Did Guilderland need to create a town ambulance service?

The Enterprise — Elizabeth Floyd Mair 
Alan Fitzpatrick of the Western Turnpike Rescue Squad believes the town should have discussed its need for faster response time with town residents and gotten their input before voting to create its own ambulance squad. Here he addresses the town board on June 5.

GUILDERLAND — Without ever broaching the subject at a previous meeting, the town board voted unanimously on June 5 to establish its own ambulance service, buy a used bariatric ambulance for $52,000, authorize the supervisor to enter a shared-services agreement for the county to use the ambulance, and hire enough emergency medical technicians — 10 part-timers — to staff the ambulance 24 hours a day.

Until Tuesday, all of Guilderland’s ambulance services were contracted with two not-for-profit rescue squads: Western Turnpike and Altamont. The town also has a mutual-aid agreement with several local agencies.

With the decisions made Tuesday, the board was solving a problem that the heads of Guilderland’s medical services say exists between midnight and 6 a.m., when the average length of time it takes an ambulance to arrive is 12 minutes.

Alan Fitzpatrick, president of Western Turnpike’s board of directors, spoke several times at the June 5 meeting, pressing town officials to give more details. He later told The Enterprise, “Something as important as this needs public comment.”

Western Turnpike Rescue Squad’s emergency medical technicians are all paid.

No one from Altamont Rescue Squad was present at the meeting, but the squad knew that the move was coming and has no problem with it, said director of operations Warren Quinn.

Altamont Rescue Squad uses a mixture of about a dozen volunteer and about 18 paid part-time emergency medical technicians.

The town’s plan

The town board voted to establish a town ambulance service; the board heard that the plan is to hire 10 part-time EMTs to cover one additional ambulance that will be operated 24 hours a day, seven days a week. The board also voted to authorize the town supervisor to sign a shared-services agreement with the county for use of the bariatric ambulance.

Finally, the board voted to buy a used bariatric ambulance, capable of carrying severely obese patients, and to make it available to the county when needed — if Guilderland isn’t using it — on a shared-services basis. The state may reimburse half the $52,000 cost, Captain Daniel McNally, who directs the Emergency Medical Services division of the Guilderland Police Department, said this week. The town would not make it available for mutual aid during the overnight hours, McNally said.

The town does not know where this additional ambulance will be housed, McNally told the board. Town officials have had some preliminary discussions with fire departments in Guilderland about possibly keeping the ambulance in a firehouse, he said.

Transparency

Town Supervisor Peter Barber told Fitzpatrick, at the June 5 meeting, that delayed response time has been discussed since 2016.

Western Turnpike Executive Director Drew Chesney said this week that there have been approximately a half-dozen meetings over the last two years on a variety of topics including response time.

He said that the Western Turnpike squad had been asked to provide another ambulance in the overnight hours and had told the town that this would cost Western Turnpike an additional $60,000 or $70,000 in salaries per year.

Western Turnpike had suggested a number of options including that the town use one of the company’s four ambulances not currently in use during the overnight hours — which would save it from having to buy one — as well as that the overnight hours be covered by one Western Turnpike crew member and one of the town’s.

But, Chesney said, “Unfortunately, there was never a reply to those options, and the town felt it best to move forward with the plan that they have now.”

Chesney also said, “There’s a lot of flexibility; there’s a lot of options that could have been part of this discussion, but it just wasn’t apparently of interest to the town.”

McNally told The Enterprise that the board meeting on June 5 was the first time that the matter had ever been discussed with town residents.

There was no public hearing; all of the measures that the town board approved were agenda items requiring no public notice.

“12 minutes”  

McNally said that the decision to start the town service and buy the ambulance is all about reducing the response time in which an ambulance can arrive at night. Getting patients to a hospital faster is crucial, particularly for critical patients with, for instance, strokes or heart conditions, he said.

The average response time now for an ambulance to arrive in a midnight-to-six emergency in Guilderland is 12 minutes, McNally said. He told The Enterprise the daytime average is about seven minutes.

There are currently two ambulances on between midnight and 6 a.m. in Guilderland, one belonging to Western Turnpike, and the other to Altamont Rescue. If both of those happen to be out on other calls when a third call comes in, the town uses its mutual-aid agreement to call in help from whatever ambulance service is currently near the town, such as Colonie’s, the Albany County Sheriff’s, Five Quad’s (the University at Albany’s service), and Rotterdam’s. These calls, in which an ambulance comes from outside the town, are figured into the 12-minute average.

There are four ambulances on during the day, until 8 p.m., McNally said. Western Turnpike’s ambulances serve the town in two “zones” — to the east and west, with ambulances housed near the Westmere firehouse as well as on Carman Road. Having only one Western Turnpike ambulance on at night, he says, can sometimes slow down response time from one end of the town to the other by a few minutes.

Just a week ago, McNally said, a patient with a cardiac problem waited 30 minutes for an ambulance during the overnight hours.  

The town asked Western Turnpike, McNally said, to put on another ambulance crew during the day to meet increased need, and Western Turnpike was able to do that. More recently, though, when the town asked Western Turnpike to add another ambulance, including a crew, at night, the rescue squad said that it was unable to, he said.

McNally said that Western Turnpike’s focus, in response, was its “financial problems,” rather than the public’s need for another ambulance.

He said that, while he doesn’t like to focus on issues of control — “I’m more of a cooperation and consensus type guy” — that experience does give the town pause.

Another similar issue, he said, has been that the town has sometimes needed to pay a paramedic overtime to ride on a Western Turnpike ambulance in place of an EMT, to fill in when, for instance, an EMT calls in sick to Western Turnpike.

He estimated that a paramedic fills in about once a week, and clarified that sometimes it can be managed with a paramedic already on duty, without paying overtime. “What we can’t control,” McNally said, “is when somebody calls in sick for Western Turnpike. We can’t mandate an employee to come to work.”

Asked about Fitzpatrick’s concern — that this represents the beginning of the end for Western Turnpike — McNally said, “I don’t agree with that. If us adding that ambulance … takes some of the burden off Western Turnpike, I see that as a good thing.” He said the town is not asking Western Turnpike to do any less; the town is just adding more, to make sure residents will have sufficient coverage.

McNally also said that the town is trying to act proactively at a time when ambulance services statewide are having a hard time surviving. He asked, hypothetically, what would happen if one morning Western Turnpike’s doors were suddenly closed, although he added, “I’m not saying that’s going to happen.” But if it did, he said, the town would be left scrambling to start an ambulance service.

There is a shortage of bariatric ambulances in the area, Dr. Donald Doynow told the board on June 5. Doynow is the medical director of the Guilderland Police Department’s paramedic unit. Colonie and Clifton Park both have bariatric ambulances, he told the board, but a year ago, a patient in Guilderland needed to wait an hour-and-a-half for a bariatric ambulance, the board was told. A bariatric ambulance is one capable of transporting severely obese patients. It has a larger interior, a hydraulic lift, and a larger stretcher.

Beginning of the end?

When Western Turnpike was asked by the town to put on another ambulance at night, it was “this close” to being able to afford to do it, Fitzpatrick said, gesturing with this thumb and index finger almost touching. He wishes that the town had come back and said, “What do you need?” instead of simply making other plans.

There was no response from the town, he said, and Western Turnpike didn’t hear from the town until it requested a meeting and sat down with town officials; that was the first time Western Turnpike heard anything about a bariatric ambulance, he said.

“We’re in the business; all we need is a little help,” Fitzpatrick said. That would be less costly for the town, he said, than buying an ambulance, hiring new people, and figuring out how to run an ambulance service.

He noted that Western Turnpike has been in operation since 1939.  

Fitzpatrick said that he would like to see the data the town used to come up with the 12-minute average. Those figures and other data should have been presented, he said.

Chesney said that there were times a town paramedic helped out when a Western Turnpike employee had called in sick. He said it might happen two or three times in a month or, in other months, not at all. Referring to the town, he said, “They initially offered up that individual to fill in and help out, but now that counts against us, apparently.”

Town officials had not indicated at the June 5 meeting how many people they planned to hire until pressed by Fitzpatrick.

Western Turnpike board member Benjamin Weaver said, “You need a full plan, especially when you’re talking about the health and safety of the residents.”

Fitzpatrick took exception to the idea of buying an ambulance without knowing where it would be housed. He said he thought the town was “cobbing it together, unless there really is a plan, and they’re just not telling the public.”

Fitzpatrick is a former military man, he said, and, when in the military, he would never have gone to his superiors with a plan for spending money unless he had all the facts and figures at  his fingertips, ready to show them.

Town officials, though, he said, presented only the barest of outlines to town residents on Tuesday night.

“Something as important as this needs public comment,” Fitzpatrick said after the meeting.

“My opinion: Once government starts doing things, it doesn’t stop,” he said.

For Fitzpatrick, this move signals the beginning of the end for Western Turnpike Rescue Squad.

“Eventually what I foresee,” he said, “is Western Turnpike and Altamont folding, and everything working under one umbrella out of town hall, and having to hire a lot of people.”

Fitzpatrick said he reads his tax bill closely and that his tax bill for Western Turnpike’s services have gone up, since 1999, “15 dollars. Maybe 20. Not even the cost of a dinner.” His fire-department taxes, on the other hand, he said, have gone up “significantly.”

Chesney, the executive director of Western Turnpike, said that, in fact, there has been no increase over that period for Western Turnpike’s support. “Nothing at all,” he said.

While there are a lot of ambulance services in the state that are struggling, Chesney said, Western Turnpike is fiscally “very sound.”

Western Turnpike board member Weaver said, “There hasn’t been a reason to think we would close our doors — we’ve got reserves and we meet our expenses.”

Weaver said this week, “I really believe it’s been in the works from their side for a long time, and we just didn’t hear about it until this winter. It was like, ‘We’ve already got this, and we’re just telling you so you’ll play along.’”

It sounded to him, Weaver said, like town officials had been talking about this issue among themselves for a long time, “and we were just invited in at the end.”

Chesney said that, while he thinks the town ambulance will have “some negative effect” on Western Turnpike’s operations, he is not convinced it will push it to the brink.

“It really depends on what the town does next,” he said. “So, they purchased this one ambulance, OK? And, you know, what’s their next step — that we will find out after everybody else does, again?”

He said town officials never told Western Turnpike that their intent was to man the new ambulance 24 hours a day, seven days a week. Western Turnpike was told, he said, a week ago, that the ambulance was to help with the midnight to 6 a.m. situation.

“And now it turned into something completely different,” Chesney said.

‘Everything’s positive from our end’

Altamont Rescue’s Director of Operations, Warren Quinn, said that he viewed the new measures as “a town effort to provide good services to residents.”

He said he had been present at “a couple of meetings within the last six months,” with town officials and members of the Western Turnpike Rescue Squad.

Altamont contracts with both the town of Guilderland and the town of Knox.

“Everything’s positive from our end,” Quinn said, adding, “We contracted with the town to provide an ambulance, and we do that.”

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