Madison Ambulance Director, Board President Express Concerns About Staffing Levels At Night

Madison residents, this time of year, are potentially vulnerable at night if they have a medical emergency, according to the head of Madison Ambulance Association and the president of its board. That is because funding levels, and the town's contributions to those funding levels, do not allow for the kind of coverage that would be optimal for a town of this size and population, they say. 

Madison Ambulance Association Director Chris Bernier and Madison Ambulance Association Board President Samuel E. DeBurra, Jr. said that when they draft their budget request, to be submitted in December and discussed as part of overall deliberations on the town budget in January, that they will once again be asking the town to provide sufficient funding to provide adequate coverage around the clock. 

For the past two years, they said, they have been disappointed after making that request. 

"Not receiving funding at a level that is adequate"

"We are not receiving funding at a level that is adequate to provide for the town's safety," said DeBurra. "Maybe the town needs to re-look at its priorities." 

From June or July until October, Madison is covered by two ambulances during the daytime, both with a paramedic and an EMT. During that time the town is covered by two ambulances at night as well, both with a paramedic and an EMT. 

At the beginning of October, when the town’s population drops, that coverage shifts. From 7 a.m. to 7 p.m., the busiest time, there are still two ambulances, both with a paramedic and an EMT. But, from 7 p.m. to 7 a.m., there is only one paramedic in a fly car, and one ambulance with two EMTs. 

Some response times as long as 45 minutes

That means that if one call comes in that requires the paramedic and ambulance to travel to Yale New Haven Hospital, for example, additional calls have to be covered by a call-in crew, if crew members are available, or by summoning mutual aid from a surrounding town. 

One Madison parent, who said she would prefer that her name not be used, said she knows of three incidents where it took about 45 minutes for an ambulance to respond, including two incidents that involved broken bones and a third that involved a sports injury. 

She wanted to know if Madison residents are vulnerable at night. 

"We don't want to panic people"

"Sure. Yes. Potentially they are," said Bernier Thursday. "We don't want to panic people. But if that one ambulance is out on a call, it could take anywhere from 15 minutes to 45 minutes to get an ambulance from a surrounding town, depending on where it has to come from." 

Both Bernier and DeBurra said the town's dispatchers, and emergency service providers do the best they can to keep response times low. The dispatchers, if they get multiple calls, work to get all of the information they can to triage the calls. The town's police department and volunteer fire departments do respond to calls. They can provide a basic level of medical care. Bernier said he did not know of any emergencies where someone died because an ambulance did not arrive in time.

But for some emergencies, a paramedic with advanced life saving skills is the best option.

"Like three legs on a stool"

The ambulance association, a non-profit 501(c)(3) emergency medical service organization, is funded in part by insurance reimbursements, with Medicare and Medicaid being the largest payor in that category; in part by donations from residents; and in part from the town. 

"It's like three legs on the stool," Bernier said. "You take out any one of them and the stool falls over." 

Bernier explained that with the Medicare/Medicaid reimbursements, the ambulance association has to write off about $500,000 each year from its normal billable rate. "That is money that does not come back into the community," he said. It also sometimes takes a long time to get insurance reimbursements, due to litigation involving an accident, for example, or because two insurance companies are trying to figure out who should pay for what, he said. 

"People are very generous. We are very grateful."

When it comes to donations, both DeBurra and Bernier said, the Madison Ambulance Association is very lucky. "People are very generous," Bernier said. "We are very grateful." 

When it comes to town funding, both DeBurra and Bernier said the town should rethink its priorities and provide more funding to support additional paramedic support.

Bernier said the town's ambulance coverage was improved in May of 2011. Prior to that time, Middlesex Hospital provided service that--for 24 hours a day, seven days a week, all year--provided one paramedic. In addition, Madison Ambulance provided a fly car for the paramedic, and an ambulance staffed with two EMTs. Paramedics can provide a higher level of medical care than EMTs. 

In May 2011, Improved Coverage With Same Budget

After May of 2011, after learning that the service provided by the hospital was going to increase in cost, Madison Ambulance decided to staff its own paramedics and EMTs, and, in making that shift, was able to provide additional coverage to the town. The ambulance association was not getting any more money, it was just using it more wisely, Bernier said. The town was able to improve its coverage to provide two ambulances from 7 a.m. to 7 p.m., both with a paramedic and EMT and from 7 p.m. to 7 a.m., a paramedic in a fly car and one ambulance with two EMTs. 

While that did improve coverage, DeBurra and Bernier said that an analysis of response times showed that two paramedics and two EMTs, day and night, would provide optimal coverage for the town. 

For the 2012-2013 budget, the ambulance association made that case to town officials during the budget process. They requested funds to add one more paramedic, but the town decided to partially fund that request instead. The ambulance association received an additional $35,000 that budget year to bring the amount it gets from the town, for capital expenditures and operations, to $415,000. (There is a separate town fund for large equipment purchases like a new ambulance).

Service Shifts At Beginning Of October 

DeBurra and Bernier said the ambulance association decided the best course of action was to increase coverage during the summer, when the town's population increases substantially with the arrival of summer residents and day vacationers at Hammonasset Beach State Park and other beaches. That leaves the rest of the town with lower levels of coverage during the remainder of the year.

The Board of Selectmen and Board of Finance said during the 2012-2013 budget season that, if the ambulance association, after evaluating response times and incidents, still thought it needed more, it could make that case during deliberations for the 2013-2014 budget. During deliberations for 2013-2014 budget, the ambulance association again asked that its budget be increased, to about $515,000 from $415,000, to increase staffing levels to two ambulances, each with a paramedic and EMT, year round, day and night

That request was turned down. 

"Very frustrating" 

"It's very frustrating to see where this town's priorities are," said DeBurra. 

"Very frustrating," Bernier agreed. Bernier said that staffing an ambulance operation below optimal levels affects not only the immediate town, but other towns in the region as well, since a system of mutual aid is in place.

Bernier and DeBurra said they are in the process of preparing their budget request now and plan to, again, ask for the town to pay enough so that the town has adequate coverage for all of its residents, the whole year. 

“We do always appreciate the town’s support and the community’s support as well. We would not be able to do it without them. But we just want to make sure town has optimal coverage.” 

Bernier said that if town residents have any questions about the ambulance operation in general, or if they have any specific concerns, that they can contact him at his office at 203-245-9821.