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Concord fire officials propose bringing ALS service in-house, citing faster response and near-term revenue offset
Summary
Fire department leaders told the Finance Committee they plan to train existing ambulance crews to paramedic (ALS) level using a one-time grant; officials estimate roughly $300,000 in added annual operating costs offset by about $459,000 in additional billing revenue, producing an early-year net in the low six figures.
Concord fire leadership told the Finance Committee on Sept. 24 that the department intends to bring Advanced Life Support (ALS) provision in-house by training existing ambulance staff to paramedic certification, a change officials said would improve response times and stabilize ALS availability.
Concord Fire Chief (name not provided) said a recent audit of regional ALS coverage showed dwindling availability from the current third-party provider and a marked gap in Concord’s ALS response rate. "We provide ALS service now through a third party, but availability and response times have declined," the chief said, adding that the department’s ambulances reached a nearby medical emergency in two minutes while a paramedic-level unit arrived about 11 minutes later in a recent local call.
Dr. Ryan Kring, medical director at Emerson Hospital, told the committee that the clinical difference between basic (BLS) and advanced (ALS) prehospital care can affect outcomes for cardiac arrest, stroke and other time-sensitive conditions. "Paramedics can administer medications and advanced airway care that BLS providers cannot; that can make a dramatic difference in outcomes," Dr. Kring said.
Assistant Chief Whitney and Assistant Chief Walter Latta reviewed the program’s costs and revenue projections. Officials said a one-time federal grant awarded to the department will fund training during a two-year performance window; Chief and staff described the grant as roughly a $1,000,000 award used to train existing personnel. The department is targeting 14 staff to enter training and expects to have at least 16 paramedics available to staff two 24/7 ALS ambulances once the program ramps up.
On the finance side, staff corrected an earlier projection slide and presented conservative revenue modeling. The department reported total system ambulance revenue in the $1.2 million range over recent years and said Concord currently receives about two-thirds of the system revenue under the existing regional billing arrangement. If Concord provided ALS directly, officials projected an additional annual ALS revenue of about $459,000 for the town and estimated incremental operating costs near $300,000 in the first full year of operation. Assistant Chief Whitney summarized the spreadsheet as showing the new program would yield a net improvement of roughly $159,000 in the hypothetical first year of service.
Officials emphasized the net cost figures reflect pay-rate changes for current staff (EMT basics upgraded to paramedic pay), additional ALS supplies and upfront capital needs to outfit ambulances for ALS. "This is existing personnel who are going to be trained to the paramedic level, not a new-service headcount," Whitney said. The department said the capital/equipment request in the presentation should have read $275,000 (a missing "K" on the slide was corrected during Q&A) to outfit ambulances and purchase equipment ahead of licensure.
Committee members pressed on workforce risk and rate-setting. A member asked whether pay increases required to retain newly trained paramedics might grow over time; the department acknowledged the market for paramedics is tight but said Concord’s wages and work environment have supported hiring and retention to date. Committee members also recommended a public, Select Board review of ambulance rates; the department said rate-setting mechanisms vary and that the town manager would ultimately advise on the governance and public-review process.
On collection and fund management, staff said a new ambulance revolving fund approved at town meeting (effective July 1) will receive receipts; the department reported roughly $128,000 in receivables to date since July 1. Officials said excess revolving-fund balances could be used later to buy ambulances or offset capital expenses.
The department did not seek a vote from the Finance Committee on Sept. 24. Members invited staff to bring the proposal and any outstanding questions to the Select Board for further public discussion and review.
