If funds shrink, can EMS in rural PA survive?
Ambulance crews see shrinking funds and staffing, even as they are tasked with saving residents in an unprecedented epidemic of overdoses.
July 11, 2017
The radio crackled to life. Another overdose. But this time it was for Connellsville, another station, about 12 miles from the Uniontown fire and EMS station. I turned back to the conversation and was surprised to see everyone rise. It had already been a busy 13-hour shift for medics Jim Hammaker and Alex Atkinson. "This is just the way things work," Jim explained as he and his colleagues climbed into the ambulance. With statewide cuts in funding and a shrinking pool of medics and volunteer firefighters, they increasingly found themselves out “covering” other stations.
Twenty minutes later, we sat in the parking lot of an abandoned gas station, the Round Town, a rough halfway point between the two stations, Connellsville and Uniontown. In the case that either received an emergency call, we would have the best chance of responding in a timely manner.
In Uniontown, Pennsylvania, the fire station sits at the end of East Main Street. The building houses the city’s fire department and the Fayette County EMS. The city has nine paid firefighters and a volunteer firefighter department. Eight people make up the emergency medical team. Within the station, there are bunk rooms for both men and women, though many stand empty. The walls are covered in photographs of past EMTs and firefighters and, at the end of the hallway, there is a room with a treadmill where veteran firefighter Mike Smithburger runs 3 miles in full firefighting gear every shift.
I had been told earlier that evening that for most fire departments the ideal number of people to have on a shift is 14. Uniontown operates with just three. Standard procedure is to leave the station with three people on each apparatus: a driver, an officer and a guy on the back. With two engines and a ladder truck, the Uniontown firefighters leave with only one person on each vehicle. “Sometimes you will be fighting fire by yourself,” Mike said. “It’s a roll of the dice. It’s only a matter of time until something happens.”
The next call comes in around 9 p.m. It’s a Uniontown address. The guys had been there earlier that day. Again, it was the man burning mattresses in his backyard.
The police are at the scene. The cops try to talk to the backyard arsonist, and Mike, instead of hauling over the firehose, hops the fence and locates a garden hose.
I had originally gone to Uniontown in Fayette County to better understand the “opioid epidemic” through the eyes of emergency service providers in a small Pennsylvania town. By all accounts, heroin and opioid abuse permeate Fayette County and its experience is emblematic of the growing statewide crisis that has spread to every corner of the state. After spending well over 60 hours with the Uniontown fire and EMS crew, what I found was much more than another vantage on drugs in rural America. I was witness to the more nuanced and human story of the individuals in small-town America whom people rely on when disaster strikes and they dial 911.
There is no such thing as a typical day for emergency service providers in Uniontown. Their daily lives carry emotional highs and devastating lows; there are days when their 24-hour shifts pass without rest and there are days when the radios remain silent; there are times when the calls border on the absurd and there are moments when the trying reality of the job can bring these men to their knees.
“You can go from making a difference and saving someone’s life to leaving the ER and knowing that that 2-month-old is being put into the ground,” said Jim, 29. “What I have learned is that if you don’t have compassion for people, there’s no point in doing this job.”
I first showed up at the Uniontown fire station on Saturday, April 8.
There under an hour, the radio came to life announcing that there was an unresponsive 1-week-old baby on the other side of town. Within seconds, we were racing across the city. The father met us at the door with the infant, visibly the wrong color and frothing at the mouth. Jim made a split-second decision to go directly to the hospital. I sat in the back of the ambulance while Jim, a man all of 6-foot-4 and 350 pounds, administered life-saving care to the fragile newborn.
An hour later, we were leaving the hospital. The baby was stabilized and staying overnight, but Jim was still thinking of him.
“Kid calls are always the hardest,” he said.
Later that evening, we heard a call for the same address come over the radio. This time it was for domestic disturbance, and it was the police who responded.
“It’s the circle of life here in Uniontown,” Jim remarked.
Funding cuts and prohibitive mandates
Organized in 1947, Uniontown once had its own ambulance service. Fire Chief Buck Griffith, 61, points to a lack in state funding as the reason that, in July 2013, they ultimately went out of business.
“We finally couldn’t pay the bills anymore. The larger Fayette County EMS ultimately absorbed the city of Uniontown.”
Coinciding with funding cuts, Uniontown has also seen a steady decline in its number of volunteers. Neither the funding cuts nor the decline in volunteers are unique to the city.
The chief explains that in the 1970s the number of volunteers in the state of Pennsylvania rested around 300,000. Today, the number is well below 50,000.
When the chief joined the fire department in 1978, he says there were three volunteer firefighting companies in the city; each was limited to 50 volunteer members. “That’s 150 volunteers. I waited for two years before I could even get a spot,” he said.
“Now, we tell people that we have 30 volunteers, but that’s not entirely true.” There is a pool of volunteers, but the number they can rely on regularly is far fewer.
As firefighter Chris Hughes explained, the number of volunteers that show up when the siren sounds depends on the time of day. “After 5 p.m., you will get more volunteers; in the morning, not so much because people are at their true day jobs.”
He is thankful for the retired volunteers. When there is a call, they will often man the station while the others go to the fire. Without them the station would often stand empty.
Chief Buck acknowledges a change in attitude about the work as one reason for a decline in volunteers, but he also talks about the barriers to serving.
“We’ve mandated ourselves out of existence,” he said. While the state has no rules for people to serve as volunteer firefighters, the National Fire Protection Association requires 166 hours of training to be an interior firefighter (someone who can go into burning structures).
Mandates create similar barriers for potential medical volunteers. Previously, once paramedics were certified, they only had to keep up with continuing education. “Now, it doesn’t work anymore. You still have to test out every so often,” Buck said.
“I’m not saying that it’s too much — there’s no such thing as too much training,” he continued. But the chief believes volunteering should be made easier.
The strain on the Uniontown EMS department is all too common.
According to the Ambulance Association of Pennsylvania, EMS departments rely upon reimbursements from the insurance companies of their patients. When responding to patients on Medicare or Medicaid, they only reimburse EMS for a fraction of the costs. EMS workers respond to calls regardless of the ability of a patient to pay, so the departments often go uncompensated.
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Edgar Grant, the director of Penn Township Ambulance in neighboring Westmoreland County, said he wished the government would fund EMS departments the same way they fund police. If municipalities don’t have the funds for a local police force, they have the state police.
“There is no default state EMS unit for municipalities,” Grant said.
The lack of funding has far-reaching consequences. The increasing instability is starting to alienate students from the field, Grant said. One symptom: Westmoreland County Community College’s EMT spring classes were canceled due to low enrollment. However, its summer class is running. “EMS is in real trouble,” Grant said. “...Someone’s not going to spend the money knowing the earning’s half of that of a [registered] nurse.” Jim and Alex have been in emergency services since they were teenagers.
Jim was 14 when he started volunteering at Fayette EMS as part of the “explorer” program of the Boy Scouts of America. Fifteen years later he is a paramedic and the senior member of the two-person team. He loves helping people, but there’s a catch.
“Shitty things happen to good people, and it sucks,” he said.
His partner, 24-year-old Alex, recently overcame his own health scare. He was at work when his supervisor sent him to the hospital to get a bulge in his neck evaluated. “The day started out normal,” he said. “By that night, I had found out that I had cancer.” The crew stood behind him; they displayed #AlexStrong stickers on the ambulances and offered any other support they could. Alex was declared cancer-free on May 9, 2017. He had already returned to work despite having two months of chemotherapy remaining. “I love what I do and I couldn’t stand to just sit at home anymore.”
Like many residents of Uniontown, Jim and Alex were born and raised in the area and are now setting down roots. Jim is engaged to be married and plans to pursue nursing or critical care. Alex is taking his test to become a paramedic in March 2018; he plans to move into a position that will allow him to both fight fire and provide emergency medical care.
‘Lax about drug use’
For Jim and Alex, responding to the opioid epidemic has nearly become a part of daily life in Fayette County. The station has lost count of the number of overdose calls they have responded to. Oftentimes, they are responding to the same person overdosing.
When I arrived to the station on April 12, Jim shared that they had just dealt with an overdose death. It had been the second time in a 24-hour period that they responded to the same man. The first time they were able to revive him using Narcan, a nasal spray that can reverse an overdose; on the second call, he was already dead.
Overdose Free PA reports that in 2016, Fayette County had 60 drug-related deaths. As of 2016, there were roughly 1,100 total drug-related deaths in Allegheny, Armstrong, Beaver, Butler, Fayette, Westmoreland and Indiana counties. Of these, 60 percent were in Allegheny County.
But the deaths only capture a glimpse of the problem. Emergency service providers are charged with reaching people before it gets to that point. Many are equipped with Narcan, the overdose antidote.
Narcan is seen by some as a saving grace, but it is a point of controversy at the station.
“People are more lax about drug use, more willing to take risks, when they know that Narcan is available,” Buck said.
“I don’t think that taking it away is the answer, but I also don’t think that handing it out like candy is right either.”
Narcan is just one of the many topics of debate these medics and firefighters discuss over dinner each evening.
Sometimes the meals, and their conversations, are interrupted by the radio, and the men run to their vehicles to make their way to whatever part of the city is in distress. The food is left on the table to be reheated hours later.
Late nights at the Uniontown Fire and EMS station are typically spent outside, at a picnic table in the station lot where the events of the day are recounted, personal lives are discussed and lifelong friendships are formed and strengthened.
On days like Sunday, July 2, those bonds are tested. The crew responded to two overdose deaths, a raging house fire and a flurry of other calls that sent them racing throughout the city. Those bonds get them to the next day.
But despite their commitment to each other and to the mission, Jim candidly admits they could all use a bit of a break:
“We are all just very tired.”
Story and photography — Maranie Rae Staab
Maranie Rae Staab is a Pittsburgh-based freelance journalist. She can be reached at firstname.lastname@example.org or 412.979.6187.
PublicSource intern Atiya Irvin-Mitchell contributed to this report.
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