Bob Hartmann, a longtime Mount Kisco resident, can remember an era when his neighbors responded to the town’s emergency medical calls, no matter how inconvenient it might have been.
“Lew Zee, of Zee’s Vacuum Store, would close his store and put a sign on the door that he was on an ambulance call,” recalls Hartmann, a volunteer driver for the town’s ambulance agency.
Though Mount Kisco still maintains a strictly volunteer corps, it’s becoming an anomaly among Westchester’s ambulance agencies. Most of the 45 ambulance agencies in Westchester call themselves a VAC, or volunteer ambulance corps, but if you dial 911 during a weekday, you’re likely to get a responder who collects a check for services that were once provided for free by a volunteer. It’s a trend that’s impacting town budgets and ultimately residents’ tax bills across the county.
Communities that have added paid emergency medical technicians (EMTs) to their ranks of previously uncompensated EMTs have done so because they started having trouble regularly rounding up a crew to respond to 911 calls.
“Being able to find people who are willing and able to take time to volunteer is a consistent challenge,” says Chris Kalish of Westchester Regional Emergency Medical Services Council (WREMSCO). As WREMSCO’s chairman of public information and education and an EMT volunteer with the Tarrytown Volunteer Ambulance Corps for three decades, Kalish has seen a lot of changes in the county’s emergency medical response. Tarrytown, once exclusively a volunteer agency, began to fill in its shifts with paid EMTs in 1994. Presently, the Tarrytown corps responds to about 1,000 calls annually and employs four EMTs.
One of the consequences of a decrease in ambulance volunteers is an increase in response times. The Emergency Communications Center in Valhalla, known as 60-Control, which dispatches more than 50 percent of all the county’s ambulances, has a list of alternate towns designated to provide mutual aid when the initial agency is unable to rally a crew. This can happen either when a town’s ambulance is already on a call, only one of the required two-person crew is available, or no one responds.
Though mutual aid is a viable solution for a volunteer-strapped community, the downside is that it can be as long as six minutes before an out-of-town VAC is notified about its neighbor’s emergency. In addition, it takes longer for the ambulance to travel into town from farther away. Those few minutes can make a big difference for someone whose life depends on rapid transport to an ER.
Westchester EMS, the agency contracted to provide advanced life support (ALS) for the more serious calls to eight Northern Westchester towns and 10 VACs, has encountered that delay.
“There have been times when it takes quite awhile for an ambulance to arrive,” says Donald Cottle, quality assurance manager at Westchester EMS. Westchester EMS responds to 911 medical emergencies with a paramedic in an SUV, known as a fly car. However, it relies on the prompt arrival of the town’s ambulance to transport a patient to the hospital. This scenario can put them in the unfortunate position of being on a scene with a serious patient without the means to move them.
“When that happens, we have made offers to the VACs to provide transport in our ambulances that may be nearby,” says Cottle.
Typically, 60-Control dispatchers notify an agency about a medical emergency in their town through a radio tone and then wait for a driver and EMTs to respond. They will send a second radio alert at the three-minute mark. If a crew isn’t assembled after six minutes, they will send a third tone while simultaneously notifying the designated mutual aid town.
“We answer about 500 calls a year. Maybe 20 of them need mutual aid,” says Captain Joe Gentilesco, of Chappaqua’s Volunteer Ambulance Corps, still 100 percent volunteer. Chappaqua’s mutual aid can come from towns including Pleasantville and Mount Kisco. Hastings-on-Hudson Fire Department, home to the town’s ambulance corps, relies on 22 volunteer EMTs to answer between 600 and 650 annual ambulance calls. Twenty of those EMTs work outside the town, making it particularly challenging to round up a crew for an emergency during the day.
“On average, we call for mutual aid 35 to 40 times a year,” says Fire Department Chief Bob Russak.
The spirit of neighborly cooperation stretches only so far. As agencies move toward per diem staff, they are less likely to allow those paid employees to answer calls in another town. It would be difficult to explain to their residents, who are now paying for an ambulance, why one isn’t available when it’s needed. There are some who say that mutual aid should be reserved for major accidents, like the recent Metro-North train crash in Valhalla.
“We’ve had to sit down with one or two ambulance corps over the course of my tenure and tell them mutual aid is for big
mass casualties, not day-to-day operations,” says WREMSCO Chairman Joseph Barca. “For the most part, [these situations] were solved by taking on per diem people to work their day shift.”
An Evolving Role
Volunteers were essential in establishing the county’s original ambulance agencies. The first people to provide emergency medical care were groups of residents affiliated with hospitals, Lions Clubs, Rotary Clubs, Kiwanis Clubs, or VFW Posts. Little training was needed because they adhered to the “scoop and swoop” philosophy: collect the patient and hustle to the nearest hospital.
By the late 1960s, there was a nationwide push to improve emergency medical care. Instead of simply rushing off to the hospital with a sick or injured patient, responders were expected to have some fundamental medical expertise. A course in basic life support, known as BLS, was developed in 1969. People who became certified in BLS skills were called EMTs. As the profession established roots, some of those EMTs found paying jobs, others became volunteers for their communities.
In 2000, the New York State Department of Health mandated that ambulances could only roll with a certified EMT on board. Westchester County agencies were well positioned to comply with the mandate, as many had already established bases with a devoted cadre of community-minded residents. Among their ranks were housewives and high school students, business owners and bus drivers—anyone with a strong stomach and some free time in their day.
“When I started, we had three-person crews 24/7 and a waiting list [to become a member],” says Yorktown VAC Captain Rich Cariello, a 41-year vet. “Over the years that has really dwindled.” Yorktown still retains a completely unpaid EMT staff, but Cariello admits it would be nice to have a few more than 40 volunteers to answer its 1,400 annual calls.
Most agency leaders attribute the personnel shortages to an increase in organizations vying for volunteers as well as the changing economy. The one-income family gave way to a two-income family, reducing the availability of homemakers—once the mainstay of the VAC—during the day.
“When I joined, during the day there were plenty of housewives,” says Cariello. “Two or three mothers would take turns babysitting while the other rode on the ambulance. In fact, the majority of our volunteers during the day were women. With the economy as it is, we don’t have that population to pull from anymore.”
Finding members is only half the problem. Keeping them is the other half. People who join an ambulance corps because they’re attracted to the excitement of lights and sirens may be dismayed to discover there’s a lot of classroom time. In the span of a few decades, people providing emergency medical care have gone from simply needing a driver’s license to needing all sorts of skills. Besides maintaining a CPR certification, there are now classes on Narcan administration for opiate overdoses, EpiPens for peanut allergies, glucometry for diabetics, and mandatory lectures on domestic terrorism, national disasters, hazardous materials, weapons of mass destruction, and mass casualty incidents. Additionally, volunteers must be up to speed on whatever public health concerns arise.
“There’s a lot of training to be a volunteer here,” says Bob Stoddard, outgoing Lewisboro VAC captain. “It’s impossible from the outside to appreciate how much we do here.”
Besides the training time, ambulance corps traditionally ask their members for a six- or 12-hour weekly commitment, some of which can be overnight. Fires, football games, and community events can also require an ambulance to be standing by so it can respond quickly to an emergency. It’s difficult to keep up with the demands without paying people.
“It means we have to put more money in the budget,” says Stephen Altieri, Mamaroneck’s town administrator. About 10 years ago, Altieri explains, Mamaroneck added a line item for per diem EMTs at about $17 an hour to fill in gaps created by the shortage of daytime volunteers. Other towns have added a tax district to fund ambulance costs, while still others rely on revenue recovery, by billing a patient’s insurance for their transport. Donations, once actively solicited, can no longer cover the costs of insurance or equipment upkeep.
While volunteers decline, the need for emergency care grows. A large aging population means an increasing call volume in the coming years. Despite the best efforts of volunteer agencies to recruit and retain members, the future of the fully volunteer-staffed ambulance corps is uncertain.
“Volunteer services can provide exceptional care and manage costs extremely well for municipalities,” says Chris Kalish with WREMSCO. “However, with tough economic conditions and work/life balance challenges, many feel that volunteering will not be realistic.”
