WESTERLO — At a town board meeting last Tuesday in Westerlo, board members and residents turned to Debra Mackey, co-captain of Westerlo Volunteer Ambulance, to explain a sudden increase in the town’s 2018 budget — the town must pay about $20,000 more for Albany County Sheriff’s Emergency Medical Services.

Mackey, sitting in the back row of the gallery with her fellow captain and husband, Kenneth Mackey, said she expected the increased cost to the town from the county was due to an emergency medical technician in an ambulance being stationed in the Hilltowns in addition to a paramedic in a vehicle known as a fly car, because it is mobile. She was right.

The paramedic is stationed in Westerlo during the day and in Rensselaerville at night, while the EMT stays in the town of Berne. This arrangement was made shortly after an ambulance was brought in this summer to cover the town of Rensselaerville after its own volunteer squad, Rensselaerville Volunteer Ambulance, closed.

“We didn’t ask for the EMT and the ambulance, it was put here … Nobody told us, nobody asked us; it was just put here.” said Mackey.

Councilman William Bichteman said he was concerned about the cost escalating.

The cost last year, for the county service, was $95,000, and will increase to $121,000 in 2018, said Mackey, and with the ambulance often going off the Hill, Mackey noted that this ambulance was not even a guaranteed service.

According to Brian Wood, captain of the Albany County Sheriff’s emergency medical services unit, the costs are going up for the towns of Berne, Westerlo, and Rensselaerville due to the addition of an EMT post since Rensselaerville Volunteer Ambulance closed this summer. The additional staffing will cost the county $200,000 in 2018, he said. Paramedics are paid around $21.50 an hour, and EMTs are paid around $14.50 an hour, Wood said. This does not include additional costs such as workers’ pension, benefits, and overtime rates, he added.

To cover the cost, the three towns will have an additional amount to pay each year for the next four years, with the amount based on each town’s population.

According to the the 2010 federal census, Westerlo has a population of 3,361; Berne has 2,794; and Rensselaerville has 1,843. Knox, which is not being charged because it does not use the county system, has a population of 2,692.

Westerlo will be paying an additional $20,000 in 2018, then $40,000 in 2019, and finally will be paying $80,000 by 2022. Berne, with a somewhat smaller population, will start by paying $17,000.

Rensselaerville, though it has the smallest population of the three towns, will be initially paying $60,000, because — unlike Westerlo and Berne — it is relying entirely on the county’s emergency medical services. The town had already gone over this cost following its volunteer EMS squad’s closure. It was noted at special Rensselaerville Town Board meeting in June that the $60,000 for basic life support would be added to the $54,500 that the town pays for advanced life support.

Knox, Wood noted, while one of the Hilltowns, will not face this charge because it is served by the volunteer Helderberg Ambulance squad as well as the town of Guilderland EMS. Knox Supervisor Vasilios Lefkaditis said that Knox pays Guilderland EMS about $51,000 annually for advanced life support, and splits $55,000 between Helderberg Ambulance and Altamont Rescue Squad, which provide basic life support.

Westerlo is covered by Westerlo Volunteer Ambulance, and Berne by Helderberg Ambulance, with the county acting as mutual aid and responding to calls when the volunteers cannot answer them.

Rensselaerville without volunteers

According to Rensselaerville Supervisor Valerie Lounsbury, the town’s 2018 budget will include a line item for the basic life support at $60,000 and a line item for advanced life support at $56,977. For the second half of 2017, following the closure of Rensselaerville Volunteer Ambulance, the town will also be paying $30,000 to the county for basic life support coverage. In previous years, the town paid $20,000 for the volunteer service, she said.

County workers may stay at the former Rensselaerville Volunteer Ambulance station, which has sleeping quarters, so they can rest. Like Mackey, Lounsbury noted that the ambulance may have to leave the Hill on occasion to answer a call.

Lounsbury, who is not running to keep her post this year, said she is confident in the county and feels it was a fair amount to pay for services.

“We have, 24/7, an ambulance that’s guaranteed,” she said.

She said she amount of time and effort needed to become certified as an EMT or driver, especially for those who work far away from Rensselaerville and have obligations to their families, in her opinion, has led to the lack of volunteerism. Lounsbury added that there is not much that can be done about this.

“The volunteer service that we are losing is a heartbreaking loss,” she said. “It’s just sad that there aren’t just volunteers anymore.”

Berne has Helderberg Ambulance

Berne town Supervisor Kevin Crosier said that the town pays around $83,000 to $85,000 a year to support a county paramedic who provides advanced life support. He said that, despite the increase, the tentative town budget for 2018 includes a 3.8-percent property tax cut.

Crosier noted that the increased county costs would mean the town should look for future savings elsewhere, such as through sharing services with the county’s department of public works, something the town is seeking to study the possibility of.

“I want to commend [Sheriff] Craig Apple and Brian Wood,” he said, noting that, while the town pays a fraction of the cost for the ambulance, the sheriff’s office will be paying for the difference until the total is paid for four years from now.

Alan Zuk, the president of Helderberg Ambulance, noted that, as volunteerism in the Hilltowns has decreased, the sheriff’s office has had to do more in the Hilltowns.

“It is expensive to have an ambulance staffed, you know, with even one EMT, around the clock is pretty expensive,” he said.

Zuk noted, however, that the county program still depends on volunteers.

“You can never have too many,” he said, of the volunteers on his squad.

The volunteer ambulance squad has increased its efforts to recruit new members, such as having volunteers attend sporting events at Berne-Knox-Westerlo, but even that needs members to be available, he said.

At the Helderberg Ambulance station on Cole Hill Road in East Berne, the sheriff’s ambulance sits alongside the volunteers’, with an EMT continually stationed there. Calls that are not especially serious go to the volunteers, and, if they are not there, the sheriff’s ambulance goes to the call, or if the call is serious enough to need backup, both ambulances go, said Zuk.

The sheriff’s program also provides advanced life support through its paramedic, while the volunteer organizations can provide only basic life support, Zuk noted. A paramedic, he said, has much more training, more advanced equipment, and can provide a higher level of care on the scene or while a patient is being transported.

The ALS program has existed in New Scotland and the Hilltowns since 1995. At the time it was enacted, Zuk was town supervisor, and Crosier was one of the first people to work for the county as a paramedic.

Zuk said of concern about budget increases for county ambulances, “There was the same response to the program 20 years ago.”

Increase explained

All six of the towns that receive mutual aid or direct aid from the county — Berne, Westerlo, Rensselaerville, Coeymans, New Scotland, and Bethlehem — will see at least a 5-percent increase in the cost of aid provided by the county, Wood said.

New Scotland had been served by the volunteer squad, Voorheesville Area Ambulance Service, which lacked members to continue, closing last October. A few remaining members joined volunteers in Bethlehem.

Wood defended the increase in costs, attributing the added expenses partly to a lack of volunteers in EMS squads that leave the county taking a large number of calls — 100 out of 600 in the three Hilltowns since the first of the year.

“Hopefully we’ll bring more savings in from ambulance billing,” he said, referring to the practice of billing a patient’s insurance for ambulance services.

The cost to the towns, Wood explained, covers paying EMTs and paramedics to be available 24/7. The additional costs, such as for fuel and equipment, are covered by insurance billing. Any money left over from that is credited back to the towns, but Wood said he cannot predict how much the county will spend and receive, given the closures in Voorheesville and Rensselaerville in the last year-and-a-half that have led to unexpected expenses.

Out of the providers in Albany County, Westerlo remains the only EMS agency that willingly opts not to charge patients. Others, like Onesquethaw Fire and Rescue in western New Scotland, cannot charge because it is part of a fire department; New York State fire departments are not permitted to charge patients.

Wood noted that the volunteers are still an important factor in emergency services in these areas, and are the ones first called in an emergency.

Debra Mackey said at the Sept. 5 Westerlo meeting that the volunteers, while needed, have felt ignored, or have not gotten similar priority for training.

“They still got to keep volunteers, but, most people know, once you start bringing in paid people, the volunteers kind of get pushed to the side,” said Mackey last Tuesday, though she added that volunteers are still needed by the county.

“So they try to keep us, to some degree,” she added.

Mackey, Zuk, and Wood all  have acknowledged that volunteer ambulance squads have been struggling to keep enough staff members to continue services. When Rensselaerville announced the volunteer ambulance squad would close, Wood, who was a Rensselaerville volunteer as well, lamented that his mother, Brenda Wood, had been covering a majority of ambulance calls due to a shrinking and aging rescue squad.

At Helderberg Ambulance, Zuk said that there are about 25 volunteers, with around half-a-dozen EMTs serving regularly. The volunteer ambulance squad also had five new members join a few months ago, but Zuk said that it can take six months or more to become certified as an EMT and able to serve on a call.

Those who volunteer as drivers or attendants also need to be certified in basic first aid and cardiopulmonary resuscitation; it is less training, he said, but an EMT is needed any time the ambulance leaves for a call.

Mackey had told The Enterprise in July that there are 18 volunteers on Westerlo Rescue Squad, but only about seven regularly volunteer. This includes herself, her husband, and her two sons.

“Volunteerism across the board is probably phasing out,” she said.