The week of May 18-24 marked the 51st Emergency Medical Services (EMS) Week in the United States. This year's theme was We Care. For Everyone. As a 35-year career professional and paramedic in EMS I think it's important to recognize our profession and my colleagues. but also and perhaps more importantly acknowledge an opportunity to discuss that EMS in the U.S. and locally are in crisis.

Across the nation, EMS is struggling and in many places failing due to multiple factors that include: a lack of local public funding, limited or decreased reimbursement from insurance and Medicare/Medicaid, significant declines in volunteerism, increasing cost for medical supplies, payroll, benefits, fuel/equipment, employee burnout, abuse of the system by patients, regulatory burdens, and a continued lagging of respect overall by the health care system.

When I started in EMS with Mercy Ambulance in 1990 (thank you Phil Ethier for giving this kid a chance) we were in a place of building a more solid county-wide advanced life support (paramedic) system. Some 27 years later I returned to the area from Colorado and have observed a local EMS “system” that is suffering from dwindling volunteers, reduced resources, funding challenges, fragmented town/city based departments, turf battles, nearly daily and frequent need for mutual aid, and overall lack of coordination and leadership to work towards a county-wide integrated system in Franklin County.

EMS Systems in the U.S. that are doing well in providing comprehensive integrated pre-hospital care share many of the same attributes; county-wide or regional service area, single EMS provider with multiple stations, dedicated public funding (some studies suggest at least $50-$75/citizen/year), unified command and support structures to reduce redundancy, dynamic deployment plans to adjust to fluctuations in demand, system-wide paramedic coverage, central prioritized dispatching, well-developed education and quality management programs, community and preventative programs to improve health and reduce the need for EMS, mobile integrated health care programs, and overall they meet the needs of the community every day with high reliability.

EMS systems that are struggling and/or a failure are typically highly fractured, town/city based (as one community enjoys a good system while their neighbor suffers), lack of public funding, are limited in services (such as only providing 911 service), and rely heavily in mutual aid. Mutual aid is not a sign of strength, it is a sign that an area already has/or needs a regional system. Only 18 states have designated EMS as an essential service. This means there is no recognized mandate to provide EMS and hence fund and facilitate the provision of EMS such as police and fire services. Massachusetts is not one of those.

During COVID EMS came forward to help our communities. We provided a vast amount of mass vaccination and testing across the country. And the public and public health systems took notice. EMS is an essential public service and part of our critical infrastructure. But recognition and appreciation cannot build and strengthen our system. It takes hard work and funding. A 2023 documentary called “Honorable But Broken: EMS in Crisis” tells the story quite well (https://www.honorablebutbroken.org/) — available streaming on Tubi for free. I would encourage anyone interested in knowing more to watch this important film.

Recently, I read that 26 ambulance services in West Virginia have ceased operation in the last two years, most due to the reasons outlined above: little/no public funding, a lack of volunteers and burdensome regulation. And I am reading similar stories from across the U.S. every day. I hope that this is a wake up call for Franklin County to take notice and seriously think about a better approach to providing EMS county-wide before we start to see services fold and fail here. EMS is an essential service. Let's treat it that way. 

Marc Burdick lives in Turners Falls.