With their services already in precarious financial situations, the coronavirus pandemic could be the death knell for many EMS agencies in Butler County.

“We were in a crisis before this,” said Jay Grinnell, Harmony EMS president. “COVID-19 is going to be what's going to break the back of a lot of ambulance services.”

Call volumes are down 25 percent to 40 percent across the state, he said. Because ambulance services receive nearly all of their income from payments for service, the drop in call volume directly impacts their bottom line.

Ted Fessides, Cranberry Township EMS chief, estimated the EMS lost about $70,000 this year from its decreased dispatches — nearly two full-time EMTs' annual wages, he added.

Layoffs have begun

These losses already have materialized in layoffs and staffing changes. Cranberry cut the hours of two administrative employees, while Quality EMS, based in Adams Township, laid off five people, mostly transport employees, according to director Erica Corso.

“The call volume just isn't there to have them on staff right now,” she said.

While the layoffs have yet to affect clinical employees — the paramedics and EMTs — that's a future possibility as the lower number of calls means less of a need to run concurrent crews, Corso said.

Quality runs two crews at all hours, but it's possible right now to cover all calls with one.

The future possibilities may be more dire than that. In Cranberry — where Fessides told township supervisors in January the financial outlook already was less than good — the pandemic greatly exacerbated an existing problem.

“If we do nothing and we just do business as usual, with these decreased calls we're going to be gone by July,” Fessides said.

Nonemergency calls nonexistent

Gene Troyan, Butler Ambulance Service's director of operations, said his group has been trying to find exactly why the calls have gone down. Nonemergency calls are virtually nonexistent, Troyan said, but other dispatches have decreased still.

“I think people are maybe thinking, 'Oh, I don't want to go to the hospital, I don't want to go in public,' ” Troyan said.

Fessides said even calls for heart attacks and strokes are down alongside the nonemergency calls. Dispatches to car accidents have shrunk, too, because people are driving less.

“For years, the big joke was, 'Oh man, if people would only use EMS and the ER for what it was designed for, emergencies and everything,' ” he said. “Well, that's what we got. And it turns out it's terrible.”

Even additional sources of income — CPR classes, home childproofing, donations from car seat inspections — have dried up due to social distancing measures.

While that makes up just 5 percent of Cranberry's budget, Fessides said, that's roughly $8,000 a month that won't be there.

Solutions

Unlike police departments, EMS agencies aren't funded by municipalities, nor do they receive fire tax revenues like fire departments. But they still have to pay for gas, utilities, vehicles and, most importantly, employees.

Nearly all of the ambulance services in the county have applied for small business loans and grants to float them through the crisis.

Grinnell said Harmony EMS received a roughly $14,000 grant, but added that the monthly bills are more than $100,000.

“We did get a little bit of financial assistance from a federal grant that was based on your Medicare reimbursement,” Grinnell said. “In the long run, it keeps the place open for a couple of days.”

Payroll protection program loans, as well as grants through the Small Business Administration, are possibilities too, Fessides said. However, approval and disbursement of these funds can take at least a month.

“Those things take time,” Fessides said. “And unfortunately that's not something we have a lot of.”

Township trying to help

Cranberry Township manager Jerry Andree said the township has been in conversation with CTEMS about how it can help the ambulance service during the crisis, if possible.

“Obviously, the township does not want them to lay employees off because we want them to continue having the same level of service, so we have been having conversations because the supervisors want the township to have the EMS services the community has come to expect,” he said.

Services that had financial reserves before the pandemic can tap into those, Grinnell said. But the financial situation many ambulance services were in before the pandemic prevented them from having any significant savings.

“EMS is bleeding. Everyone ramped up and was all prepared, but we were on the other side of this,” Fessides said. “Nobody saw the bottom dropping out. We thought we'd be overrun with calls.”