5.13.25 – Telegram & Gazette (Worcester, Mass.) – WESTBOROUGH
Emergency medical services across Massachusetts are under significant strain due to increased medical calls, a shortage of trained personnel, and high operational costs, according to fire chiefs, including Westborough Fire Chief Patrick Purcell and Auburn Fire Chief Stephen Coleman. The situation has been exacerbated by the closure of hospitals and inadequate reimbursement from insurance companies for ambulance services, leading to reliance on mutual aid and longer response times.
Only two of the nine staffers working the day shift at the Westborough Fire Station May 8 were at headquarters around noon. The rest of the crew was out on ambulance runs — one a motor vehicle crash involving a pregnant woman, the other a call about an unconscious person at the VFW.
Both incidents required the crews to transport a patient to UMass Memorial Medical Center — University Campus in Worcester, less than 10 miles away. Despite the distance, the trip could take 30 minutes or longer, depending on traffic.
The back-to-back calls left only the shift commander, Capt. Craig Rossi, and firefighter Patrick Sheridan at the station in case of another emergency é enough personnel to staff a third ambulance but not enough to run the engine to a fire.
Ostensibly, the department staffs the station with 11 crew members per shift — four assigned to the engine, two to each ambulance, and the shift commander. In reality, the chief has a nine-member daily complement on duty when accounting for time off.
On that particular day, an additional call would have stripped the station of first responders and forced Chief Patrick Purcell to use the state’s mutual aid conventions to call surrounding communities for help.
While fire departments across the commonwealth all respond to calls for mutual aid, waiting for an out-of-town ambulance or firetruck to arrive can cause significant delays in response time.
“Every fire chief managing an EMS service currently is walking a high wire right now,” said Purcell, the incoming president of the Fire Chiefs Association of Massachusetts. In describing the situation, Purcell, while moving his hands as if rearranging dominoes, said that the chiefs in the region move crews and equipment between communities on a daily basis.
Stressing the service, Purcell said, is an increase in medical-related calls; a shortage of resources, mainly trained personnel; and the high cost of delivering service. It’s a situation plaguing fire chiefs who run EMS service from their departments throughout the state, Purcell said.
According to the state Department of Public Health, which governs EMS services in Massachusetts, the lack of personnel is a nationwide trend. The department indicated that while the number of certified EMTs and paramedics in Massachusetts has held steady at around 26,000, in the last few years, the portion of this group that actually works staffing ambulances continues to shrink.
Calls have increased significantly
Auburn Fire Chief Stephen M. Coleman Jr. said calls for service jumped by 500 in the year from 2021 to 2022. Since then, calls have increased by an average of 100 a year, topping out at 2,610 last year; averaging more than seven a day.
“EMS is relied on more than ever,” Coleman said, adding urgent care and other quasi-medical facilities add to that pressure. Urgent care centers routinely call for an ambulance if a medical emergency is out of their scope of service. Senior living facilities also rely on EMS and fire departments to transport residents who fall ill.
One fire chief called local EMS services “a safety net” for urgent care centers.
At the heart of the problem is the lack of a unified and coordinated plan for health care in Massachusetts, said Sen. Jamie Eldridge, D-Marlborough, whose district includes Ayer, home of the now-shuttered Nashoba Valley Medical Center.
Eldridge cited a patchwork system of EMS providers: Some communities are serviced by private ambulance companies, while others, like Worcester, are served by an ambulance team run by UMass Memorial Medical Center. While the city’s Fire Department responds to all 911 emergency calls, it’s the hospital-run crew that’s responsible for transporting patients.
A spokesperson for the Department of Public Health noted that EMS services are provided on a local level, with response times and operational plans set locally. Local administrations determine the number of ambulances they need based on their resources, population, historical call volume data, and other demographic factors. There is no state law or regulation that governs local decisions regarding the number of ambulances to operate.
In addition, the state must approve an EMS service zone plan that identifies a municipality’s primary ambulance service, sets EMS performance standards, inventories its EMS and public safety resources, and sets out an operational plan, according to the spokesperson.
While service zone plans are required, the DPH’s Office of Emergency Medical Services has no authority to enforce this requirement, according to the spokesperson. The EMS staffing challenges are felt by all sectors of the health care system. Hospitals are also experiencing capacity constraints due to patient volume and staffing shortages, which contributes significantly to ambulances and their EMTs being tied up waiting in emergency departments.
The state has also not set fee schedules or determined who pays for an emergency transport.
Who covers the cost?
Purcell said that when fire officials seek reimbursement for ambulance transports from many health insurance companies, they are denied payment as fire departments are considered “out of network.”
The back-and-forth has been ongoing for the last decade, Eldridge said.
“Does health insurance cover the cost or does the consumer?” Eldridge asked, citing a scenario where a heart attack patient received a bill for transport a month after the incident for $5,000 to $10,000. “Should the fire department absorb the cost?”
The senator is advocating for a regional planning office to address EMS and ease the burden placed on municipal first responders.
“We need a robust office to ensure better EMS services,” Eldridge said, citing the increase in the numbers of senior citizens now living in Massachusetts, as well as the impact of opioid overdoses. “We’re working blind here.”
Richard MacKinnon, president of the Professional Fire Fighters of Massachusetts, an organization that represents more than 12,000 firefighters, called the EMS situation in Massachusetts “a perfect storm, in a bad way. Many of our departments are not staffed adequately; they have a dual role and must be ready to respond to all calls.”
MacKinnon and fellow chiefs have cited a decline in applications for all first responder positions, from police and fire to EMS, that is also taxing departments.
“We’re seeing a decrease in the number of applicants,” said MacKinnon, blaming low pay, round-the-clock work schedules and the need for a better work/life balance.
“Younger firefighters don’t want to work around the clock, nights and weekends. Or be held over into the next shift if a colleague calls out,” MacKinnon said.
The bankruptcy of the former Steward Health Care System hospital in 2024 that precipitated the closure of two of its regional hospitals has severely taxed the fire departments that served residents who relied on those hospitals for medical services.
Regional fire chiefs complain of longer travel distances to medical facilities and longer periods of inactivity once they arrive at a hospital.
That stress is not limited to departments directly affected by those closures.
Foxborough Fire Chief Michael Kelleher, outgoing president of the state fire chiefs association, said the issues affecting fire departments that fed into the Nashoba Valley facility are affecting fire departments statewide.
At a January meeting of the Massachusetts Municipal Association that featured a presentation on the state’s mutual aid system, Kelleher said the “health care system is a mess,” pointing to the loss, over the last decade, of hospitals and hospital services. According to a document prepared in 2016, at least nine facilities closed or lost services. The document did not include the two Steward Health Care sites.
“Over the last 20 years, Massachusetts has lost many hospitals. We’re waiting longer for beds to open up for patients to transfer care,” Kelleher said. “We’re providing care for people in (hospital) hallways.”
A small department like Ayer employs 19 career firefighters who are cross-trained, able to respond to fires as well as medical emergencies.
A four-member crew is assigned to a fire apparatus; two crew members run the ambulance. Ayer hires highly trained paramedics to run its advanced life support rigs. These vehicles are staffed with crews who can perform complex interventions such as intubation, IV administration and cardiac monitoring. In addition, the ALS rigs are stocked with more sophisticated equipment, such as ventilators, defibrillators and IV pumps.
In the past, 70% of calls to Ayer EMS were routed to the Nashoba Valley Medical Center, said Ayer Fire Chief Timothy Johnston. Those short trips with fast turnaround times ensured there was an ambulance in town available for the next call. Now the 3-mile trip to the medical center has turned into a 12- or 16-mile trip. Crews can spend anywhere from one to almost three hours out of service on a call.
“The ambulances are gone much longer because they respond out-of-district,” Johnston said. With the two ambulances and their crews gone, Johnston has had to recall off-duty firefighters to fill in gaps, then invoke the mutual aid system.
“We’re holding our own, for now,” Johnston said. But the calls for service have increased. February was the department’s busiest month with 305 calls. “At times, I don’t know how we’re going to sustain this level of service.”
Johnston has to take his employees’ health and well-being into consideration.
“Sure they are paid overtime, but the pace of calls take a toll on staff,” Johnston said.
In Westborough, Purcell declines to recall off-duty staff.
“I try to leave people alone on their days off. You don’t want to exhaust the staff,” Purcell said.
His shift commander, Rossi, said always being out on a call is “exhausting. When the calls come in, when the lights go on, your heart rate goes up, you can’t control it, it’s a natural reaction,” he explained. “You feel it at the end of a 24-hour shift, the exhaustion.”
Firefighter Patrick Sheridan, 34, agreed: “You’re always ready, you don’t know what’s going to come in on a call.”
Healey proposes significant funding for EMS providers
In response to a letter signed by 13 fire chiefs and as many state and local legislators, Gov. Maura Healey added $10 million to her supplemental budget, filed in April, for distribution to fire departments hit hard by the shuttering by Steward of Nashoba Valley Medical Center and Carney Hospital in Boston.
In the letter, the chiefs requested enough money to cover the added costs of running their departments for the next two years, $350,000 per department per year, as well as a $500,000 stipend to fund an independent study of the Nashoba Valley EMS response system.
“Governor Healey heard clearly from local officials, medical professionals and residents across the state, especially in communities impacted by Steward Health Care’s closures, that they need more support when it comes to emergency services,” said Karissa Hand, a spokesperson for the governor. “That’s why she proposed significant funding for EMS providers that have faced extraordinary costs in her recent supplemental budget. We appreciate the Legislature’s consideration of this important proposal.”
The state department of public health indicated there are efforts to ease the situation regarding ambulance availability and the demands on the EMS system.
Massachusetts has implemented a “mobile integrated health” program that uses EMS personnel to deliver nonemergency medical care to patients while they are still at home or in nonhospital settings. Expanding the program may reduce demands on hospital emergency departments while allowing patients to be treated at home.
However, Purcell pointed out, these programs come with a price tag, and only 11 have been implemented in the state to date.
Information on the state website indicates a $13,000 cost to apply for the program.
The Ayer Fire Department recently purchased a special paramedic car with a $250,000 state department of public health grant. The car, staffed by a paramedic, is designed to meet with EMS crews to provide a stepped-up level of service. It is not a transport vehicle.
Mental health calls continue to surge
Transports of residents suffering mental health issues also cause overcrowding at ERs.
Coleman points to the crisis in mental health and lack of treatment centers and beds for Massachusetts residents suffering through a crisis.
“When a family member is suffering through a crisis and they call their primary, or even a mental health hotline, the first instruction they receive is to call 911,” Coleman said. Ambulance crews respond, deescalate the situation and then transport the patient.
In some ways, the public campaign for 911 emergency response has worked too well, Coleman said. Years ago, people resisted calling for emergency help; now calls to 911 are routine.
Leominster Mayor Dean Mazzarella concurred.
“The faster paramedics can get to people and start care, the better the outcome,” Mazzarella said. He is calling for the state to “step up to the plate” to ensure uniformity of EMS service across Massachusetts.
Chiefs have also suggested that EMS services be housed under the Executive Office of Public Safety rather than public health. Some have suggested that ambulance crews could transport patients with non-life-threatening conditions to urgent care centers for treatment rather than emergency rooms to ease the crunch.
Mazzarella rides around his community listening to police and fire calls coming in on scanners. “I hear dispatchers looking for available personnel,” Mazzarella said, adding that many times, local dispatchers will be calling for the next town over for help.
“But this isn’t a cab service, it’s not Uber,” Mazzarella said. “When an ambulance is called to an emergency, that call should not be delayed.”