Chautauqua County Is In The EMS Business For The Long Haul

The March 1, 2018, editorial of The Post-Journal concerning the Chautauqua County government’s new Emergency Medical Services (EMS) Fly Car Service’s financial realities raised issues that I had previously raised in a Readers Forum letter. At that time the proposed service was pending on the legislature’s agenda. The editorial takes the position that county legislators must commit to ending the service if a “workable budget” cannot be established for the service that keeps the service from becoming a “money-draining program.” The inference is that a workable budget should be a break-even income/expense budget or I suspect something close thereto.

My letter made it clear that the county taxpayers will always have to subsidize the EMS Fly Car System and that the subsidy can be expected to increase due to program growth actions that will inevitably follow. After 45 years of EMS involvement in many settings I am drawn to no other conclusion. The letter then cautioned the decision makers “to enter into this new long term expense commitment with everyone’s eyes wide open.” It also noted that “Once the door is opened, the county will have crossed over the point of political no return and will have boxed itself into a corner.” That is, once the program is put in place that it will be politically untenable to discontinue it. Given the editorial, we are already at that juncture today only a year and a half later. And, the County Fire Chiefs Association currently is in the process of requesting that the service be expanded, an expansion that I previously predicted to be inevitable and which is the mere tip of the iceberg in terms of expansions that are likely to occur.

It is not unusual for governments to provide fly car and ambulance services at taxpayer expense. The problem with adding or expanding such services today is that governments have become income limited and are operating in an environment where the taxes are already at a burden level for the citizens. The editor is correct that a plan addressing how to move forward needs to be devised now before the crunch of budget time arrives. Such a document has yet to exist.

Questions need to be asked and answered. My letter raised several questions previously that I won’t take space here repeating. Serious and extensive program evaluation needs to occur. How needed has been Advanced Life Support (ALS) vs Basic Life Support (BLS) patient care? How have patient outcomes been affected by services provided? Is the Emergency Medical Dispatch (EMD) method of regularly placing county owned vehicles on the roadways in emergency mode bringing undue increased liability to the taxpayers? Can the increasing number of EMT sheriff deputies take the place of expanding the Fly Car System? At what point can the county expect to be placed into the position of staffing county owned ambulances and how many will be required and what will the cost of that be? The plan cannot be developed just for next year. While dealing with immediacy it must nonetheless take a hard look toward the future.

The use of EMS services is not going to go away and is increasing daily. There has been and always will be a need for response to emergencies. Today the response need throughout the county has gone beyond emergency need to minor illness/injury attention that in yesteryear and in many rural communities elsewhere today would not rise to the level of requesting an ambulance.

The future of the volunteer service is in serious jeopardy. Fewer people volunteer today, be it for EMS or for other community organizations. More and more requirements are being placed on the volunteers by the state and the local physician medical directors. All well intended. All resulting in fewer persons being interested in becoming and then continuing as EMTs. Thus there will be fewer volunteer ambulance services in Chautauqua County within the foreseeable future. This will result in a longer wait time for an ambulance which will inevitably result in a higher patient mortality rate. The loss of the ambulances can be slowed if a throttle is placed on the regulators although it is unlikely that such will happen. When these situations occur the current discussion will become a larger discussion. The ball will bounce onto the legislators’ court again. Yes, Mr. Editor, a plan needs to come to the table. And, the plan’s authors need to come from all sectors of the county – not just the legislature and emergency services venues. At the same time we all need to understand that any plan will entail a taxpayer subsidy. The question will be not if the subsidy will continue but rather how much the subsidy will be. The county has crossed over the line of no return in committing to this deficit program expense going forward into the future.

Douglas Conroe is fire chief of the Maple Springs Fire Company Inc.

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