PITTSFIELD — A coalition of Berkshire County's first responders and emergency personnel are working to quantify widening gaps in ambulance services they say are hurting health outcomes.

Emergency Medical Services of Berkshire County recently launched a countywide mobilization plan to respond to the problem: unanswered medical calls and subsequent delays in treatment.

When the call volume spikes, officials say, there simply aren't enough ambulances to go around.

"It's beginning to be a larger problem than people really want to talk about," Pittsfield Fire Chief Robert Czerwinski said.

At issue is a lack of volunteers to staff available ambulances — a deficit that, officials say, stems largely from ever-increasing hoops that EMTs have to jump through to maintain their certifications. When a volunteer department can't scrounge together two EMTs to respond to an emergency, that means their ambulance is stuck at the station and another department makes the trek.

Richmond Fire Chief Stephen Traver said most of the emergency calls in his town require aid from Pittsfield, meaning it can take EMTs as much as 20 minutes to get to the station and an additional 10 minutes to get to the scene. This jeopardizes their ability to get a patient to the hospital within "the golden hour" for treatment — the time after a traumatic injury or illness when treatment has the best chance of saving a life.

"It's just taking too long to get there. That's my worry," Traver said. "It's not the best thing if you're having a heart attack. The quicker you can get to people, the better off you can treat them."

Compounding the issue is the fact that the county's population is trending older, meaning more demand for services. The first step toward a comprehensive solution, committee members decided, is to compile call data into a countywide list to identify the holes and assess the extent of the problem. Meantime, some officials are pushing for waivers that could offer relief for volunteer departments. Additionally, committee members drafted an agreement this month that, if signed, would enable them to share personnel between municipalities.

Czerwinski told fellow committee members there have been at least a couple of dozen times that a Pittsfield medical call has come in "with no rig available."

"That starts to worry me," he said.

He said the current way of sharing services ends up "short-changing someone down the line." He said data collection would help light the path forward.

"It's going to give a clearer picture, across the county," he said.

A report commissioned in 2015 by the city of Pittsfield and the Berkshire Regional Planning Commission projected that the majority of the county's residents will be 50 or older by 2030. Czerwinski said call volume will only increase as the population continues to age.

"As we grow in age, the need for these types of services will be all the greater," he said. "It's everybody's problem."

Committee members say the problem is already reaching a breaking point.

"In certain communities, this is getting to crisis level,"said Brian Andrews, EMSCO president and president of County Ambulance and Western Massachusetts Emergency Medical Services.

Officials in Hinsdale are banking on a legislative amendment that they say could save volunteer service in their town. State law requires that each ambulance be staffed with two certified EMTs before leaving the station, but state Sen. Adam Hinds, D-Pittsfield, is working on a waiver that would allow small, volunteer departments in less-populated areas to respond to calls with one first responder as the driver and one EMT to treat the patient.

"There are a range of state regulations that, when applied to small towns or rural areas, just don't make as much sense," Hinds told The Eagle. "The bottom line is, this is a policy that's impacting lives."

Hinds said the waiver, which he filed as an amendment to the Health Care Act, passed the Senate and is up for review in the House.

Dick Scialabba, a 24-year volunteer firefighter in Hinsdale who serves as ambulance captain, said difficult rural terrain and a lack of volunteers complicate his department's ability to treat patients in a timely fashion. The waiver would make a big difference for the small town, in which he said a career ambulance service would not be profitable and, therefore, isn't viable.

"We're probably in a situation where it's necessary, because you're going to lose some of the volunteer services without it," Scialabba said. "The situation is such that if you don't have the volunteers — which are very effective, and have been for a long time — the only other option is, you have to determine how you pay for it."

Volunteerism dropped off dramatically in the past decade or so, officials say, leaving rural communities strapped. When towns like Richmond, Dalton, Lanesborough and Hinsdale can't find volunteers to take a call, they'll ask for mutual aid from Pittsfield.

"They just can't get those ambulances out the door," Czerwinski said. "They depend on Pittsfield when they can't get theirs out or they're already out on a call, then we suffer because we have to wait for extended periods."

Czerwinski said there are about 4,500 medical calls a year in Pittsfield, and there were about 200 calls in the past year for which there was no ambulance available and he had to go elsewhere in the local network to provide services.

Mutual aid across geographically large towns in Berkshire County is taxing for everyone, he said — especially those who need the treatment. When it takes 30 minutes for an ambulance to arrive at the scene of an emergency, he said, that means there's often no way to transport patients to a hospital within the suitable time.

"That puts in question the survivability of a patient if that care is delicate," he said. "That's a problem already."

They say it's because there aren't enough young people living in the rural communities that need their volunteerism, that home life is more demanding since both parents work and do so at longer hours than they used to, and because of considerable EMT requirements.

"People just don't have the time — let alone to volunteer, but commit to another five-week class," Czerwinski said. "The training requirements to maintain your skills are pretty extensive."

Dalton Fire Chief Gerald Cahalan said he started paying EMTs on a per diem basis about a year ago, and his department is still missing more calls than he feels comfortable with.

"We're all stealing from each other," he said of area departments. "We need a countywide approach, and we need people."

Officials said small departments all over the country are grappling with the issue of decreased volunteerism and how to handle it. Some are skeptical of whether the legislative waiver is a good idea, given that a first responder would not be able to offer medical assistance when the team attends to severe injuries. Still, members of small departments already contending with unanswered calls said it's better than missing the golden hour entirely.

"We have to do something — we're not doing what we're supposed to be," Traver said, adding that he's unclear on how to solve the problem, but that a waiver "would help tremendously."

"I have no idea what the answer is. We've done everything under the sun to try to improve it."

North Adams Ambulance Service General Manager John Meaney told fellow committee members that town leaders might be reluctant at this point to address the problem, given limited budgets, but "when someone dies because an ambulance doesn't show up, they're going to be knocking on the door."

Reach Amanda Drane at adrane@berkshireeagle.com, @amandadrane on Twitter or at 413-496-6296.