Ambulance and fire truck Credit: Alexander Oganezov via Shutterstock

A legislative panel on Thursday began an effort to get its arms around the shifting landscape of Connecticut’s patchwork of ambulance response systems in an effort to avoid workforce shortfalls and service “deserts” in some communities. 

During a morning hearing, the Public Health Committee heard testimony from Emergency Medical Services providers, hospitals, and state regulators on the status of Connecticut’s emergency response coverage. The hearing left some lawmakers concerned about the sustainability of Connecticut’s medical response providers, particularly in the state’s rural areas, if a new strategy is not adopted. 

“The existing volunteer-based EMS systems that are there, their sustainability is in question and we’re moving towards EMS deserts in our state. Is that a fair way of looking at it?” Sen. Saud Anwar, a South Windsor doctor and acting co-chair of the committee, asked.

The question was directed at Ben Zura, a representative of the Connecticut Association of Paramedics and EMTs. 

“Without doing anything? Absolutely, yes,” Zura answered. “That’s the direction things are going.”

Zura and the association’s director of external affairs, Robert Glaspy, offered a disconcerting snapshot of Connecticut’s EMS landscape. Increasingly, the commercial ambulance services which the state’s 911 system was built around have been bought up by a shrinking number of hospital networks, who themselves have been consolidating. 

“There’s been this tectonic shift sort of underneath everything and it puts all of us in a different place than we were,” Zura said. “Ambulances operate a little differently than hospitals and all of that needs to be accounted for and understood.”

Anwar and others suggested the acquisition of ambulance services by larger hospital networks could benefit the state in the long run by offering financial stability. However, Zura said the state’s regulation of ambulance providers was written with commercial services in mind and has yet to be updated.

The change also comes as some Connecticut hospitals have sought to consolidate their services like maternity wards in the state’s urban areas. And that shift coincides with workforce and financial difficulties affecting the volunteer and nonprofit ambulance services that cover many of the state’s communities. 

Nonprofit financial reporting requirements reveal that many of those services are losing money, Zura said.

“It paints a stark picture of the state of these ambulance services,” Zura said. “Many are operating in the red, which isn’t so unusual for a nonprofit but in the context of the rest of these performance measures, it paints a scary picture. This part of the EMS system is not sustainable and these people are doing the best that they can.”

Meanwhile, towns have generally failed to fund ambulance services at the same rates they fund other public safety services like police, he said. 

“Everybody’s trying to figure out how to fund their EMS systems at the municipal level,” Glaspy said. “I’ve said it before and I’ll say it again: there are only so many spaghetti dinners and pancake breakfasts that you can hold to fund EMS.”

Towns have also struggled to recruit personnel to work at the volunteer departments which cover most corners of rural Connecticut. Betsy Gara, executive director of the Connecticut Council of Small Towns, said the COVID-19 pandemic exacerbated the problem, which has existed for years. 

“Some towns saw a drop of half of their volunteer EMTs during this time, up to a third in some other towns,” Gara said. “Understandably, because these people were juggling with a variety of new demands, child care, taking care of elderly parents.”

Gara said she expected towns would increasingly be forced to transition away from volunteer services towards hybrid or full time paid models.

The number of qualified emergency responders in Connecticut has remained stable or grown in recent years, according to statistics offered Thursday by the Department of Public Health. In 2019 there were 13,358 certified EMTs as opposed to 17,101 in 2022. The number of licensed paramedics grew from 2,534 to 2,889 in the same period.

However, Bruce Baxter, executive director of the Connecticut EMS Chiefs Association, said he suspected many of those qualified workers were no longer active in ambulance services.

“There’s a wage war,” Baxter said. “I can tell you that a lot of those people are not actively practicing and if they are, they’re going into alternative environments to practice where the risk is a little bit less and they have a better work-life balance.”

Baxter, who is also CEO of New Britain Emergency Medical Services, said his organization has found it difficult to retain responders who are often lured away by more competitive salaries and benefits.

“I don’t beget people a living wage but when you see wages increase 35 – 45% over the course of a nine month period it is difficult… for us to compete,” Baxter said.

During the hearing, Raffaella Coler, the agency’s director of emergency medical services, sought to ease the panel’s concerns about the state of Connecticut’s emergency response systems.

“Do we have concerns in EMS? Absolutely. Are we aware that we have concerns? Absolutely. I don’t want the committee to have the representation that we are going to fall apart tomorrow,” Coler said. 

Anwar said Thursday’s hearing was the beginning of a larger discussion, which he hoped would result in a broader strategy to ensure the sustainability of Connecticut’s EMS coverage.