Resident Calls for Ambulance, Coverage Upgrade
By Patricia Roy
When Liz Theiler was diagnosed with a heart tumor two years ago, her treatment involved surgery to remove the growth as well as a bicuspid valve replacement.
About eight months later, Theiler felt ill again and called 911 for an ambulance.
Holliston responded in a timely fashion, she said, but with only Emergency Medical Technicians (EMTs) on board, they were limited in what they could do for her.
“All she could do was to hold my hand and say ‘relax,’” Theiler said, referring to the limits of treatment an EMT is allowed to provide.
EMT Basic level treatment, which is what the town’s ambulance provides, generally means patient assessment, first aid and transport.
Since Theiler’s situation involved a heart patient, Ashland ambulance with its Paramedic level staffing and a portable electrocardiograph machine was called, arriving about 15 minutes later to transport her to Newton-Wellesley Hospital. This is known as Advanced Life Support or ALS staffing.
In spite of the wait for a second ambulance to respond, Theiler considers herself lucky. It takes two EMTs to man an ambulance call and there are not always two on duty at the Holliston station. In that case, a second EMT has to be called in by the dispatcher. If no one responds, the call must immediately be passed on to another town or a private service.
Theiler was unsure of the amount of time it took the town’s ambulance to respond in her own case, but taking on the additional wait for an upgraded ambulance shouldn’t have to happen, she thought. Nor should anyone have to wait for a second EMT to provide ambulance staffing when there could be a full-time roster.
“I don’t comprehend it at all,” Theiler said. “To just leave it wide-open when it comes to people’s health and safety is not reasonable.”
Her experience prompted Theiler, a researcher who has a PhD in biomedical chemistry to become an advocate on the issue of coverage.
“Our town is staffed by paid on-call EMTs,” said Fire Chief Michael Cassidy. “We strive to have three members on each ambulance shift, exceeding the state minimum staffing of two.”
Having the third member available helps with division of labor, lifting and moving patients and a faster turnaround time at the hospital, he said.
There are 17 EMTS who regularly work ambulance shifts, he said.
“There is not always at least one EMT at the station,” he acknowledged. “Most shifts there are one or more EMTs at the station, but not every shift.”
Shifts are 12 hours (6 a.m. – 6 p.m. and its opposite) and the town changed its pay structure last summer to incentivize personnel to be at the station for a full shift.
The move was successful, Cassidy reported.
Mobilization time (from unit notification to en route status) was reduced from an average of 4 minutes, 28 seconds to 3 minutes, 52 seconds. Response time (unit arriving on scene) was also clipped from 8 minutes, 10 seconds to 7 minutes, 22 seconds.
Police officers are often first on the scene, he said, and they are equipped with first aid bags, oxygen, defibrillators, glucose and naloxone. Triage and treatment can begin even before the ambulance arrives, he said.
Theiler remains critical of the apparent staffing shortage and the lower level of care provided by the town ambulance service.
“What does a hole in coverage mean to the resident who calls 911 for an infant or ill family member?” she asked.
Most of the surrounding communities have ALS coverage or in the case of Sherborn, two EMTs are paid to be mat the station at all times, she said.
The Municipal Resources, Inc. (MRI) a study on fire and emergency medical services commissioned by the select board made recommendations for ambulance service upgrades, warning ambulance staffing shortage is a slowly building crisis.
The MRI study suggested a number of fixes to be made over three to five years.
About 70 percent of calls to the fire station are for an ambulance, Theiler said.
According to FireNews online, the town has more than 1100 ambulance calls each year.
Theiler suggested new job descriptions be posted that require new hires to work a certain number of shifts at the station while offering a pay differential for holidays and weekends.
Currently, EMTs are not required to work one shift a week to maintain health benefits, she said, but are only required to work nine shifts in a quarter.
She objected to Fiscal Year 2024 budget request for funding to create three auxiliary fire officer positions that were not recommended by the MRI study at a rate of $35 per hour.
“This money should be used to hire EMTs or paramedics required to work at the station so that Holliston would have a sound and timely Basic ambulance service while we advance to ALS service which is the standard for our region,” Theiler said.
The EMT shortage is nation-wide, Cassidy said, providing a CBS report from Dec. 22, 2023. Low rates of reimbursement from Medicaid for non-emergency transport has worked to depress wages.
Currently, about 39 percent of EMT positions and 55 percent of paramedic positions have gone unfilled nationally since the COVID pandemic, the report said.
Theiler called back to the MRI study that stated on page the operational deficit of the town’s ambulance service “should not be dismissed as acceptable and should be recognized for the operational crisis and risk it represents to the town.”
“Holliston residents should not have to wait three to five years to have reliable EMS treatment,” Theiler said.