Imagine running a business where you are mandated by law to provide service to everyone who calls, whether you are paid for the service or not. Then consider that people who do pay, pay you a non-negotiable amount, determined by them, that is often well below what it costs you to provide the service. Lastly, any attempt to recoup a balance owed is government restricted. How does your business survive when the non-negotiated payment has only increased 20% in 18 years, but your costs have risen 67% or more in the same time period? This is the reality faced by the Commonwealth’s EMS agencies.

A few weeks ago, EMS agencies and their providers — Paramedics, EMTs, Prehospital RNs, EMRs — were snubbed by the Governor’s Hazard Pay Grant for frontline workers. For nearly a decade the EMS community has been overlooked by the Administration and the General Assembly despite being statutorily defined as an “essential service.” Numerous remedies have been presented — none acted upon.

The prevalent crisis facing EMS is funding. Inadequate funding from government and commercial insurance reimbursement for life-saving services delivered; inadequate or non-existent funding for the costs of readiness from state, county or municipal entities whose constituents expect — demand — EMS respond at a moment’s notice. Access to critical, life-saving treatment and transportation should be a guaranteed right for all. Yet for decades, EMS agencies barely tread water due to below cost reimbursement and a lack of state, county or municipal support, all while operational costs and regulatory mandates increased.

Regrettably, the majority of proposals to correct reimbursement rates to allow for adequate compensation, to update archaic EMS payment policies and to increase Medical Assistance payments, have received little to no legislative or administrative action. The bloom that was the promise of the Senate Resolution 6 Commission Report recommendations is rapidly fading.

EMS agencies in this Commonwealth were in dire financial straits prior to COVID-19 and since the pandemic, the meter is pegged toward total system failure. Response times are increasing and ambulances are failing to respond to the public’s 911 calls and to urgent requests to move critically ill patients from community hospitals to specialty care resource hospitals.

As our hour glass drains, EMS agencies continue to respond with fewer ambulances and personnel. Until such time these issues are effectively addressed, EMS remains continually responding and constantly forgotten — those sands are rapidly draining. So may be the life of the next caller to 911.

(Dean A. Bollendorf is president of the Ambulance Association of Pennsylvania.)

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