Ambulance service: NDP in North East

NORTH EAST — A lack of volunteer manpower is what was at the root of the town of North East’s need to contract out for ambulance service at the start of this year. Thus far its agreement with Northern Dutchess Paramedics (NDP) is turning out to be a good one, according to both the town and NDP. The Millerton News met with representatives from both for a sit-down interview to assess how the arrangement is working out, and what town residents are getting for their tax dollars.

“You know the travails that got us this far,” said North East town Supervisor John Merwin, referring to the North East Fire District’s letter to the town that stated it would no longer be able to provide daytime ambulance service come Jan. 1, 2015. “So far [the arrangement with NDP] is above expectations. Of course, we knew what we were getting because of their track history.

“We’re glad they’re in our community,” he added. “We took this issue seriously and wanted to make sure our community remained protected.”

The cost

The $180,000 annual contract between the town and NDP is for 24-hour Advanced Life Service (ALS) and Basic Life Service (BLS) coverage to town residents with a 15-minute response time (a $100 per minute penalty kicks in if more than 10 percent of calls have a response time longer than 15 minutes). For a household assessed at $150,000 that adds about $57 onto the tax bill; for a household assessed at $250,000 that adds $96; and for a household assessed at $350,000 that adds $134. 

“That’s why we think it’s the best of both worlds — a good contract with a good company at a fair price,” said Merwin. “Protecting our community was essential and we weren’t going to walk away from it.”

The contract commits Northern Dutchess to the town whereas previously the ambulance company provided auxiliary care to the Millerton Fire Company’s Rescue Squad.

“North East prior was not a responsibility of ours,” said NDP President and CEO Edward B. Murray. “Now it’s a firm commitment.”

NDP has an outpost on Route 22 in the town of North East,  just south of the village of Millerton (total town population clocks in at 3,031). It was there for about seven years before moving to Dover, where it also has a contract with the town. Once it joined forces with the town of North East it moved back to those offices, right next to the Jehovah’s Witness meeting hall. Its central location means that NDP will also continue to provide ancillary care to rescue squads in Amenia, Wassaic and Pine Plains, though Murray said that’s getting “harder and harder to do.

“It’s fiscally tough to staff for those not providing us a subsidy,” he said. 

“Call volume is up and transport times are longer,” added NDP Director of Operations Mark Browne. “It’s certainly not an issue limited to Millerton.”

In addition to being subsidized by North East and Dover, NDP is also under contract with the town of Hyde Park, the hamlet of Staatsburg and five towns in Columbia County.

The need

The fact so many municipalities find it necessary to contract out for ambulance care goes to show how tough it is for people to volunteer their time these days.

“That’s the way it’s going with dual-income, multi-job families,” said Murray. “Nobody has the time to walk off their job like in the old days. And to provide certification [is demanding]; in New York state you must recertify every three years. Continuing medical education adds more and more time to people who go uncompensated.

“It’s the perfect storm for volunteers between the economy and training requirements — it’s unfortunate,” he added.

“It made it a necessity to look for not only 12-hour coverage but for 24,” said North East town Councilman George Kaye. 

The result has been more than satisfactory, to both sides, according to Murray.

“It’s only been a couple of weeks but so far it’s good,” he said, adding that NDP has had no problems keeping up with its contractual obligations, including the 15-minute response time.

“Thunderstorms, trees down, snowstorms — those are things we just don’t have control over,” said Murray about possible reasons for delay, “but we’re confident that’s not going to be an occurrence of any regularity.”

He said he based that assessment “on historical agreements with other municipalities.”

Community para-medicine

In the future Murray and Browne said there may be more care at home, versus having to be transported to hospitals or emergency care facilities.

“We’ll be allowed to bring the emergency room to your living room,” Browne said. 

“That’s going to develop as communications become stronger,” said Murray. “We should be able to interface [with all of the players] at the same time. It’s got really good potential.

“Plus, the nation is moving in the direction of community para-medicine, where the paramedics arrive and give treatment as  opposed to being transported,” he added. “The way with hospitals overcrowding and urgent care centers gaining popularity that trend is there.”

ALS vs. BLS

The question is whether that ambulatory service will provide ALS or BLS care. 

“ALS brings a collection of different medications that can be administered in the field,” explained Browne. “Cardiac monitoring, EKGs, advanced airway equipment — it’s a skill set that requires paramedics to have a two-year circuit as opposed to EMT [Emergency Medical Technician] circuit of six months.”

EMTs only have to have BLS training. 

The cost for such care, whether ALS or BLS, depends largely on one’s insurance provider. Medicaid and Medicare have fixed costs with minimal copays ranging between $40 and $60. Private insurers, depending on the coverage, could have a net deductible from zero to several hundred dollars. NDP, Murray noted, isn’t seeking to raise costs.

“It is not in our own interest to make people struggle, so we work with everybody who calls us to say they need help paying,” he said, adding the billing component for North East residents won’t change due to the contract with the town. Those with questions about their bills are asked to call 845-876-3860; for ambulance service call 911.

Murray also remarked that the cost different between ALS care and BLS care is “negligible” for the consumer.

“The equipment is different so it’s different to equip an ALS ambulance,” he said. “It costs over $100,000 in excess of the price of the vehicle. There’s significant overhead, but it does not make a difference to the consumer because the cost is fixed. There’s a slightly higher charge to the ALS cost but it’s not significant.”

Among its ambulance fleet, NDP has the only bariatric emergency truck in Dutchess County. Bariatric trucks cost roughly $25,000 to outfit and can care for the morbidly obese.

Staffing

Regardless of what type of care is needed, most ambulances are manned by two people: one paramedic (ALS certified) and one EMT (BLS certified). About 50 rescue workers staff the North East office, with eight typically serving on a given shift. Those 12-hour shifts rotate to make the most of workers’ abilities.

The decision

Knowing that serving on a rescue squad can be extremely demanding, not to mention exhausting, Murray and Browne said they were sympathetic to the town’s plight.

“John [Merwin] and George [Kaye] worked really hard to get this done and they’re to be commended for their proactive approach,” Murray said. “This takes some fortitude.”

“Another group that needs to be commended for recognizing the problem is the fire department,” said Browne. “It’s hard to admit you’re struggling and make sure your constituents are cared for.”

Millerton Fire Chief Keith Roger, who could not attend the sit down with this newspaper, NDP and the town, said he’s just glad to know that residents have the care they need.

“So far everything has been great; it’s going smoothly so there have been no problems that have come about,” said Roger. “We’ve worked pretty closely together with NDP in the past several years and they’re very professional and very courteous and they understand the needs of Millerton. I think the taxpayers feel pretty comfortable with them.

“It’s unfortunate circumstances that we had to go to the tax base but we had to and that’s just the way it is,” he added. “This was really going on for about seven years, but this year we nailed it and didn’t back off because the need was there.”

“They recognized the issue several years ago — that it was a crisis,” said Merwin of the fire district. “This is why we had to act the way we did. We tried this and tried that — we’ve been there — but this is a serious matter and only had one way to rectify it.”

Kaye added that it was “difficult to turn away from a community-based rescue crew who knew all of the players in town and could provide that personal service,” and contract with an outside provider, but that it was necessary. He added one last thought.

“I think our Town Board recognizes the valuable service of our fire department and Emergency Medical Service (EMS) that these people have provided,” said Kaye. “It’s something that we are extremely grateful to have had. There’s no way that we can really thank them enough for what they have done for the community.”