Andrew Bokulich, right, helps Mike Crawford set up a demonstration on how to use a video laryngoscopy at Quality EMS in Adams Township on Friday, Jan. 24, 2025. Rob McGraw/Butler Eagle
Rob McGraw
Emergency medical service departments are facing a crisis.
For more than a year, EMS departments in all corners of Pennsylvania have sounded the alarm to state and local officials about systemic issues that threaten their existence — including staffing shortages, inflation and stagnant reimbursements from insurance.
“There is definitely a crisis in EMS, in not only the Commonwealth, but the nation,” said Steve Bicehouse, emergency services director for Butler County.
As of September, there are 1,205 EMS agencies across the state, according to the state Department of Health. That number used to be higher.
Over the past year and a half, numerous agencies have succumbed to the financial strain and closed up shop. Jeannette EMS, Lifestat Ambulance Service in Saltsburg, and others in East Allen Township, Northampton County, and Kecksburg, Westmoreland County, have shut down.
Closures and decreased staffing levels have led to backlogs in cases and increased response times for remaining EMS departments — which could be a matter of life and death.
Mike Crawford prepares a mannequin as he gets ready to demonstrate how a video laryngoscopy works at Quality EMS in Adams Township on Friday, Jan. 24, 2025. Rob McGraw/Butler Eagle
Rob McGraw
Today, there are 13 agencies that are either primarily based in Butler County or occasionally cross over county lines to perform mutual aid here.
While no EMS services in Butler County have folded as of yet, multiple chiefs say they still are dealing with the same issues.
The video camera used in a laryngoscopy helps medical professionals see a person’s vocal cords and larynx and surrounding areas at Quality EMS in Adams Township on Friday, Jan. 24, 2025. It is used for airway management when other procedures fail. Rob McGraw/Butler Eagle
Rob McGraw
“We are no different from any other service,” said Matt Nickl, executive director of Cranberry Township EMS. “Between increased labor costs, increased equipment costs, delayed deliveries and stagnant insurance reimbursements, this makes for a perfect storm for disaster.”
At the start of 2025, EMS professionals across Butler County have mixed opinions as to whether the situation has gotten better, worse or if anything has changed at all over the past 12 months.
“In some respects, I believe it has gotten worse and better,” Nickl said. “It has gotten worse because of the stagnant insurance reimbursements, increased call volume and an overall increase in the cost of doing business. Services are facing a significant staffing crisis. The issues have gotten better because of the light shined on the situation, on a local level, state level and federal level.”
Rich Jones, deputy chief paramedic with Cranberry Township EMS, and his brother Quinten Jones, an advanced EMT, stand with two new ambulances at the station on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
While the issues facing EMS services in Pennsylvania are numerous, chiefs in Butler County point out one central dilemma: Reimbursements from insurance companies, the main financial lifeline for the departments, have largely remained stagnant over the years and have not been enough to make up for increased expenses across the board.
“Insurance companies rule the world,” said Mark Lauer, president of the Karns City Regional Ambulance Service. “They're the ones that tell you what they're paying, what they're not paying, things like that. Until legislation happens where the Commonwealth tells insurance companies, ‘this is what you're going to pay for this call and this patient,’ it’s always gonna be this way. The insurance companies have a lot more lobbying money than the ambulance services do.”
Nickl estimates that CTEMS loses money on each call it receives due to their dependence on insurance reimbursements for revenue.
Mike Crawford meticulously inserts the tube for a video laryngoscopy at Quality EMS in Adams Township on Friday, Jan. 24, 2025. Rob McGraw/Butler Eagle
Rob McGraw
“85% of our revenue is generated from insurance reimbursement. About 13% of our dispatched calls do not generate a bill,” Nickl said. “Our average charge for an ambulance trip is roughly $1,200. Our average reimbursement per billable trip is around $420. A rough break-even cost per trip would be about $550 to $600. That number goes up if you factor in the 13% of calls that don’t generate a bill.”
Another major problem is staffing, a side effect of the lack of municipal and state funding available to EMS departments in Pennsylvania.
Conrad Pfeifer, executive director of Quality EMS, says recruiting new people is difficult at the salaries they can offer for the work they are asked to take on.
“EMS professionals are twice as likely to commit suicide as the general population,” Pfeifer said. “The daily horrors our society asks them to face, asks them to do it for less than what a cashier at a gas station makes.”
In this regard, Butler County has taken a step to address the issue by forming a partnership with Butler County Community College, which started a program to pump new emergency medical personnel into the workforce.
“The county, in partnership with BC3, founded and funded an EMS academy to train emergency medical technicians to augment the shortages of staff,” Bicehouse said. “They are trained and paid a full-time stipend for eight weeks, and then have to commit to a Butler County agency for a year. So far, they have graduated 14 new EMTs to test and start in the EMS workforce. This program is still ongoing and was funded through the ARPA funds the county received.”
In June, the county struck a deal with Independence Health System to allow EMS departments to use paramedics or pre-hospital registered nurses from Butler Memorial Hospital to fill holes in their staff. The county paid Independence Health $600,000.
This was good news for Lauer, who says he currently has some Butler Memorial Hospital paramedics on his staff.
“I think our situation has become better,” Lauer said. “There was a time when we didn't have enough EMTs and I congratulate the county commissioners and Butler County Community College for putting the EMT program together. That definitely helped our program and our agency to provide better emergency medical services.”
Over the past year, the state has taken some steps to address the existential issues facing emergency services. Three state Senate bills signed in November 2024 allowed municipalities to allocate a larger share of EMS and fire tax revenue toward personnel costs without raising taxes. Previously, state laws only allowed municipalities to use half of such revenue for those purposes.
While EMS departments in Butler County welcome the new legislation, opinions are mixed on whether the measures taken so far are enough to make a difference. Municipalities in the state of Pennsylvania can only charge half a mill for their EMS tax or one mill by referendum.
Nickl points out the change doesn’t affect Cranberry Township EMS at all, as the township doesn’t charge an EMS tax.
“Gov. Shapiro’s changes allow municipalities to waive this 50%, which is a great start,” Nickl said. “The downside is that a half mill tax in many areas in Butler County does not generate the necessary funding for long-term sustainability.”
“The main reason for the EMS crisis is lack of funding to pay career staff. There has been no discussion of direct funds for personnel wages and benefits,” Pfeifer said.
Compared to other EMS departments in Pennsylvania, or even in Butler County, Pfeifer’s Quality EMS — which serves a chunk of southern Butler County — is in a relatively privileged position due to two straight years of hefty contributions from the six municipalities that it serves. This includes contributions of $125,000 from Adams Township in both 2024 and 2025.
Cranberry Township EMS Quinten Jones an advanced EMT stocks supplies one of the new ambulances at Cranberry Township EMS on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
“Our six municipalities have begun a journey of financial support that is unheard-of in the county. They are blazing a trail that all municipal leaders need to follow,” Pfeifer said. “Their dedication to financially support us, paired with our unique approach to supporting our team in combination with financial stewardship, is the recipe for success that EMS needs.”
While he acknowledges that Quality EMS is relatively stable, Pfeifer doesn’t go as far as saying it is thriving.
“Quality EMS may be in a more stable, but not necessarily sustainable, financial position than some because of its excellent history of financial stewardship,” Pfeifer said. “This is due to Quality’s decades of responsible management and fiscal acuity.”
Quinten Jones, an advanced EMT with Cranberry Township EMS, goes through the process to show Matt Young what its like to be taken in an ambulance as Matt was there visiting his mother at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Cranberry Township EMS is also taking its financial fate into its own hands.
“We are currently engaged in a study with eleven municipalities and a neighboring ambulance service to develop a system for funding EMS throughout those areas,” Nickl said. “We are also in the beginning stages of a regional study to discover why people aren’t progressing in their EMS careers through qualitative data. Our goal is to create programs to help other services successfully recruit and retain skilled talent.”
“New buildings, ambulances and training are a small part of the equation, but until we can make EMS a lifetime career — like police, paid fire or nursing — the crisis will continue,” Pfeifer said. “A new building, cool equipment or ambulance are useless unless people want to make a career in EMS.”
Quinten Jones, an advanced EMT, backs one of the new ambulances into the garage at Cranberry Twp Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Rich Jones, deputy chief paramedic, and his brother Quinten Jones, an advanced EMT, stand with the two new ambulances at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Quinten Jones, an advanced EMT, stocks supplies one of the new ambulances at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Rich Jones, deputy chief paramedic with Cranberry Township EMS, and his brother Quinten Jones, an advanced EMT, stand with two new ambulances at the station on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Quinten Jones, an advanced EMT, stocks supplies one of the new ambulances at Cranberry Twp Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Cranberry Twp EMS Quinten Jones an advanced EMT goes through the process to show Matt Young what its like to be taken in an ambulance as Matt was there visiting his mother at Cranberry Twp Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle)
Quinten Jones, an advanced EMT, gets a stretcher ready for a patient at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Quinten Jones, an advanced EMT, goes through the process to show Matt Young what its like to be taken in an ambulance as Matt was there visiting his mother at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
A Cranberry Township EMS ambulance on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Quinten Jones, an advanced EMT, gets ready to take an ambulance out for a call at Cranberry Township EMS on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Quinten Jones, an advanced EMT, stocks supplies in an ambulance at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Quinten Jones, an advanced EMT, gets the stretcher ready in an ambulance at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Quinten Jones, an advanced EMT, gets ready to take an ambulance out for a call at Cranberry Township EMS on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Quinten Jones, an advanced EMT, gets a stretcher ready to take an ambulance out for a call at Cranberry Township EMS on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Quinten Jones, an advanced EMT, looks in the back of an ambulance at Cranberry Township EMS on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Cranberry Township EMS has LifePak 15 Monitor and Defibrillator at Cranberry Township EMS on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
Mike Crawford prepares a mannequin as he gets ready to demonstrate how a video laryngoscopy works at Quality EMS in Adams Township on Friday, Jan. 24, 2025. Rob McGraw/Butler Eagle
Rob McGraw
Mike Crawford meticulously inserts the tube for a video laryngoscopy at Quality EMS in Adams Township on Friday, Jan. 24, 2025. Rob McGraw/Butler Eagle
Rob McGraw
The video camera used in a laryngoscopy helps medical professionals see a person’s vocal cords and larynx and surrounding areas at Quality EMS in Adams Township on Friday, Jan. 24, 2025. It is used for airway management when other procedures fail. Rob McGraw/Butler Eagle
Rob McGraw
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Quinten Jones, an advanced EMT, backs one of the new ambulances into the garage at Cranberry Twp Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Rich Jones, deputy chief paramedic, and his brother Quinten Jones, an advanced EMT, stand with the two new ambulances at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Quinten Jones, an advanced EMT, stocks supplies one of the new ambulances at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Rich Jones, deputy chief paramedic with Cranberry Township EMS, and his brother Quinten Jones, an advanced EMT, stand with two new ambulances at the station on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Quinten Jones, an advanced EMT, stocks supplies one of the new ambulances at Cranberry Twp Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Cranberry Twp EMS Quinten Jones an advanced EMT goes through the process to show Matt Young what its like to be taken in an ambulance as Matt was there visiting his mother at Cranberry Twp Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle)
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Quinten Jones, an advanced EMT, gets a stretcher ready for a patient at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Quinten Jones, an advanced EMT, goes through the process to show Matt Young what its like to be taken in an ambulance as Matt was there visiting his mother at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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A Cranberry Township EMS ambulance on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Quinten Jones, an advanced EMT, gets ready to take an ambulance out for a call at Cranberry Township EMS on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Quinten Jones, an advanced EMT, stocks supplies in an ambulance at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Quinten Jones, an advanced EMT, gets the stretcher ready in an ambulance at Cranberry Township Emergency Medical Services on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Quinten Jones, an advanced EMT, gets ready to take an ambulance out for a call at Cranberry Township EMS on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Quinten Jones, an advanced EMT, gets a stretcher ready to take an ambulance out for a call at Cranberry Township EMS on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Quinten Jones, an advanced EMT, looks in the back of an ambulance at Cranberry Township EMS on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Cranberry Township EMS has LifePak 15 Monitor and Defibrillator at Cranberry Township EMS on Tuesday, Jan. 21, 2025. Justin Guido/Special to the Eagle
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Mike Crawford prepares a mannequin as he gets ready to demonstrate how a video laryngoscopy works at Quality EMS in Adams Township on Friday, Jan. 24, 2025. Rob McGraw/Butler Eagle
Rob McGraw
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Mike Crawford meticulously inserts the tube for a video laryngoscopy at Quality EMS in Adams Township on Friday, Jan. 24, 2025. Rob McGraw/Butler Eagle
Rob McGraw
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The video camera used in a laryngoscopy helps medical professionals see a person’s vocal cords and larynx and surrounding areas at Quality EMS in Adams Township on Friday, Jan. 24, 2025. It is used for airway management when other procedures fail. Rob McGraw/Butler Eagle
Rob McGraw
