. The goal is to show the value of the EMS past answering emergency calls.Cranberry EMS offers CPR certification classes, first aid training, car seats checks, safety programs for new parents and wellness checks of elderly people and chronically ill adults. They also host a weekend-long training blitz each year to offer continued education training to EMTs and paramedics.“We try to solidify ourselves as a needed public service, not just to take people to the hospital,” Kelly said.
