Seacoast chiefs ask Rockingham County for funding to sustain regional paramedic program

Chief Knudson, a Seacoast fire chief who led the effort to re-create paramedic coverage after Exeter Hospital wound down its program, told the Rockingham County Board of Commissioners on Oct. 9 that the municipal plan now provides paramedic-level care to 18 communities and is seeking county help to remain sustainable.

The county presentation focused on operational results from the program’s first six months and on shortfalls in near-term funding. “Our first six months of service, we've responded to over 1,400 calls,” Chief Knudson said, and described clinical accomplishments including 15 rapid sequence intubations and return of spontaneous circulation for 11 of 16 cardiac arrests the team attended.

Why it matters: Commissioners said the readiness provided by regional paramedics fills gaps for smaller towns that cannot sustain dedicated paramedic staffing and that service interruptions would leave county residents — including people traveling through smaller towns — without advanced prehospital care.

Knudson and other presenters laid out a mixed funding picture. Beth Israel/Exeter Hospital and the William H. Donner Foundation provided seed money to start the program for 2025. The program charges user fees to transporting agencies (listed in the briefing as ALS‑1 at $115 and ALS‑2 at $327) but those fees likely cover a small share of operating costs; early estimates discussed on the record put fee revenue in the first year in the low hundreds of thousands of dollars while program costs are measured in the low millions.

Knudson described two near-term budget options: a mid‑2026 request of about $1.8 million to add a third paramedic response vehicle (for coverage in Plaistow, Brentwood and Stratham) and a full 2027 budget request of roughly $2.6 million to sustain a larger staffing model. He said a major challenge is getting individual towns to enter multiyear payment agreements; state law provisions on contracting and ballot measures make multi‑year town commitments difficult in some communities.

Chris Rosenstalk, representing the William H. Donner Foundation, urged a county‑level approach so the entire county population could be guaranteed access to advanced life support rather than relying solely on a patchwork of town budgets, and he gave examples of other regions that have shifted to county funding to preserve readiness.

Commissioners asked for more detailed budget spreadsheets and town‑by‑town cost scenarios before any commitment. One commissioner said the county could consider partial subsidy while town buy‑in increases, and another described willingness to assist with outreach to town leaders during this budget season. No motion or vote to allocate county funds was taken.

Next steps: Commissioners asked program staff to provide the detailed cost model and a list of which towns have agreed to participate, and they said the information would be used to determine whether to include a county contribution in next year’s budget or a supplemental request to the delegation. Chief Knudson said federal and foundation funding streams he has pursued are uncertain beyond 2026.

Ending: County officials described the presentation as a start of a multiagency discussion. Chief Knudson thanked the board; commissioners said they would continue the conversation and requested the program return with the written budget and participation commitments to inform possible action during the upcoming budget process.