What to do about ambulance service in Hinesburg took up the lion’s share of the selectboard meeting on Monday, Oct. 7.
The decision has become more complicated since the town was notified in January that St. Michael’s Rescue would stop providing ambulance service to the town on June 30, 2020.
As Hinesburg Selectboard Chair Phil Pouech said more than once at the meeting: “I went into this with my eyes only half open.”
The board has discovered that there is a lot more to the decision than they first thought, he said.
Town Administrator Renae Marshall and selectboard member Merrily Lovell presented a summary of what has transpired so far with the ambulance committee.
The summary relates how the selectboard formed the committee in early June to look at the options and how much each option would cost. The assumption at the time was that the committee would make a recommendation to the selectboard about whether Hinesburg should start its own ambulance service, contract with another ambulance service or do nothing and rely on mutual aid from surrounding ambulance services.
After several meetings, the committee determined that the issue was much more complicated and asked the selectboard to hire an unbiased expert as a consultant. But the selectboard discovered the cost for a consultant was extremely high.
So, the committee held a meeting with department heads from a number of nearby municipal and private ambulance services – UVM Medical Center HealthNet Transport, St. Michael’s Rescue, Burlington Fire, Essex Rescue and Williston, as well as Lovell, Marshall and Hinesburg Fire Chief Al Barber.
Hinesburg ambulance research summary
Lovell reviewed the summary and said the committee’s research and discussions resulted in three options:
• Hinesburg could contract with an ambulance service from another town. And the only viable options for that are Richmond and Charlotte.
She said Richmond has put forward a proposal, recommending that they would cover the eastern side of Hinesburg and that Charlotte would take the western side.
• “Another option is to have Hinesburg have its own municipal service,” said Lovell. “We really looked into that thoroughly because that is kind of a risk because what happens if we’re not ready.”
• The third option is a mix of a two, she said.
“And regionalization,” said Marshall, adding a fourth option. She said a regionalized ambulance service isn’t currently a possibility in Chittenden County, but it may be in the future, possibly in 10 years or so.
“There are benefits and detriments to each option,” said Lovell. “Where the pedal hits the metal is on July 1, 2020, when St. Mike’s is going to end its service. If we decided tonight, ‘Yes, we want Hinesburg to have its own ambulance service,’ we could not do that by the deadline.”
One key reason is that it takes the manufacturer 18 months to outfit an ambulance fonce it is ordered.
Training to be an ambulance service
It will also take some time for the Hinesburg’s first responders to trained as an ambulance service.
“They know how to do first response, but when the ambulance gets there, their job has been done,” said Lovell. She said the paperwork that happens at the hospital is complex.
“The biggest piece is what happens from Hinesburg to the hospital,” Marshall said. “The transport in the ambulance, the ongoing communication with the hospital, the route-taking assessments of the patient, taking vitals and reassessing, taking vitals and communicating that with the doctor.”
Contracting with another town like Charlotte or Richmond would be a benefit because it would cost less than starting an ambulance service, but a benefit of starting an ambulance service in town would be much faster response times, said Lovell.
Pouech said that the town could do nothing and rely on mutual aid, but that they would be at the bottom of the list when it comes to response time.
Lovell said that another problem would be “that everybody hates us” because the town wouldn’t be contributing.
“The idea of mutual aid is it’s mutual and you reciprocate. We would just be taking; we wouldn’t be able to do any giving (through ambulance service),” said Lovell.
However, if it’s going to be for a few months, relying on mutual aid until Hinesburg could establish another option might work, she said.
Pouech said that from talking to Fire Chief Al Barber, he’d realized that this year’s budget is going to have to include some additional funds for a daytime person because they are having a hard time doing daytime response. Many of the volunteers that work with first response in Hinesburg work out of town.
“In the old days when most people had jobs in Hinesburg, the employers would let them off if there was a call, but most people are working outside of town and it’s not just possible during working hours for them to respond,” Lovell said.
If Hinesburg does choose to start an ambulance service, Lovell said, they will start with one full-time employee and one employee who would be paid by the day.
The expectation is that the service would grow and revenue from insurance reimbursements would grow and eventually the town would hire a third person because three employees would be “the ideal,” she said.
Marshall said none of the ambulance services they talked to, both private and municipal, recoup 100 percent of the bills for calls. The town can expect to get about 60-70 percent reimbursement.
Small-town ambulance services failing
Selectboard member Tom Ayers said he has read many emails and news articles about how ambulance services are failing in many small towns.
“When we found out that St. Mike’s is no longer going to serve us, I looked at it as an opportunity,” he said.
He said this an opportunity for small towns in the area to do something different and team up.
Rather than having separate management in each town, he thinks towns like Hinesburg, Bristol and Charlotte could form a regional ambulance service, citing Rutland, which is served by an ambulance service covering 12 towns.
“I do not think it’s sustainable for all these small towns like us to have their own ambulance,” said Ayers. “It’s just not efficient.”
Lovell said they had talked about a regional ambulance service and that it is “an idea that everybody supports,” but the organizational infrastructure on either the municipal or county level isn’t there.
“The only thing that’s regional right now is the sheriff,” she said. “That needs to be developed. It’s not going to happen tomorrow, but I do think it’s going to happen.”
“Our population is growing. Not by that much but it is growing,” said Lovell. “Chittenden County is where the jobs are. So, I think we’re going to be less in that realm of the small rural town that doesn’t have a population to support an ambulance service as time goes on.”
Jamie Carroll, a Hinesburg resident who also is an advanced EMT in Middlebury said, “There is an opportunity here to regionalize. I think Richmond is the right partner to begin that with. They’re already a private nonprofit. They’re looking for call volume to staff their current truck.”
Municipal vs. private ambulance services
Marshall said from their research and meetings she gathers there are big differences between private and municipal ambulance services. Municipal services already have “certain structures in place from the municipality” while a private service has to build all of its physical and administrative infrastructure.
“We have HR, personnel policies and pieces that are already there,” she said.
As far as developing a regional ambulance system, neither Shelburne, Williston nor UVM are interested in partnering with Hinesburg, Lovell said. So far, the only towns they’ve identified with ambulances who are interested are Richmond and Charlotte.
Lovell said, whether Hinesburg uses an outside ambulance service ($70,000-$100,000) or establishes its own ($120,000-$170,000), it will be a cost to taxpayers. “It’s not going to be free and it’s not going to break even,” she said.
Selectboard member Jeff French said, “I think if we go into this, we go into it eyes open. This is not going to be a pay-for-itself model.”
“In talking to the different providers and especially the municipal-based providers, it’s not a quantum leap; it’s a jump. But it’s very doable,” Marshall said.
Whether or not the town starts a municipal ambulance service, fire and rescue expenses are going to go up. For years the town got free ambulance service from St. Michael’s, but that’s ending. And whether it’s a fire station or a fire and ambulance station, a new building will eventually need to be built.
“Whether we get an ambulance or not, there’s got to be a new facility,” Lovell said. Hinesburg needs a ladder truck and the current building isn’t big enough to house one.
Barber has said if there was a fire in the top floor of buildings in Thistle Hill the fire department would have to wait for a ladder truck from another department to fight it.
Pouech said the current fire department building would accommodate an ambulance, but only temporarily.
Lovell said that waiting until Town Meeting Day for a decision is a problem because that would mean that a new ambulance service wouldn’t be in place for a good while after that. “We’d have to contract with Richmond and Charlotte for a year or more.”
Pouech said he wasn’t “fixed on any one solution” at this point and he thinks the town should “kick it around a little bit.” Now, he wants to get public input about what people want for ambulance service and said maybe it should be on the town ballot in March.
He believes the situation is similar to when the town considered what they wanted for police service in Hinesburg.
“It really ended up in the end being people deciding that they really liked having a police department and they were willing to pay,” Pouech said. “It may be that people are willing to pay 3 cents on the tax rate to know that they have an ambulance that doesn’t take 15 or 20 minutes, that’s going to take 5 or 10 minutes.”
To view the summary of the ambulance committee’s work go to: www.hinesburg.org/selectboard/meeting_packet/19-1007. From the list choose #6(a).