ALS cost estimate


At the Board of Selectmen last night Chef Kingsbury handed out the attached estimate of what it would cost the town to hire eight new paramedics, such that the Medfield Fire Department would be staffed by four full time firefighters on duty, 24/7.  Under this scenario, the Medfield Fire Department staffing would double from eight full time firefighters to sixteen firefighters, with half of the employees being paramedics, and half EMT’s.

Since 2000 we have provided EMT intermediate ambulance services, and we employ eight full time EMT’s to do so.  We are staffed by two EMT’s per shift, 24/7.

I believe that the major treatment difference between EMT and paramedic services is the ability of the latter to administer medication and insert IV’s.  I also understand that paramedics have about 1,640 hours of training beyond EMT’s.

At the meeting, ALS services were estimated to be used on 80% of the current runs, needed on maybe 60%, and currently ALS services are provided by ALS intercepts, if available, as the result of a ten year old agreement with the towns of Westwood, Walpole, and Norfolk.  We split any fees received for runs with ALS intercepts with the other towns on a 50/50 basis.

The data that especially interested me was that the Medfield Fire Department does about 650 ambulance runs per year, or about two per day on average, and that each run takes up to an hour and a half.  That would appear to mean that there is a lot of capacity for which we are staffed, to do more runs.  When figured on a yearly average, if the two runs take about three hours, there is about twenty hours per day of non-run time.  If all the departments in surrounding towns have the same issue, it seems that it cries out for a regional solution by which all departments are using more of that currently underutilized capacity.

There were several comments made about the safety issues of being properly staffed with employees who have the proper training, both for the safety of the firefighters themselves and for the safety of the public.  One call firefighter assured that no apparatus ever leaves the station without being fully and properly staffed.

Alternatives that were also mentioned included:


  • converting to a paramedic service slowly over time by requiring any new hire to be a paramedic
  • hiring a company to provide the ALS service on an intercept basis, which was estimated to cost $600,000/year,plus a charge per run, for three towns;
  • starting a regional ALS service shared with other towns that do not currently have ALS (i.e. Millis, Dover, Sherborn, and one other, Holliston maybe), but it was reported that there appears to be no interest in those other towns per the Chief in doing a regional service; and
  • NB, it was stated that there was felt to be little interest among our current EMT’s in their becoming paramedics.


Another alternative, that was not discussed, is whether the Medfield Fire Department could just be converted to an all paramedic service by requiring current employees to become paramedics within a set amount of time, say within the next three years.  In the past the Chief has opined that was not possible.

The more I learn about ALS services, the more uncertain of the right solution I become.  What is the proper balance between services and costs?  I still need a lot of education, so I hope the selectmen get a lot more input.  Today in follow up discussions with one of the meeting participants I was provided the Massachusetts EMERGENCY MEDICAL SERVICES PRE-HOSPITAL STATEWIDE TREATMENT PROTOCOLS, all 176 pages of it – so I have some homework to get me started.

*]])RAJF'Ir* ALS Paramedic Budget Proposal (Estimated) Based on hiring 8 Firefighter Paramedics (Step 4) 2184 hrs (42per wk x 52) x $25.62 = $55,954 per $55,954 x 8 = $44 7 ,632 Additional annual personnel costs: Medic Stipend - $6000 x 8 = $48,000 Vacation-96hrs x 8 x $38.50 = $29,568 Sick Time-72hrs x 8 x $38.50 = $22,176 Holidays-11x8 x 10.5 x $26.62 = $23,673 Personal Time - 31.5hrs x 8 x $38.50 = $9702 Clothing - $600 x 8 = $4800 Cleaning - $300 x 8 = $2400 Town share health care - $50,000 Town share Medicare - $6500 Annual Estimated costs - $644,451 One time startup costs: Protective Clothing- 8 x $3200 = $25,600 Uniforms: - 8 x $600 - $4800 Medical Equip - $60,000 Estimated startup costs - $90,400 Year one estimate - $734,851 Annual Medical Control Fee $10,000 - Revolving Acct (pay $5000 now)

5 responses to “ALS cost estimate

  1. Mr Peterson,

    First of all I would like to commend you for staying on top of the ALS issue. I would just like to comment on a few of your points.

    The difference between a EMT basic and a EMT paramedic is so much more then just giving medicine and starting IVs. That is a over simplification of the job. Reading the protocols will only give you a small glimpse into the responsibilities of a Paramedic. I could write pages of the responsibilities of a medic but if you really would like to get a understanding of what they do you would need to sit down with some medics and discuss the job.

    There is approximately 1200 medical and fire calls a year. The medics would be crossed train as firefighters so it would be an average of just under 4 calls a day. This doesn’t include the daily activity of running a fire department. Such as equipment and station maintenance, fire prevention and inspections, training, and hopefully would have enough time to get out into the public and educate people on fire and medical safety. My wife who is the inspector at Natick fire has set up a program to educate seniors on fire safety. She goes into the seniors homes and installs smoke and co detectors at no cost to them. This type of program is possible in Medfield with the proper staffing.

    The window for a regional solution has well passed. The surrounding towns have made a huge financial and time commitment to upgrade. Regionalization would be a step back for them. They would go from having a committed ALS unit to one they have to share. Millis started in the beginning of 2014 sending members to medic school. They are planning to go ALS soon. The only towns possible might be Dover and Sherborn. Each town does about half the calls Medfield will do in a year so we still would be the primary contributor. Also a regional service means the medics would not be crossed trained as firefighters.

    Medfield will always need a call force. How ever at certain times of the day it’s hard to get members to respond. Such as day time when members are at work or early morning around 12-5am. This is not a slight on the call force. I have worked with most of them and know how committed and passionate they are for the job. It’s just the way it is.

    Waiting until members retire and replace them with medics would take almost 20 years to get a paramedic staff.

    Telling the current staff that they have to become a medic in three years is not an option. The last thing you would want to do is to force someone who has no interest in becoming a medic to become a medic. A medic is a huge commitment. Between the time it takes to get licensed, the upkeep, and experience to become a average preforming medic can take years. You need to be 110% committed to even become a halfway decent medic.

    Thank you again for spending time on this matter.

    Chad Boylan


  2. Selectman Osler "Pete" Peterson


    First, instead of calling me Mr. Peterson, please call me Pete.

    Second, thank you for your input. I clearly have lots to learn about this topic, and appreciate getting assistance as I try to figure out how to provide the right level of service that our residents want at the least cost to the residents.

    I am coming to understand that with a paramedic one just has a higher level of training than an EMT, and therefor more and greater understanding. Similarly, I often tell my legal clients that one of the major thing they are buying when they hire me are my gut reactions derived from having done the things for forty years.

    From your comments, I am inferring that you feel if the Town of Medfield wants ALS services, that it should accept the idea of adding eight paramedics to the existing staff, as the Chief laid out – is that correct? Thanks in advance.


    • Pete,

      I believe the best choice is to add 8 paramedics.

      There are no towns willing to regionalize at present and a private ambulance company is not financially feasible based on our call volume. Even with Both of those options it still leaves the current staff at 2, which is still understaffed. Understand that during a fire call 2 members would still have to wait for a call member to respond to the station from home or work before they can start a response. This can cause significant delays, and put simply a delay can be the difference between life and death or property damage. With these options I would still think that 4 firefighters should be hired. This would put staffing up to 3 a shift. 3 members responding when a call comes in without delay. It’s not the most optimum number but at least you can get a engine out the door as soon as the call comes in.


  3. Regionalization is always dismissed too quickly for town services in New England. Most of the rest of the country uses counties as the means to delivery more effective and efficient public services. I can not believe nor agree that the window has closed for Medfield to pursue such ideas. This is a big decision with much impact a very thorough, thoughtful, rational, and well considered approach is needed.


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