The region’s largest ambulance service is part of a group advocating for a softer interpretation of the state EMS law that requires ambulance services to respond to any calls they’re capable of answering, no matter how far beyond their normal coverage areas.

In place for the past 10 years, that interpretation by the state Bureau of Emergency Medical Services contrasts with the initial intent of Act 37 of 2009 — that ambulance services should be required to respond only to calls from within municipalities listed on their licenses, AMED’s Executive Director Gary Watters said after a board meeting Monday.

The expansive current interpretation has created an incentive for some smaller municipalities to quit supporting their ambulance services because they can rely instead on larger outside services. That approach causes their own ambulance agencies to wither, while straining the outside agencies due to the distance their crews must travel — forcing patients to wait longer for help in the small municipalities, while cutting into the efficiencies of the bigger agencies, according to Watters.

“(The bureau is) now trying to come up with a reasonable interpretation” — a compromise, Watters said.

The law states: “An EMS agency shall respond to a call for emergency assistance as communicated by the PSAP (Public Safety Answering Point), provided it is able to respond as requested. An EMS agency is able to respond as requested if it has the staff and an operational EMS vehicle, if needed, capable of responding to the dispatch. An EMS agency may not refuse to respond to a dispatch based upon a desire to keep staff or an EMS vehicle in reserve to respond to other calls to which it has not already committed.”

“The intent of this language was to ensure that an EMS agency responded to calls for service within the municipalities they listed on their agency license,” Watters stated in testimony he gave in June 2023 before the state Senate Health and Human Services Committee.

While he understands the arguments for each side, the current interpretation is “making the system unstable,” because some municipalities that might otherwise support their local ambulance agencies can save money by simply “banking” on outside agencies coming in, Watters said.

That is helping create a situation in which smaller ambulance services are “collapsing,” according to Watters.

“This (has) created a ‘freeload’ situation where an EMS agency is forced to regularly provide service to communities that make no effort to support or fund EMS coverage,” Watters testified. “These municipalities feel they have met their obligation under municipal code because a 911 center will dispatch an ambulance to their emergency.”

In 2022, “AMED was forced to provide service 112 times to a municipality located 15 miles away in another county that has consistently refused to name or support a primary EMS agency,” Watters stated in his testimony.

Those calls were among a total of 1,042 calls outside AMED’s designated primary response area, Watters stated.

“This unfunded mandate occurs multiple times a day all over Pennsylvania,” Watters told the senators. “The situation has wreaked havoc on our system.”

Act 37 was deliberately written “in a vague manner” to be flexible enough “to keep pace with the ever-changing health care industry,” Watters stated in his testimony.

Despite those good intentions, however, “that vagueness has actually hurt the EMS system due to the bureau’s inconsistent interpretations and the establishment of policies that do not follow the intent of the legislation,” Watters stated, referring not just to the universal response requirement, but also to an issue connected with temporary licensing.

The bureau should return “to the intent of the Act,” while the state’s municipal codes should also “add stronger language stating how the municipality must ensure EMS,” Watters added, referring specifically to the issue of mandatory universal response.

A previous bureau director set the current policy, according to Watters.

The bureau “is currently working with regional EMS councils, EMS agencies, and other stakeholders to develop plans that improve processes for EMS agencies, municipalities, and Public Safety Answering Points (PSAPs)” on the issue, according to a spokesperson for the Department of Health, in response to a request for comment. “This long-term plan would both ensure patient care remains protected across the Commonwealth and support the financial sustainability of EMS agencies.”

Mirror Staff Writer William Kibler is at 814-949-7038.