Chester Looking at Taking Ambulance Service In-House

CHESTER – The Fire Department has been investigating the feasibility of bringing the town’s ambulance service in house. All of the equipment and training is there, fire officials say, and with an expensive contract with Derry for the service, it’s time to look at the possibility.

While there’s a lot to look at and consider, department members on the ambulance committee argue that the only thing that would change, should the town take on that responsibility, are the transports. They already get to calls first and administer the same level of treatment as Derry.

Many members of the department work full time with private ambulance services. There are seven paramedics, nine Emergency Medical Technician (EMT) Basics and five EMT Intermediates on staff, and in 2008 the town purchased a rescue vehicle capable of transports. It’s the highest number of members able to provide Advanced Life Support the department has ever had.

Department member Eric Emerson joked that all that would happen with the change is that there would be more work for department members. But he said this is their town and they want to do right by its residents.
Lt. Kevin Wunderly said part of the impetus to move toward an in-house service is to give back to the community. The residents have been supportive of the department, said Wunderly, noting the purchase of equipment and vehicles and funding for advanced training.

“The town has given us a lot. We’re looking to utilize the vehicle, equipment and training we have and give back to the community, and hopefully cut costs associated with having Derry provide the service,” said Wunderly.

But will there be a need for additional employees, or a move to a full-time, 24/7 department? The fire department doesn’t see the necessity of that and isn’t planning for it. It has plenty of volunteer members willing and excited to use their skills more often.

The configuration of an in-house service, as the committee has investigated so far, would be similar to the current set-up. There are already two full-time members covering weekdays. To make sure there is always someone at the station to handle ambulance runs, the department is considering setting up a $35 stipend to handle a shift. On-call pay would remain the same.

Wunderly said that even now, without any additional incentives, there are always enough members to handle the town’s calls. Fire chief Rich Antoine said the department has never not been able to handle a call, with more than enough back-up for additional calls.

Antoine has been clear that he could go either way with the service. While he thinks it’s feasible, it’s a decision best left to the town as a whole, he said. Wunderly, who works part time with Raymond’s ambulance service, noted that Raymond handles roughly 1,800 calls a year across four towns, with the same staffing that Chester has on its rolls. Chester handles about 200 calls per year now.

The department has looked at the way different communities of roughly the same population and department structure handle in-house ambulance service. Those models tell them it can be successful, said Wunderly. It’s financially self sustaining at the least, and at times can bring revenue into the town.
Emerson said a quick look at the department’s records shows that Chester is already more or less handling all of the work incumbent on an in-house system.

“There’s just one difference – we’re loading the stretcher onto a Derry ambulance rather than a town ambulance,” he said. And sometimes, because Derry’s ambulance is coming out of Island Pond Road, Chester medics need to wait for the transport to arrive.

Chester has contracted with Derry since the 1970s for ambulance service, when Peabody Funeral Homes got out of the ambulances business. According to Wunderly, a contract stipulation from that agreement has Derry agreeing to provide service to Chester.

Wunderly said a lot has changed since then. In that time rescue calls have far outpaced fire calls, to the point that 75 percent of the department’s calls are rescue related. And Chester is now able to provide the highest level of care possible, Advanced Life Support.

So, the way members of the committee look at it, the town is paying a lot more than it needs to in ambulance costs. The contract with Derry increases by 10 percent each year for the next five years. The base rate of the first year, from July 2013 until June of 2014, is $57,302. By year five that number is up to $83,896.
Plus, if Chester makes a transport, it must pay Derry, at a first-year cost of $200.

Antoine said ambulance patients from town are paying triple for the service. They pay for the town to have the necessary equipment, staffing and training; they pay Derry to be there; and then they pay the actual cost of the transport.

As an aside, according to the department, Chester has one of the highest fee collection rates in the state because of the high percentage of residents who have insurance. This means that it’s relatively lucrative to transport out of Chester.

While committee members agree that when the town was purchasing the rescue vehicle they said they had no plans to go into the ambulance business, since then things have changed and it would be unwise not to at least consider it.

Asked about the possibility of an in-house service, selectmen Jack Cannon and Steph Landau said it was worth investigating. Cannon said he had heard some persuasive arguments from the ambulance committee, and now that the contract negotiations with Derry were over, it was worth spending time to look more in depth at those arguments.

Cannon said a move toward an in-house service wouldn’t happen overnight. Cannon has looked at the basic data, he said, but to make such an important decision, all of the specifics need to be thoroughly reviewed.
Bringing it in house only made sense, Cannon said, if they could do it without an unnecessarily heavy financial burden on the community. He said they owed the town to at least evaluate it.

Both Cannon and Landau spoke about how regionalization of service could be beneficial. Cannon said he didn’t ever see the town turning its back completely on Derry, but rather looking at ways to reconfigure the service.
While members of the department’s ambulance committee say the financial side is there, they’re also looking at the emotional side.

Antoine directs all of his department members to treat each patient like a family member. The overarching protocol for handling any call is to do right by the patient. That isn’t to say that Derry isn’t doing that, they said, but they think there’s a difference when it’s a neighbor or someone you know from town. And rescue personnel say there are benefits to staying with a patient from first response to the hospital.

Also key to that relationship is the comfort that patients feel when they’re in a tough spot and someone they know, or someone they’ve seen around town, shows up to handle their emergency. While it’s not the bottom line for considering a change, members say it’s an important point.

The next step is the formation of a broader ambulance committee, with members of the department, public, selectmen and budget committee. Any final decision, said both department members and selectmen, will be made by the voters.

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