Butler County Rural EMS departments face special challenges
Nearly every emergency medical service agency across Pennsylvania is struggling with similar, long-standing issues: inadequate staffing and stagnant Medicare reimbursement.
However, EMS agencies serving more rural areas — such as Karns City Regional Ambulance Service, Portersville Muddy Creek EMS and Superior Ambulance Service — experience those issues in their own ways.
“It’s a struggle for every EMS agency,” said Craig Book, president of Portersville Muddy Creek EMS. “I know some of the bigger EMS agencies and I’m friends with some of their leadership and they’re facing the same struggles we are.
“It’s just that we’re just on a different level than they are.”
Karns City, Portersville and Superior, along with other EMS agencies in the rural northern part of the county, typically cover wider areas.
For instance, Karns City covers the townships of Donegal, Fairview, Clearfield, Concord, Washington and Parker; plus the boroughs of Chicora, Karns City, Petrolia, Fairview, and Bruin — nearly the entire northeast part of the county.
Although it is based in Grove City, in Mercer County, Superior Ambulance Service president Doug Dick said a large portion of its calls come from Butler County — specifically, from Harrisville, Marion and Mercer townships and part of Cherry Township.
“We cover more area in Mercer County, but we do a lot of calls in Butler County,” Dick said.
According to Mark Lauer, president of Karns City Regional Ambulance, the wider coverage area for rural EMS agencies can sometimes translate into extended response times, depending on the location of the call.
“Everything’s a drive,” Lauer said. “If it’s downtown Petrolia or Karns City, it’s one to two minutes. If it’s North Washington, eight minutes. If it’s down in the lower side of Armstrong County, it might be 12 to 15 minutes.
“But our out-the-door average time, we try to make it two minutes.”
The wider footprint and relative isolation can also lead to a lack of flexibility on busier days — especially for Karns City and Portersville, both of which usually have only one crew out at a time.
“One challenge is turnaround time,” Lauer said. “If we go to a residence in Bruin and we transport them to Butler hospital, there’s no other service covering the area out there. And we actually get a lot of back-to-back calls.”
Despite their wider area, these areas are more sparsely populated — meaning fewer revenue-producing rescue calls on average.
Lauer said Karns City responded to 1,234 calls in 2025. By comparison, Butler Ambulance Service had 2,704 calls to Butler Township alone, which is only part of its coverage area.
Book estimates Portersville Muddy Creek EMS responds to about 450 calls in an average year.
“Being in a rural community means fewer calls to respond to that have a fee for service,” said Book. “That makes us have to seek out different options, like standbys at football games and track meets and special events. … Some of the agencies that are around us are running thousands of calls because they have a denser area. There are housing developments and stuff like that in their area.”
Of course, rural EMS agencies are not immune to the issues facing the entire industry in Pennsylvania.
“In the last 20 years … the money that comes into EMS, the reimbursements from Medicare and Medicaid, hasn’t gone up nearly as much as the general inflation has,” Book said. “Twenty years ago, we were paying our EMTs $8 an hour or even less, because there were just so many EMTs. But now, EMTs are getting paid like $20 an hour, which I truly believe they deserve.
“There’s probably all kinds of legislation that needs to be looked at … The health care industry needs to look at emergency medicine as a primary point of health care, not just a secondary.”
Despite the challenges, all three departments are making things work in their own way.
Portersville and Superior are trying to generate additional revenue by offering a subscription service to residents.
Dick said Superior provides subscription benefits automatically to all residents of municipalities that provide the agency with some form of annual financial reimbursement, such as an EMS tax or other contribution. This includes Harrisville, and Marion and Mercer townships.
“For the nonpaying municipalities, their residents have an option to have a membership if they so desire,” Dick said.
Book talked about the membership program, grants and donations as means to support EMS.
“Once a year, we have a business drive in our area and our local businesses support us to help keep us in business,” he said.
Karns City also benefits from its participation in Butler County Community College’s EMS Academy, an eight-week program which provides certification training for aspiring EMS professionals and puts them to work for agencies across the county. The program is entirely funded by Butler County.
According to Lauer, the program has supplied four students to Karns City.
“The county commissioners have done everybody a solid by putting these classes on,” Lauer said. “It's been fantastic for us and for other agencies across Butler County.”
Although Dick said he lobbied for its inclusion, Superior Ambulance does not currently participate in the BC3 EMS training program. However, the agency does maintain its own educational institute, which provides EMT classes for aspiring EMS professionals.
“We are basically training our own people,” Dick said. “A lot of the people that go through our EMS education institute end up employees.”
