Editor's note: This story was originally published Aug. 29, 2013.

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.

See also: York Hospital's president looks at the future of EMS

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."