Dan Santoro has consistently heard the same concern from Cranberry Township EMS: expenses are rising faster than revenue.

Hearing the call for help, the Cranberry Township manager guided the municipality into a multi-governmental, yearlong study of emergency medical services in southwestern Butler County.

“It has been on the radar of local governments, as well as EMS agencies, for a while,” Santoro said.

Rather than sink dollars into potential possible solutions, the township and 10 other municipalities served by either Cranberry Township EMS or Harmony EMS invested in a study to try to discover the root of the problem.

The municipalities completed a regionwide survey, analyzed data for the services and published their findings in late 2025. The study, done with Robb Consulting, looked at strategies, objectives and communication that could be implemented in coming years.

“The long-term sustainability is really what the aim was,” Cranberry Township EMS director Matt Nickl said. “I think it’s easy for any ambulance service to go to a municipality and ask for money, but what we wanted to do was a needs assessment for why we needed money.”

Specifically, the 63-page report featured three recommendations: develop a multi-governmental governance entity, implement a consistent funding plan and launch a communications and messaging plan.

“Our EMS providers have been coming to us saying, ‘We need more assistance — we’re operating on a thin line or in the red,’” Santoro said.

The report makes clear that traditional methods like ambulance subscriptions, fundraising and insurance billing do not adequately cover the true cost of maintaining 24/7 emergency readiness.

“The cost of ‘readiness for service,’ which means 911 emergency service organizations ability to respond to a call for service 24 hours a day, 7 days a week, 365 days a week is substantially underfunded,” the October report said.

Harmony EMS and Cranberry Township EMS are nonprofit entities. A significant portion of their revenue is insurance reimbursements.

Director and president of Harmony EMS Jay Grinnell said that’s no longer a sustainable model moving forward.

“The study just proved the fact that EMS cannot survive on reimbursement from insurance companies,” he said. “It’s going to need public support — same as the fire departments and the police departments receive.”

Some municipalities served by Harmony EMS have recently opted to support a proposed half-mill tax increase to boost funding.

Three of the primary municipalities that Harmony EMS covers — Zelienople, Jackson Township and Harmony — implemented the support as a recurring tax. Lancaster Township officials, meanwhile, opted to provide the equivalent of the half-mill out of their general fund budget to avoid the tax increase.

Grinnell said he anticipates the half-mill bump will generate about $120,000 in new revenue for Harmony EMS. However, he noted it doesn’t stretch nearly enough to cover equipment and staffing, which are two of the largest expenses.

“Frankly, a half a mill doesn’t go very far,” he said. “EMS services are expensive to run. It’s $2.5 million a year at least for our service.”

Grinnell said if funding gaps continue to widen, a last resort would be to cut staff, which could mean longer wait times for service and an increase in missed calls.

“If no future help comes, the only survivable way that any EMS agency is going to stay is we’re going to have to cut staff,” he said. “We’ll be responding to what we can, when we can and if we can.”

Harmony EMS serves Jackson, Lancaster, Connoquenessing, Forward and Franklin townships and Harmony, Zelienople and Evans City boroughs in Butler County, along with Marion and New Sewickley townships in Beaver County.

Cranberry Township EMS serves Cranberry Township and Seven Fields in Butler County and the southeast portion of New Sewickley Township in Beaver County.

Those that participated in the study were Evans City, Harmony, Seven Fields and Zelienople and Cranberry, Forward, Jackson and Lancaster townships in Butler County and Marion and New Sewickley townships in Beaver County.

While Cranberry Township supported the recent study, Santoro said Cranberry EMS does not currently levy a dedicated EMS tax. It instead provides support through fuel, fleet maintenance, IT services and other in-kind assistance.

While a half-mill levy is one option available to municipalities under Pennsylvania law, Santoro said the study suggests such an approach may not be sustainable on its own.

“Could we do a half-mill? Sure,” he said. “But that is not the long-term answer, because it’s not going to be enough. At some point, you’re still going to have to dedicate additional general fund resources.”

Cranberry EMS operates as an independent nonprofit, similar to Harmony EMS. However, Santoro said the township maintains a close working relationship with the agency, including monthly financial review meetings.

The study also recommends exploring multi-municipal governance or shared funding frameworks, something Santoro said he hopes continues among communities served by Cranberry EMS, including Seven Fields and New Sewickley Township.

“I think long-term, regional solutions are what you need,” he said. “We can be healthy in Cranberry, but if surrounding agencies aren’t healthy, our ambulances get pulled farther out to help them — and there’s no equitable distribution of that cost.”

The study outlined several opportunities the alliance could take advantage of to “strengthen how Southwest Butler County delivers services.”

One of those opportunities is to continue to build awareness of the current state of EMS in ways that “strengthen trust, gain alignment and build support for future changes.”

A survey featured in the study found 73% of respondents were aware of the current EMS study. Another 27% had “no knowledge” of the study until the survey arrived in their inbox.

“I do think that as this issue becomes more widely discussed and understood, we’ll move toward more collaborative regional solutions,” Santoro said. “It may take time, but the system is going to look very different in five to 10 years.

“Ultimately, we want a financially sustainable system that ensures when people call 911, an ambulance arrives — ready to go.”

According to the study, “the need and desire for consistent, reliable funding has overwhelming support, with about 90% of participants supporting that aspiration.”

Santoro said while Cranberry EMS isn’t in an immediate crisis, there could be issues down the line if no planning is done.

“We see the problem on the horizon — and if we do nothing — at some point in time, we will end up in crisis,” he said. “I expect that we will do something that will help turn it around and make it better from a financial sustainability perspective.”