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Wednesday, May 22, 2013

By Steve Myrick
Published: July 23, 2009

Tri-Town Ambulance, the inter-municipal service that serves the three up-Island towns, has entered into an agreement with Oak Bluffs to cover short-term staffing deficits. The agreement provides an Oak Bluffs paramedic to answer calls in West Tisbury, Chilmark, and Aquinnah during day shifts, when no Tri-Town paramedic is available.

The agreement illustrates cooperation in the public interest among Island towns. "It's a friendly offer from a neighboring community to help," Oak Bluffs ambulance service chief John Rose said. But the agreement also illustrates a larger issue of ambulance staffing difficulties in the more rural, more isolated up-Island communities.

"I can't put my finger on it," Aquinnah police chief Randhi Belain said. Chief Belain is the new chairman of the Tri-Town Ambulance Committee, and himself an EMT. "I don't think its because we don't have enough EMTs. I'm not sure there's a clear answer. We're going to have to look at the big picture as far as incentive pay. The whole system needs to be looked at. There's a lot of money we budget for. I think it needs a fresh look."

Tisbury and Oak Bluffs each have a separate ambulance service under the control of a full-time department head. In Edgartown the ambulance service is a department of the fire department under the control of the fire chief.

Tri-Town ambulance currently employs one full-time paramedic. Bob Bellinger, currently works four 10-hour day shifts during the week, from 7 am to 5 pm. Mr. Bellinger commutes from Falmouth, so the committee has slightly adjusted his schedule in recent months to accommodate ferry schedules. Island-based paramedic Andy Bluestein has recently agreed to cover several daytime shifts per month. Night shifts are covered by a paramedic shared with Tisbury.

The current staffing level leaves at least one day shift per week to be covered under the new agreement with the Oak Bluffs Ambulance Service.

At its July 22 meeting, several board members aired concerns about the new agreement with Oak Bluffs. Committee member Walter Delaney of Aquinnah was troubled about response times to his town. Under the agreement, Oak Bluffs paramedics on call for the Tri-Town Ambulance service would respond from Oak Bluffs. They would not be required to spend their shifts in one of the up-Island towns.

Also of concern was the possibility of higher pay rates for Oak Bluffs paramedics covering shifts up-Island. At the meeting, committee member Diane Powers of West Tisbury said she hoped the agreement with Oak Bluffs would spur an extra effort to achieve a full staffing level without having to rely on other towns.

Chief Belain is optimistic that staffing issues will improve with the graduation of a new class of paramedics, currently taking advanced instruction through an Island-based program. "At least two if not three of the students are on the Tri-Town Ambulance roster," Chief Belain said. "Once they get certified I think we'll see an increase."

There are also shortfalls in EMT staffing. According to the minutes of the Tri-Town Ambulance Committee meeting of May 18, committee members discussed possible incentives to increase coverage. Among the ideas discussed were a mentor program for new EMTs, increasing incentive pay, and continued development and professionalizing of the squad.

At that meeting, committee members voted to increase the shift pay rate, the compensation an EMT earns for being on call, to $75. By comparison, Oak Bluffs pays $100 for an EMT to be on call for a 14-hour night shift, and $150 for a paramedic to be on call. Edgartown pays the same rates. In Tisbury, basic EMT's are paid $65 for a night or some weekend day shifts, intermediate EMT's are paid $90, and paramedics are paid $110.

A sub-committee of the Tri-Town Ambulance committee is currently reviewing incentive pay rates, spurred by requests from EMTs to make the incentive pay scale more equitable, compared to other towns.

Ambulance economics

Each town appropriates money for operating costs at the beginning of the fiscal year. Income earned by the ambulance services, usually in the form of insurance reimbursement, goes back to the town. The goal of each Island ambulance service is to cover its costs with payments for its services.

"That's the way we would hope it to be," said Alex Schaeffer, who manages the ambulance service for Edgartown. "If we received all the money for the services we provide, we would, but we don't always receive payment." The ambulance service provides care to everyone, without regard for the ability to pay. When the patient doesn't have insurance, taxpayers sometimes foot the bill.

In Oak Bluffs, the ambulance service handles many off-Island transfers and medical flight transfers from Martha's Vineyard Hospital. According to the most recent town report, about half of all Oak Bluffs ambulance runs are for transports or medical flights. Insurance reimbursement for those interfacility transports is collected in an ambulance reserve fund, established by special legislation. Revenue from that fund is dedicated to the purchase of public safety equipment and vehicles.