ALS costs

Chief Kingsbury provided new figures for various permutations (use the link to get a copy with correct formatting):




Advanced Life Support for the Town Of Medfield



Total calls for service by the Medfield Fire Dept. was 1274 for 2016 of that 517 were for Emergency Medical Services.



Emergency Medical Services


517 Requests               257 BLS Transports                189 ALS Transports               71 Refusals



The 189 transports were accompanied by paramedics from Events EMS, Westwood FD, Walpole FD, Norfolk FD and Brewster EMS.


Events EMS ceased operations and Brewster as of now is not available.


The Problem? Who is going to provide Advanced Life Support (ALS) for the almost 200 calls requiring Paramedic (Medic) intervention? What are our options?


  • If we do nothing.


We might be able to get away with it. It delays providing in-house ALS for a year if not more. It takes advantage of other communities ALS at their expense. We risk being shut off from their services as it is not mutual aid. A fellow chief who is struggling to staff his volunteer Fire Dept. and is using mutual aid excessively said it best,


“Mutual Aid is a network of sharing, with resources flowing back and forth across jurisdictional borders, and should not routinely benefit one partner in the form of subsidized services by the taxpayers of another community.”


  • Hire a Private Provider


Initial conversations with Millis & Medway resulted in a proposal from a private company for a dedicated ALS response truck to service the three communities it would be @ $600,000 per year and another $225.00 per intercept. Millis & Medway were not interested in pursuing further. On 01/19/17 as requested, I met with Chris DiBona of Brewster Ambulance to see if there was anything his company could do with either the three towns of Medfield, Dover and Sherborn or from their base in Norwood. Chris got back to me on 01/25/17 and said they were still working on it. I reached out to the Fire Chiefs in Sherborn and Dover, Sherborn expressed a little interest as they are struggling too and Dover does not appear to be interested.  I have not heard anymore as of yet. I will provide any info as soon as it’s available.








  • Add Staffing (options)


  1. I met with the Fire Chiefs from Millis and Medway on 01/23/17 to further discuss what options we might have. Both of those towns are pursuing advancing to the ALS level through hiring and training, more so hiring. As a result of these discussions if we were to get to the level of at least four (4) Medics each we could seek permission from our Medical Directors to run at a Paramedic/Basic (P/B) level and when needed we would pull a second medic from a neighboring town to facilitate a two medic event.


Pro’s: It’s a start                                                       Con’s: 2nd Medic availability =

We would have 2 Medics 50% of the time     delayed response

Increased Revenue                                           Expense


Cost Estimate:  4 Staff @ $80,556 = $322,224

Startup                       $90,400

Est. Total                                           $412,224         


 B)If we were to hire six (6) additional Medics we would have adequate resources to staff the Ambulance at the ALS level 24/7/365. The additional staff would have two shifts with four (4) personnel and two shifts with three (3) personnel.


Pro’s: 24/7 coverage at the ALS level                  Con’s: Expense

Increased Revenue

Staffing to aid in medical calls

Staffing to respond to fire calls



Cost Estimate:  6 Staff @ $80,556 = $483,336

Startup                        $90,400

Est. Total                                            $573,336


  1. If we were to hire eight (8) additional Medics we would have adequate resources to staff the Ambulance at the ALS level 24/7/365. The additional staff would have all shifts with four (4) personnel. With the additional staff and by having a second ambulance, in the event of back to back medicals, we could staff it to respond at the Basic Life Support (BLS) level. Added Medic staff would be able to cover open shifts to maintain ALS staffing.


Pro’s: 24/7 coverage at the ALS level                  Con’s: Expense

Increased Revenue

Run a 2nd BLS ambulance

Staffing to aid in medical calls

Staffing to respond to fire calls



Cost Estimate:  8 Staff @ $80,556 = $644,451

Startup                        $90,400

Est. Total                                            $734,851



According to Joy Ricciuto our Town Accountant, the Ambulance service generated $439,644 for FY16. Although I do not want to predict how much in this volatile time in Healthcare, it is safe to say there will be an increase to our revenue stream by advancing to the ALS level of service. By keeping it in-house we will keep the $62,000 we paid for outside services. The likelihood of increased revenue by way of increased demand for ALS calls and being able to reciprocate with mutual aid does exist.


Hiring additional Staff to provide ALS




By providing in-house ALS you get the needed resources to the patients side the fastest possible way. No delay with patient care by waiting for a regional or alternative ALS intercept service.

Patients deteriorate every minute you wait for intervention.


You have more control on direct patient care by managing ourselves. We can choose the equipment to use to provide services. You have the ability to participate with any project waivers when they are available.


We can control the training of in-house medics. Training is key to this type of operation.


We have the ability to schedule medics in teams to capitalize on their experiences and skill level to provide the best service for the town.


We will maintain our own local medical control MD that is knowledgeable of the region and will oversee our entire service.


Increased billing for services rendered at the ALS level will result in increased revenue.


Increased staffing could result in running a 2nd ambulance resulting in increased revenue.


Increased staffing will aid in responding to Fire related calls for service as well as the day to day operational activities that are done.




Delay in providing ALS intervention to patients in need. Our avg. response time is under five minutes; it is a fifteen minute response from Norwood if we were to use Brewster as an intercept.


The startup expense is a downside but will be offset by increased revenues that will be better determined after it is up and running.




This is an issue that will not be going away. We as a community need to address it so that all our residents have the best medical resources available to them in their time of need. I believe this decision as to what level of care is acceptable to our taxpayers should be left up to them. I would recommend the hiring of six (6) Medics to properly cover at the ALS level 24/7/365.

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