On a recent Thursday afternoon, four county EMS responders and one DBEMS paramedic were on hand at the north DBEMS station, temporarily located next door to the Delmar Fire Department. From Left: Lt. Matt Wiley, Advanced EMT, DBEMS; Dan Green, Paramedic, ACSO; Brenda Adams, Paramedic, ACSO; T.J. Foley, Paramedic, ACSO; Chief Steve Kroll, EMT, DBEMS; and Dennis Kilcullen EMT, ACSO. Photo by Ali Hibbs/Spotlight News
Editor’s Note: This is the second in a three-part series regarding Delmar-Bethlehem EMS, which is celebrating the fifth anniversary of a merger that joined first responders from the northern and southern parts of Bethlehem.
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BETHLEHEM —As recently as the 1990s, few volunteer-based emergency medical service providers in the region were consistently able to provide paramedic-level care when responding to emergency calls, according to Albany County EMS Captain Brian Wood.
Today, said Delmar-Bethlehem EMS Medical Director Bruce Ushkow, both a state certified emergency medical technician (EMT) and a licensed paramedic respond to every call in the Town of Bethlehem.
Delmar’s first “Rescue Squad” was organized in 1939 by Floyd Irons, who served as its first captain. Early members were recruited from the Delmar Fire Department, the umbrella under which Delmar EMS began, and learned how to administer first aid.
Peter Applebee of Applebee’s Funeral Home donated the first ambulance to the squad in May 1940, which he outfitted with an emergency “resuscitator” a year later. That first Delmar EMS squad serviced residents of the Delmar, Slingerlands and Elsmere Fire Districts. By the 1970s, the Delmar emergency response team had a reputation as one of the best volunteer squads in the region, boasting paramedic-level care when no one else could.
In the mid-90s, however, Delmar was experiencing problems keeping volunteer paramedics on staff. “It was hard to get people to commit to that kind of training and stay here as volunteers,” Wood explained. “There were also people who took advantage and would get the education on [Delmar’s] dime and then say, ‘See ya! I’m going to go work somewhere I can make a paycheck.’”
Delmar was not only short-handed, but was also responding to Bethlehem EMS calls requiring paramedics for advanced life support. (Bethlehem EMS, which incorporated in 1956 as an independent, volunteer-based organization, served the southern half of Bethlehem.)
“At the time,” said Wood, “Delmar EMS was running at a paramedic level, but was really struggling to maintain the high quality of care they were known for, and Bethlehem EMS had no paramedics at all, but knew they needed them.”
It was also in the mid-90s that an increasing need to provide advanced emergency care in rural, volunteer-based areas beyond Bethlehem prompted the late Albany County Sheriff James Campbell to implement a county-based paramedic response program in an effort to ensure that responders with paramedic level training were available to county residents in those areas.
The Albany County Sheriffs paramedic program was initially conceived to respond to calls out of Berne, Westerlo, Rensselaerville and the county’s outlier hilltowns. According to Wood, however, both EMS squads serving the Town of Bethlehem quickly realized they would also benefit.
The county paramedic program began in February 1996. From day one, the program had two vehicles serving Bethlehem and one covering the hilltowns, which had a considerably lower number of calls due to population. Immediately, however, it became obvious that the gap in services in the towns of Coeymans and New Scotland would pose problems.
“We had this big canyon in the middle. They didn’t want to have anything to do with the program, didn’t want to pay into it,” said Wood. “So we start doing good care, we have three paramedics on shift.” He said it quickly became common knowledge that volunteer emergency services in the areas served by the county paramedics program had dramatically improved.
In one of the worst instances related to that gap in services, Wood refused to send a paramedic to a pediatric cardiac event. He was nearly fired for the decision. “It was very unpopular. I took a lot of heat for that,” he said. “Fortunately, I had a level head.” (While Guilderland responded to the call, the infant, found at the bottom of a pool, did not survive.) “You could have had ten paramedics there,” he said. Wood said he got no criticism for refusing a call for a middle aged cardiac arrest four days earlier.
“I’m not playing God,” he said. “Either we’re going to go or we’re not going to go. So that sort of forced them to take a look and realize that maybe they wanted a piece of the pie too, because these other guys were getting better care.
“So, from ’98 on, we’ve just been providing paramedic-level care,” said Wood. “The relationship that we have is simple. We take the cost of the program and we divide it up based on the population, so the Town of Bethlehem has 57.6 percent of the total population of the six towns and they pay 57.6 percent of the total bill. Rensselaerville has, like, 4.2 percent of the total population, so they pay 4.2 percent.
“Is the level of care as good in Rensselaerville as it is here? No. Do they have access to the same resources? Certainly. The way the program is structured: if there are six cardiac arrests here in the Town of Bethlehem, I can pull the three Bethlehem paramedics, I can pull the one out of Coeymans, I can pull the shift commander [at the Clarksville station], and, god forbid, I can pull the one off the hilltowns.”
Around 2003, Delmar EMS, then still part of the Delmar Fire District, found that it was again having problems with staffing. Volunteers were increasingly unavailable for weekday shifts and a decision was made to switch to a hybrid staffing model to meet the needs of the community. To cover the costs of paying some daytime staff, Delmar EMS cut ties with the Delmar Fire District in 2010 to incorporate as a nonprofit, which allowed it to take health insurance payments for services.
Five years ago, Delmar and Bethlehem EMS agencies combined to provide improved coverage to the entire town.
Currently, the agency is predominantly staffed by volunteers from 6 p.m. to 6 a.m. every night. Approximately 70 volunteer EMTs, advanced EMTs, paramedics, and ambulance drivers respond to calls for medical assistance. Between the hours of 6 a.m. and 6 p.m., paid EMTs from the Albany County Sheriff’s Office EMS Unit supplement the volunteers by staffing three of six DBEMS ambulances.
“We’re one of the strongest ambulance corps in the area because of this model,” said DBEMS Chief Steve Kroll. “We frequently provide assistance to other communities.”
Each 911 call in Bethlehem is answered with a dual response — a Delmar-Bethlehem EMS ambulance and an Albany County Sheriff’s Office EMS Unit Paramedic. The Albany County Sheriff’s Office stations at least two paramedics in the Town of Bethlehem 24 hours a day, seven days a week. As DBEMS is also an advanced life support (AEMT) agency (meaning it can provide licensed paramedics), the two agencies often collaborate to provide care on other local calls requiring advanced life support.
“We don’t have the same relationship with other agencies as we do with Delmar-Bethlehem,” said Wood. “We meet once a month, probably more, and, for sure, talk once a week. It’s that back and forth communication that allows all of us to provide the level of care that we do here in Bethlehem.”
Comparing the DBEMS model to other local agencies that are fully paid, Wood said there is essentially no difference. “As long as you have the same standards, as long as standards are high, you can’t tell the difference.
“It’s pretty well known that this agency here. . . it just works,” he said. “They’re maintaining where other places are collapsing in a hurry.”
“New York EMS is in a real crisis in small towns right now,” said Kroll. “It’s something that, society-wide, we have to deal with. I know the state Department of Health and the governor are very actively thinking about it.”
The hybrid model has saved also DBEMS millions of dollars since the two agencies merged in 2013, and Kroll has been invited to speak about it in struggling communities around the state.
“We’re lucky that we built an economic model that allows us to be financially successful while at the same time providing top-level paramedic care on all calls,” Kroll said.
“Money is a big huge thing,” said Wood. “Anybody who can run an organization like this organization and do it with volunteers is a genius. Many have tried.”