During this period of need to hold level or reduce governmental expenditures, the Chautauqua County Legislature is being faced with adding a significant cost program.

It is proposed that the county enter into the provision of Emergency Medical Fly Car Services throughout the county. The fly cars are needed to support the many local Emergency Medical Services (EMS) volunteer fire department-based ambulance agencies that are experiencing an inability to either respond in a timely manner or to respond with advanced life support (ALS) personnel.

They struggle to find the volunteers which are needed to render ambulance care. This initiative poses significant immediate cost along with always increasing long-term expense. Now is therefore the time to enter into a discussion about what the community should have for EMS services so that everyone will have a clear understanding now and when future years’ budget deliberations occur.

When compared with other rural counties, Chautauqua County residents have heretofore been fortunate to receive immediate ambulance response in times of need. This is unusual in many rural areas. The Standard of Care has been one of Basic Life Support (BLS) care augmented as needed and as occasionally available by ALS care. Simply put, due to a significantly increased declining number of people volunteering, substantially increased state-mandated training and equipment requirements along with a greater expectation from the community and the medical profession for having increased ALS care available, the local volunteer based departments are facing personnel recruitment and retention challenges with slim hope of being able to overcome such. Augmenting those agencies with strategically based fly cars that can come to assist is viewed as the practical immediate solution, along with the additional support that is occurring in the form of BLS EMT assistance that is being provided by Sheriff’s Department officers. This results in shared services and public-private partnership relationships that impose the least cost upon the community.

Other more expensive options would be for each agency to transition to all paid personnel or for the county to enter into full service ambulance care throughout the rural areas of the county. History has proven that having a commercial provider, such as Alstar or Rural Metro for example, serve the rural areas with as immediate care as is currently the situation is not financially viable without a hefty local subsidy. Insurance payments and fees just do not cover the full cost of the operation nor does Medicare/Medicaid. This local subsidy will thus also apply to the county fly car operation as fees charged for this service will not cover the total expense. County taxpayers will see an annual expense need and should not expect that fees will cover all expenses.

Therefore, in order to enter into this new long-term expense commitment with everyone’s eyes wide open, questions that should be asked and discussed should include the following: What should be acceptable response times? Should BLS care continue to be the standard of care throughout Chautauqua County? Should the fly cars be staffed with only ALS personnel? Should all high population villages be served primarily by their own paid EMS providers as some are currently doing? At what point should expanding the fly car service beyond the current Monday through Saturday daytime planned availability be expanded, if at all? How should the system be operated/modified, if at all, to reflect the growing non-emergent use of the system by persons who either previously or in other communities would not utilize emergency services for standard first aid care or illness? How quickly can the dispatch center computer software be upgraded to meet program quality assurance needs? What next steps progression of services should be anticipated into the future? What personnel, operating and capital expenditure demands is this going to place upon the county tax base? Is the community willing to continue to financially support the volunteer agencies while also paying additionally for the fly car assistance? Is the citizenry solidly in support of this undertaking?

Discussions are occurring at EMS venues. At the same time, discussions need to occur at other venues. This is a major public policy item. Our governmental checks and balances system should be involved. It is very appropriate for the public and legislators to become involved with the decisions that will affect future public services.

Let me be clear. I support this initiative. My professional operations management career has taught me that this is one of those decisions that will have huge obligations going forward. Once the door is opened, the county will have crossed over the point of political no return and will have boxed itself into a corner. The only way out will be to forever pay someone else to perform the service or to force local governments to assume the service.

Either option places additional burden on the tax base. As the number of volunteers dwindles, more fly cars will be needed. The quantity has already increased 50 percent from the original recommendation and the program has not even started yet. Ambulances will be needed if volunteers can no longer provide such. The hours will likely go from part time to 24 hours a day coverage, seven days a week. The daytime part time plan has already changed from five days to six days a week. Personnel costs will increase and rightly so. I’m simply saying that this should not be a lightly taken decision.

Once implemented, there will probably be no opportunity to reverse directions. There are options about how to proceed and a long term plan needs to be envisioned, disclosed and included in the deliberations. I hope that my questions and thoughts are helpful in starting the deliberation. I encourage citizens to input their legislators.

Douglas E. Conroe holds a master’s degree in public administration and is a volunteer fire chief currently in his 44th year of service as an EMT. He is a member and past chairman of the Chautauqua County EMS Council and is also currently a member and current secretary of the NYS Southwestern Regional EMS Council. In addition, he serves on the county EMS committee that has overviewed the recent EMS study and will overview study implementations.