Kingston discusses joining Plaistow-led regional paramedic service as Exeter ALS winds down

Kingston Select Board members heard an extended update about a proposed regional paramedic service led by the town of Plaistow and discussed how Kingston might participate and pay for it.

The presenter said Plaistow has “secured enough funding from BLH, in the $22,000,000 to make the 1st year free,” and that an additional $2,000,000 from BLH has been brokered with help from the attorney general’s office, Janice Stevens of the governor and council’s office and regional chiefs, according to the presenter.

Board members were told Plaistow plans to host the regional paramedic service and that the first year of operating costs would be covered by donors and grants. The presenter outlined a multi-year cost-sharing plan for participating towns: year two about 20 percent of the service cost per town, year three 40 percent, year four 60 percent, year five 80 percent and by year six towns would be expected to cover 100 percent of the per-town share unless additional donations reduced those amounts. The presenter described the schedule as tied to donations and the number of towns that join the service.

Why it matters: Kingston requested advanced paramedic-level care 81 times in 2023, according to the presentation, and current ALS transport billing to the town totaled $6,885 that year under the existing arrangement. The town’s decisions will affect local EMS availability, resident billing flows and the municipal budget.

Details and remaining questions

• Billing and patient charges: The presenter explained that only the transporting ambulance can bill the patient; intercept vehicles or paramedic “intercepts” cannot bill patients directly. Under the existing arrangement, towns receive bills from the ALS provider; Kingston’s resident ALS charges currently flow into the town’s general fund, while nonresident ALS receipts go to the ambulance fund. The presenter said current bill amounts for transports vary by level: an example BLS emergency transport was cited as $1,095.13 and an ALS emergency level 1 as $1,820.18. The presenter also said the current ALS “intercept” charge to Kingston is $85 per ALS transport and that in 2023 Kingston paid $6,885 for ALS transports (81 calls).

• Contract structure and MOU: Kingston would sign an intermunicipal memorandum of understanding (MOU) with Plaistow if the town opts into the service. A draft MOU from Plaistow’s lawyers was expected the day after the meeting; board members were told they would review it before taking any commitment. The presenter said Plaistow would bill participating towns and towns would, in turn, pay Plaistow.

• Equipment and start-up funding: The presentation said Exeter Hospital had verbally agreed to donate two ALS vehicles and equipment to the new service and that roughly $1.7 million was estimated as the operating budget for Plaistow’s paramedic service, with about $300,000 available for capital purchases such as new vehicles. Donors and philanthropic groups were described as interested in also funding training and mass-casualty preparedness.

• Local staffing and resilience: Kingston officials discussed building local paramedic capacity. The presenter said Kingston has one full-time employee nearing completion of paramedic certification and planned to add two more paramedics in the coming months, which would move the town toward more local ALS capability. The presenter noted that four full-time paramedics would be needed for uninterrupted 24/7 local coverage.

• Geography and deployment: Under the current Plaistow proposal, one response truck would be based in Brentwood and another in Plaistow, with a supervisor vehicle. Board members discussed options for siting vehicles and the possibility of adjusting deployment locations after initial service months to optimize coverage for Deerfield, Candia, Nottingham, Northwood, Stratham and other nearby towns.

Discussion vs. decision

Board members asked detailed questions about billing flows, municipal budget impacts, and whether Kingston could maintain partial local capability and be billed only on a per-call basis. The board did not vote or take formal action; members requested the draft MOU and additional details and planned to receive updates after a regional meeting and a follow-up meeting with chiefs and counsel.

What’s next

The presenter said there was a meeting scheduled the next day in Kingston with regional chiefs and the attorney general’s office; the board was invited to an informational session on Jan. 16 to review a slide presentation and service area maps. The presenter offered to report back to the board with answers to remaining questions about billing, the draft MOU and deployment specifics.

Ending

Board members emphasized the need for clarity about billing and contract language before any municipal commitment. No formal vote was taken; the board directed staff to review the MOU and continue receiving updates so the town can assess budgetary and operational impacts if it chooses to participate.