Two ambulance services have closed in New Hampshire this year. Berlin EMS closed this April, taken over by their fire department, and most recently, the Warren-Wentworth Ambulance Service shut down earlier this month.
Chris Stawasz has worked as a paramedic and EMS service administrator in New Hampshire for 40 years. He’s also on the board of the New Hampshire Ambulance Association. For him, these closures reflect larger issues currently faced by ambulance services across the state and especially in rural areas. Stawasz spoke with NHPR’s All Things Considered host Julia Furukawa about the state of ambulance coverage in New Hampshire.
Transcript
So what does ambulance service coverage look like right now across New Hampshire?
Like most things in New Hampshire, you get north of Concord and it's a kind of a different world. In the populated areas of the state, they are very fortunate to have full time emergency medical services at the paramedic level, which is really the gold standard that you want to have.
And then north of Concord, where it's a little more rural and much more rural in some cases, there are still communities that rely on volunteers. They don't have full time services. The coverage with paramedics is sparse to nonexistent, in some cases. So [ambulance coverage is] dramatically different.
Chris, from your perspective, why are these ambulance services closing? What's the most acute issue they're facing?
I think it's a variety of things, not unlike anything else in healthcare. We've had a very difficult time recruiting and retaining qualified staff.
Historically, fire and ambulance in many, many small communities was staffed and staffed quite well by dedicated volunteers of the community. Unfortunately, over the last, I'm going to say 10 to 15 years, and particularly after COVID, it became even more challenging to find people that would be willing to volunteer, do those positions and keep up with all of the demands for continuing education and learning that have to go along with those positions as well.
The reimbursement, unfortunately, hasn't caught up to the inflationary factors that we have all experienced in healthcare with the higher costs of materials [and] the higher cost of fuel in our case because we rely a lot on that with vehicles.
When you say reimbursement, you're talking about insurance.
We are. The number one group that reimburses for emergency medical services is Medicare. But Medicare actually hasn't rebased its payment system in almost 30 years. They haven't looked at the overall cost and the costs that are related to providing the services and determine what that is for over 30 years now.
Chris, how have you seen these closures affect people and patients who use these services, especially when the situation may be critical?
Well, in many cases in rural New Hampshire, it is very difficult to move a patient in a timely fashion in an ambulance if they need to get moved to a different facility. The resources that previously were there are just not there anymore. It is not cost effective or [it doesn’t] even cover the cost to go up and move a patient from a far, distant facility to one down, let's say, in the southern half of the state.
In 2023, the New Hampshire Ambulance Association published a report that found that emergency medical services in New Hampshire were in a “state of emergency.” What does that mean? Are we still there?
I think we are. I think that things have gotten marginally better. Certainly our ability to train and hire new people was bolstered. Governor Sununu had made some money available from some of the government funding, ARPA money, I believe it was, that came through to allow us to train individuals and pay them while they were being trained. So that was a big boost for a lot of people.
I think we've been successful in drawing people into the profession now that COVID has passed. So it's gotten better from that standpoint, but it's still a system that lags behind, due in large part to the demands that are on it from a human perspective and the reimbursement that's available to pay people because of what we are able to collect from insurers.
If you look across the U.S., there are a number of different models that exist of how ambulance services [are] provided to communities. A lot of states provide it on a countywide basis. You know, New Hampshire has historically only done, I think it's nursing homes, jails and a very limited amount of services from a county perspective. But many other states, you know, live or die by the county, everything that's provided in the state is broken up into a county system. Is that right for New Hampshire? I don't know. Listen, I'm a New Hampshire guy. You love to have local control, but at some point, you have to look at the economies of scale and what you're able to provide, how much it's going to cost and how effective it's going to be.
