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The Facts Regarding WellSpan Health's Role in Emergency Response Services in York and Adams Counties

Monday, September 09, 2013

1.  In Pennsylvania, each municipality decides where and how to provide emergency medical response (EMS) services

  • Across the United States, there is a lot of variability in the way emergency medical response services (EMS) are provided. Some states, like Florida, manage highly centralized, coordinated systems. They integrate and strategically place Advanced Life Support (ALS), Basic Life Support (BLS) and related services in a manner that serves all of its citizens most effectively. Others take a decentralized approach. In the Commonwealth of Pennsylvania, for example, decisions regarding where and how EMS services are provided are made by individual municipalities, of which there are 2,563. Here, resources are allocated in an opportunistic manner, based on what is best for each municipality, not necessarily the county, the region or the commonwealth as a whole.

  • Despite the lack of centralization, some Pennsylvania communities have taken the initiative to coordinate ALS and BLS services across municipal boundaries. Lancaster EMS (LEMSA), which was founded in 1993, serves as an excellent example of a community-led system that integrates ALS and BLS services and coordinates the placement of these services in a strategic and efficient manner.

2.  Like many local EMS providers, WellSpan has historically contributed to a fragmented EMS system in York and Adams counties

  • In York County and Adams County, WellSpan has for more than 30 years participated in the community’s EMS system by providing ALS services through Medic Units, also known as “chase trucks.” These vehicles do not transport patients. Instead, they are dispatched by York County or Adams County 911 for the purpose of transporting paramedics trained in providing ALS services to the scenes of accidents or episodes of illness. Once at the scene, these paramedics jump on board an ambulance, which is staffed by Emergency Medical Technicians (EMTs) trained in providing Basic Life Support (BLS) services. If necessary, the paramedic will provide ALS services while on the scene or en route to a hospital emergency department.

    • In York County, WellSpan Medic Units are stationed at WellSpan York Hospital and in Stewartstown, Red Lion and Dover (a joint venture with Memorial Hospital). ALS services are also provided by several community-based organizations, including White Rose Ambulance Company, Grantley Fire & EMS and the Yoe Fire Company.

    • In Adams County, WellSpan Medic Units are located in Gettysburg, Littlestown and Bendersville.

  • For the past five years, WellSpan has also served as a staffing resource to several local ambulance companies in York County and Adams County by leasing paramedics and EMTs. Each of these local providers hired and managed their own personnel prior to engaging with WellSpan just five years ago.

3.  The current fragmented model of EMS in our region is antiquated, and it will not meet the needs of our communities in the future

  • WellSpan has invested significant resources in the development of a Level 1 Trauma Center at WellSpan York Hospital and a new, expanded Emergency Department at WellSpan Gettysburg Hospital. Simply put, WellSpan depends on solid emergency medical response services, and the health system is intensely committed to a system that will serve our communities’ needs well into the future.

  • Like Lancaster EMS (LEMSA), coordinated, community-led emergency response systems across the country have integrated ALS and BLS systems into Mobile Intensive Care Units (MICU). The community-based MICU has become the preferred model for emergency medical response nationally, and one for which WellSpan advocates for our communities.

4.  Our communities have the talent, skill and commitment necessary to meet area needs and establish a more coordinated system. However, WellSpan’s role must change

  • The best EMS model for York County and Adams County is one that is led by the community with active participation by WellSpan Health as a provider of health care, not of emergency response services.

  • When WellSpan hospitals independently began offering BLS and ALS services in the region more than 30 years ago, the availability of paramedic coverage in York and Adams counties didn’t exist. Over the years, however, advances in EMT capabilities among municipal and private ambulance have become more prolific and sophisticated.

  • Today, there are enough local BLS providers in both counties to meet the needs of our neighbors.

  • In York County, there are enough local ALS providers to meet area needs. In fact, the volume of calls to WellSpan York Hospital’s Medic 97 has dropped by more than 50%, which is an indication of the increased ALS capabilities that exist among local providers.

  • In Adams County, WellSpan is currently the primary provider of ALS services. However, we believe that local providers possess the talent, skill and commitment to expand their scope of capabilities and develop ALS services with our support. 

  • Enhanced collaboration and coordination among community providers in both counties would lead to a much more effective regional program that is led by the community, with WellSpan playing an active role.

  • WellSpan’s current role as a direct provider of ALS via an antiquated “chase truck” model reinforces the existing, fragmented system. 

  • Leasing personnel is simply not among our core competencies as a health care provider. It has become increasingly difficult to ensure the staff required to honor our contracts. We believe that our efforts are better invested in the provision of health care and in working with local ALS/BLS providers to establish a sustainable emergency response system for the community.

5.  The time is now to begin working toward a better system for the future

  • In Adams County, WellSpan will immediately attempt to engage with the local ambulance companies to which we currently provide BLS staff leasing services to review our contracts, structure and rates. Our objective is to collaboratively evaluate ways to transition BLS staff leasing services to the providers in our communities.

  • WellSpan’s provision of ALS in Adams County will continue for the next 12 -24 months. We recognize our role as the primary provider of these services in the county, and, while we will continue to evaluate the most effective and efficient way to operate our program, we will not discontinue the delivery of ALS to Adams County until a solid, sustainable community model has been developed. We are counting on the community’s interest and willingness to join us in planning such a system, and we anticipate that this transition will occur within 12-24 months.

  • In York County, WellSpan will notify ambulance companies that currently lease its services or receive ALS services from WellSpan that the organization will discontinue the provision of ALS services and the leasing of paramedics and EMTs. Per the contractual terms to which WellSpan and the local providers mutually agreed, required notifications range from 90 to 120 days. During this time WellSpan will work closely with private ALS and BLS providers to ensure a smooth transition that will not disrupt service to the communities.

  • For those municipalities with sufficient call volumes that choose to maintain their own ALS services, WellSpan highly recommends that they migrate toward the MICU model.

  • Regions with a smaller ALS call volume might consider partnering with another one of the quality community EMS services for MICU coverage for use the existing 911 dispatch call response system. There are several local ambulance companies that are located in close proximity and can support each other through a regional MICU model.

6.  WellSpan is prepared to take an active role in the creation of a more coordinated, regional system

  • WellSpan will strongly advocate for and support a process through which community providers come together to discuss and plan such a regional solution. We will contribute ideas, energy, funding and our perspective as a health care provider to this process.

  • WellSpan will strive to provide leadership in the form of a medical director as well as a full-time EMS Coordinator who would interface with local ALS/BLS providers on behalf of WellSpan’s hospitals.

  • WellSpan will support local providers with the transition by:

    • First, working with organizations to understand their needs

    • Providing expertise and start-up resources to those local providers who demonstrate an interest and ability to expand their scope of service. This might include start-up capital funds, equipment and expertise in personnel management, staff recruitment and policy development, to cite a few examples.

7.  In the meantime, WellSpan does not believe that the caliber or level of emergency response service will suffer

  • All regions of York County will have ALS coverage available through 911 Dispatch. As has always been the case, if one provider is not available, another provider will be dispatched.

  • No ambulances will be taken off the roads. Ambulances with BLS coverage support all calls into our region.

  • Clinical data indicate that the response times for BLS are favorable while outcomes are similar when compared to ALS services.

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