Rob Druga, a paramedic with Cranberry Township EMS, shows off equipment in one of their ambulances.

Emergency medical service providers nationwide are in crisis: struggling with funding, the rising costs of doing business and finding qualified workers to provide vital services.

Ambulance services are dealing with these issues in a variety of ways, like using data to run more efficiently, supporting community health programs and finding alternate sources of revenue.

Jeff Kelly, chief of Cranberry Township EMS, said municipalities are required by law to designate an EMS provider for resident. But the requirements for funding that service are vague. That leaves many EMS agencies to find their own way forward.

Butler County is served by 11 EMS providers overall. That may seem like a lot, but there used to be many more 20 years ago — a reduction that is the result of the hardships facing many organizations in recent years.

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While costs and call volumes are increasing, the funding for ambulance services is not, said Ted Fessides, Cranberry EMS deputy chief of administration.EMS agencies primarily get money from insurance reimbursements, when a patient's insurance pays for all of or part of the trip.Ambulance services must accept what is paid by Medicare and Medicaid. For people with commercial insurance — like UPMC, Highmark or Aetna — if the reimbursement amount from the insurance does not cover the entire bill, the patient is then billed directly for the remainder.If the patient doesn't pay, the bill is then sent a collections agency.

Due to the multitude of funding issues, agencies cannot afford to pay their emergency medical technicians (EMTs) and paramedics enough to entice workers into the job or keep them there long-term.“We're not able to pay them a living wage,” Kelly said.Denny Bacher, president of Butler Ambulance Service, said Butler Ambulance is one of the higher paying services in the county, but they still have trouble filling vacant positions.“Especially at the EMT level, where our staff starts at $11 an hour, they can find a less stressful job at $10 an hour,” he said.<br/><br/><em>This is the first half of a series on the struggles that EMS face. Read the second half <a href="http://www.butlereagle.com/article/20180504/NEWS20/705049887"here</a>.Read the full version of this story in the Butler Eagle.</em>