York Hospital president Keith Noll knows how he would like to see emergency medical services work in York County.
After WellSpan Health made the decision to slash its EMS three weeks ago, Noll said it's time to move forward and develop a new system.
And those changes could address problems that prompted WellSpan's decision, problems that include financial losses, an outdated system and an unequal spread of service across York County.
Over the next 18 to 24 months, York Hospital has said it will work with area fire companies and community leaders to develop a better way to provide EMS to York County.
Noll said he's interested in a regionalized model that spreads EMS providers geographically across the area, as opposed to running the services through a hospital.
"In our region, our model has become very unique, if not antiquated," he said. "Our presence in the market was
actually becoming an impediment in moving things forward."
WellSpan's decision to terminate EMS service didn't come overnight; it has been in the works for about two years, Noll said.
It began providing advanced life support services 33 years ago and began leasing paramedics to ambulances four or five years ago, he said.
But it is nixing those services in 90 to 120 days, turning over advanced and basic life support services to private providers.
Cutting the losses: Financially, the problem was evident: York Hospital lost about $1.6 million last year in providing emergency medical services, Noll said.
And Medic units 97 and 98, which station WellSpan medics in Stewartstown and Dover, have seen their volume of calls drop.
Medic 97 responded to 7,000 calls in 2009 and just 2,000 last year, Noll said, because other ambulance companies have entered the market. Medic 98 saw its volume of calls drop 10 percent in that time, as well.
Some EMS providers that lease WellSpan's services have expressed grief about the short-notice overhaul, but Noll said each company agreed to a contract that detailed that time frame. Most contracts end on Dec. 31, he said.
York Hospital has about 100 positions -- not necessarily employees -- that help support its EMS services. Out of those, 56 are full-time positions, Noll said.
"We believe the majority of people will find an opportunity, either with WellSpan or other companies in the field," Noll said.
The EMS staff has maintained its professionalism in the field since the announcement, and York Hospital empathizes with them, he said.
"There's tremendous talent in the community," he said. "It is our hope that these individuals remain in the community."
A new model: WellSpan's advanced life support system contracts with area ambulances and provides medics who follow them in chase trucks, but that's an outdated model, Noll said.
Instead, WellSpan would prefer that the area fully adopt the Mobile Intensive Care Unit model, which puts life-saving technology, two medics and two emergency medical technicians all in the same vehicle, he said.
And the key to implementing a new system is regionalization, not perpetuating an old model, Noll said.
"It's a very, very redundant system or model of care," he said. "We have to start to get the community to regionalize."
So the goal is to implement Mobile Intensive Care Units based on geographic distance rather than having a high concentration of EMS units in one area while leaving others empty, he said. Regionalizing would streamline the emergency process while trimming any unnecessary financial fat, he said.
WellSpan is willing to partner with other organizations during the transitional phase, and emergency services will not suffer because of the transition, he said.
"We would never make a decision that was going to put the community at risk," he said. "No ambulances are going off the road."
Lancaster director not surprised by decision
When WellSpan Health announced it would be eliminating its emergency medical services, Bob May, executive director of Lancaster EMS, was surprised it had not happened sooner.
That's because a similar situation happened 18 years ago in Lancaster County, when the advanced life support services of Community Hospital of Lancaster and St. Joseph Hospital merged to form Lancaster EMS, which brought eight separate companies together, he said.
The decision was financial: The two hospitals had racked up a combined $1.6 million in debt, he said. After merging in 1996, the company broke even in 2001, he said.
"And we've been in the black ever since while maintaining the mission of our organization," May said.
But it wasn't an easy path, he said.
"There was anxiety. There was fear of the unknown," he said. "However, we demonstrated the value in what the merger would bring to the collective good."
The new service provided advanced life support to 18 municipalities across the county, operating units out of five sites. It also leased EMS personnel to independent EMS agencies to assist with their staffing needs.
As someone who has followed WellSpan's situation, May echoed York Hospital president Keith Noll's hopes for regionalization, calling it the "key to survivability."
Since the regionalization model disregards politics, district lines and, oftentimes, ambulances' storied identities, some companies are reluctant to sheath their pride, he said.
"Change is scary for some, but survivability in this industry, especially today, requires services to work with each other," May said.
He said the days of individual ambulance services are over.
"Sometimes it takes courage to effect change," he said. "I understand the fear and maybe anger, but this can be a very exciting time. This is an opportunity to build something that doesn't exist."
--Reach Mollie Durkin at firstname.lastname@example.org.