In South County, help is on the way, but it might take an hour
GREAT BARRINGTON — One out of 10 people who call the Southern Berkshire Volunteer Ambulance squad face up to an hour wait for emergency help to arrive.
The national average response time is eight minutes.
Fairview Hospital Emergency Room doctor Alec Belman said the ambulance service in South County is so lacking, it's like a "black hole."
People in isolated communities that don't have their own town-funded or robust volunteer ambulance service programs can wait up to an hour or more for help to arrive, if it shows up at all, Belman said.
Local town and medical officials have been discussing ways to share services to provide quality ambulance coverage countywide for two years, said state Rep. William "Smitty" Pignatelli, D-Lenox, ever since 17 Berkshire County towns got together on Beacon Hill to sign a sharing-services community contract. In addition to spurring discussions about how to improve ambulance transportation, the Boston summit also kicked off a wave of cooperation discussions and initiatives aimed at improving quality and saving money on everything from public education to town administrators and emergency responders.
For some, the time for talk has passed, though, and South County needs to make significant changes to its ambulance services — more and more lives depend on it.
"For the public, they don't know how limited the services actually are until you're hurt or sick and you can't get to the hospital yourself," said Belman who is also Fairview's medical director for Emergency Medical Services liaison. "You might get a police car, but you might not get any medical assistance for an hour.
"In Richmond, we can't get an ambulance out the door more than 20 to 30 percent of the time," he said.
Pignatelli said the state's role in figuring out South County's ambulance problem is to loosen regulations that require the ambulance driver to have emergency response training, making it easier for volunteer departments to find responders and creating incentives for communities to share resources.
"How do we incentivize three or four or six communities getting together to share one ambulance building or to buy one ambulance or to help them pay for professional staff?" Pignatelli said. "It makes no sense for Lenox, in my opinion, to have a brand new ambulance building, and Lee and Stockbridge and Great Barrington do the same."
For 90 percent of the calls received, Southern Berkshire Volunteer Ambulance, the largest provider in the area, with a total of three ambulances, gets to the person in need within 13 minutes, 50 seconds. Their average response time within the squad's six-town service area is even better, with people waiting about seven minutes for help to arrive, said William Hathaway, Southern Berkshire Volunteer Ambulance's director of operations.
Nationally, the standard wait time for an ambulance is eight minutes, though for rural communities, that average increases to about 15 minutes, according to the American College of Emergency Physicians' study "Emergency Medical Service Response Times in Rural, Suburban and Urban Areas."
Communities within the squad's service area are Alford, Egremont, Monterey, Sheffield, southern West Stockbridge and Great Barrington. Southern Berkshire Volunteer Ambulance often travels outside its service area to help other communities through mutual aid agreements.
The other 10 percent of the time, though, Belman's estimate of waiting half an hour to an hour for help is accurate, Hathaway said. There are occasions when the area's resources — medical personnel, as well as emergency vehicles — are stretched so thin, people in need of help are on their own.
"We live in a rural area. [Some people] live close to Pittsfield, but when you get out in Sandisfield, New Marlborough, Otis, Becket, Tolland — you're a long way from nowhere," Hathaway said.
Southern Berkshire Volunteer Ambulance Squad provides mutual aid to all of South County, and it's not uncommon for the squad to be the first truck on the scene — even in towns with their own volunteer departments.
Meanwhile, the number of calls to Southern Berkshire Volunteer Ambulance Squad nearly doubled from 2013 to 2017, from about 1,800 to 3,500, Hathaway said.
Among the communities in South County — Alford, Becket, Egremont, Great Barrington, Lee, Lenox, Monterey, Mount Washington, New Marlborough, Otis, Richmond, Sandisfield, Sheffield, Stockbridge, Tyringham and West Stockbridge — there are 11 ambulances, Hathaway estimated. There are three in Great Barrington, the squad's headquarters; two in Lee; and one each in Richmond, New Marlborough, Sandisfield, Becket, Otis and Lenox.
If a town's only ambulance is out on a run, a second call for help gets put out to surrounding towns, which can increase the response time. It can also take unpaid volunteer departments a while to find two people available to drive an ambulance to an emergency.
Some areas, particularly towns with their own service, are served better than others, but few of the municipal departments have full-time staff, and finding two trained and certified volunteers to drive an ambulance on short notice can be challenging.
"It all depends where you're at," Hathaway said. "The general public, they're not aware that there's an issue. We've been coasting along, but it's only a matter of time."
Working on it
Over the past six months, Hathaway has been visiting boards of selectmen to give them presentations on the service situation.
"They're shocked at what I show them," he said.
South County's ambulance coverage problem has been developing for years and is similar to the emergency service pinch felt elsewhere — an aging, rural population creates more work for ambulance services to far-flung places, all at a time when the historically volunteer-staffed service is finding it hard to attract new members.
Nationwide, nearly 70 percent of communities are serviced by all-volunteer fire and emergency response departments, according to the National Fire Protection Association. More than half of those fire service providers are age 40 or older.
To meet the expanding needs of Berkshire County, Hathaway has grown the ambulance business. In 2013, Southern Berkshire Volunteer Ambulance Squad was running with one paid crew on during the day and a volunteer crew on at night. Today, there are two paid crews — and sometimes three — on staff 24 hours a day, seven days a week, Hathaway said. The staff also includes responders who can provide high-level medical care, seven paramedics and five advanced EMTs.
"We're getting mutual aid calls for Lenox and Lee — places we never used to go to before," Hathaway said. "If I've got all three of my trucks on the road, trying to get coverage here is tough."
Indeed, Hathaway was unable to meet for a planned interview with the Berkshire Eagle on Jan. 12, because he and all his ambulances and staff were answering emergency calls.
Standing in the way of better coverage is a lack of funding and coordination. Many towns don't have an ambulance service and don't have room in their budgets to start one, said Sandisfield Select Board Chairman John Skrip.
"Our population is aging; somewhere down the road something has got to give," Skrip said. "We can't all have police departments, we can't all have full-time ambulances and insurances, and all the maintenance and gas — you multiply that by six towns, it's expensive."
Going forward, Hathaway said he is hopeful that the Legislature will pass a few bills that will make providing ambulance service in rural areas easier. One that will allow an ambulance to do a service run with only one fully-trained emergency medical service provider, instead of the currently state-mandated two, and another to increase reimbursement rates. Pignatelli said the bills have made some progress, but far more work needs to be done.
"It's another great example of an East-West piece of legislation," he said. "The folks down east are used to full-time paid, professionals for everything, but they don't understand that our small towns in the Berkshires depend on volunteers and cannot afford full-time, paid people."
Pignatelli said he is hopeful Hathaway and the Southern Berkshire Volunteer Ambulance Squad might expand services again to better cover the region.
"The time has come, and we have to do something," Pignatelli said. "It's actually an easier fix because of their professional attitudes and their involvement. Maybe they can pick up a few more towns and then make it financially feasible for them to do that. I applaud that initiative, and I'll do all I can to help."
Hathaway said Southern Berkshire Volunteer Ambulance is exploring options but not seeking to expand services at this time.
Belman, the Fairview emergency room doctor and emergency services liaison, said the state needs to organize the towns coming together and figure out a way to establish outposts so that everyone in the county is within 15 minutes of an ambulance.
"There has to be a paramedic, or certainly someone to provide a high level of medical care in a 15-minute period of time. That's what people will assume will happen when they call 911."
Kristin Palpini can be reached at email@example.com and @kristinpalpini on Twitter.
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