 Welcome, everyone. We are doing joint testimony this afternoon with Carlos government operations and military affairs and it's important subject of EMS. If you all will remember last year in this committee, we voted out through the budget a request for, I believe it was $100,000 for a study to be done on our EMS system. So we're here to receive information from VDH on the report and then we have some of the stakeholders who are involved who are going to testify as well. We'll answer questions along the way and then at the end, Brett McCarthy and I will have a conversation of kind of there's a bill on the wall where this lands and how we move forward and if we're going to move forward. So Mike, did you want to add anything? I just wanted to say thank you to you, Representative Houghton or Lori, if we're using your rules for inviting us to do this testimony jointly. The House government operations military affairs committee has jurisdiction over a wide swath of things, including public safety and I'm very interested in how we can help work to make sure that the future of all of our public safety and emergency services serve them out as well. So very much looking forward to this discussion. Great. Thanks, Mike. And if I can just add it is public safety and it is healthcare. I think that's kind of one of how I want to set the stage here. This is the first place someone can call and they have to be responded to. So it is a core element of our healthcare system and I will just say personally, we had to call 911 and have our Essex rescue come to our house right before Christmas. For a situation and if they if we hadn't had that 911 and the quick response. I'm not sure what would have happened. So I just want to make that clear that this is public safety and really healthcare without going into number 2. Madam chair, thank you to the members of both committees. Thank you for the opportunity to speak with you today. My name is Will Moran. I serve as the director of words preparedness, response, injury prevention, and I'm happy to hear today to represent the Department of Health. First, I'll just start by thanking the members of my team and our partners and writing this report. It represents a colossal effort in a very compressed timeline together, some very important information and to do an assessment of our statewide BMS system, a limited assessment that looks at some very specific questions. So I'm going to transition to my written testimony and then I will open up to any questions. So XMDA required the Department of Health to conduct a regional coordination study to identify issues and provide recommendations for legislative consideration to sustain and improve the provision of EMS for Vermonters, the study focus on the following three areas. Issues related to cost of service and existing funding models, issues related to coordination across agencies, issues related to EMS district structure and authority, including consideration of recommendations and the number and configuration of EMS districts and their powers, duties and authority. The department contracted with emergency management to design and implement the study processes, facilitate engagement with internal and external stakeholders and provide direct support to develop the report. 673 Vermonters participated in this study by attending a public meeting, a focus group providing direct feedback via the website, submitting comments by email or answering questions on a survey. EMS in the state of Vermont, like other states, is delivered by diverse groups of types, which includes private not-for-profit, private for-profit, fire-based EMS, municipal-based EMS and hospital-based services. Decisions regarding the type of EMS service provider, local readiness, staffing, deployment models and financing are made by community officials and voters at the local level. Vermonters consistently call upon the EMS system with greater than 330 requests for EMS response made daily. No other health care entity provides unscheduled, basic and advanced medical care to anyone, anywhere at any time of the day and regardless of someone's ability to pay. In rural communities, EMS is often a substitute for primary and urgent care as there is not a local clinic within a reasonable travel distance. As Vermont's population continues to age, it is safe to assume the annual number of requests for ambulance response will continue to increase. Today, there are 3,277 certified and licensed EMS practitioners who are affiliated with one or more of the 168 first response and ambulance services across the state. Vermont EMS is rich in culture, history, community connection and identity. Local control, local choice, neighbor helping neighbor are all inherent qualities of the Vermont EMS system. EMS representatives have a tenacious appetite for community service and improving the health and wellness of Vermonters. During the COVID-19 pandemic, when Vermonters were asked to remain at home, EMS practitioners staffed ambulances, performed testing, administered vaccine and provided vital pre-hospital medical care at great personal risk. During the surge of pediatric and adult respiratory patients in the fall of 2022, a small group of EMS organizations once again stood up and partnered with the Department of Health to increase inter-facility transport capacity and capability. EMS services provide vital specialized transport and respiratory treatment for those patients moving between healthcare facilities. From one community to the next, how EMS is delivered varies. And the challenges faced by each service differs. Some EMS representatives are concerned about their fiscal outlook. Others report consistent community support and funding. Some EMS services report having a waiting list for folks wanting to join their organization. Other EMS services are worried about a lack of EMS personnel in their region. While many EMS organizations are on stable ground, others are anxious about their short and long-term viability. The stresses on the EMS system are real and vary across the state. While many problems can be solved at the local level, others cannot and more help is needed. Over the last 50 years, many aspects of the Vermont EMS system have evolved. In the beginning, pre-hospital care was no more than a basic first aid, then no more than basic first aid and a ride to the hospital in a hearse. Today, Vermonters are receiving pre-hospital medical and trauma care that is on the cutting edge of the EMS industry and are the essential component linking someone having a stroke, a heart attack or who is critically injured to the specialized systems of care they require. EMS is considered an allied health profession and Vermonters can expect to receive high quality and advanced medical trauma care anywhere from the bedside to the roadside. This is all possible due to the collaborative relationship established with the medical community and specifically the physician medical directors that are committed to advancing the knowledge skill and abilities of EMS practitioners. EMS is at the point of entry to the health care system for tens of thousands of Vermonters in need of medical care every year. Maintaining this vital community service will require solving issues that have gone unresolved for decades, such as sustainable, reliable and affordable EMS system financing. The essential service, this essential service is provided by dedicated volunteers and paid staff. The legacy that EMS has today was forged on the backs of volunteers who for decades gave so much of their time and of themselves to serve their communities. Well, volunteerism has been and continues to be a proud component of the EMS workforce. Across the EMS industry, EMS service representatives are reporting it is becoming increasingly difficult to recruit and retain volunteers. Many municipal governments are asked to give more as EMS services supplement their volunteer workforce with a greater number of full and part-time staff. These communities are now grappling with the true cost of adequate EMS staffing. While it is assumed by the public and ambulance will always be held with respond, it is not a guarantee and a greater investment is needed to sustain and grow the EMS workforce. Like other industries, there is an opportunity to create jobs, offer competitive wages, provide affordable benefits and a career path for Vermonters. EMS represents an opportunity for Vermonters to live and work within the communities they live in. Investments can be made to incentivize and create such opportunities. Other aspects of the EMS system have not evolved as quickly and are in need of change. Examples include emergency communications and over-reliance on EMS personnel to voluntarily fill key positions, greater EMS service and community collaboration and the EMS district model. While many EMS organizations need assistance and aspects of the EMS system need to evolve, a complete overhaul of the EMS system is not necessary. The EMS system would be better supported through TARP investments and system improvements. These include incentivizing regional coordination and collaboration, rendering technical assistance and support to EMS leaders, enhancing the use of data to support evidence-based decision-making, workforce development and sustainability investments, establishing and enforce EMS performance requirements, excuse me, establishing and enforce EMS service performance requirements, the modernization of the emergency communication system, improving community and healthcare system preparedness and response, and supporting the retention of EMS workers by ensuring they have access to mental health and wellness resources and supports. Regarding EMS districts, the department has developed a draft vision conceptual framework, role and responsibilities. EMS service representatives, personnel and others have expressed an ongoing need for regional organization, communication and coordination between EMS services, physician medical directors and the state and the department concurs. I recognize there is a need for greater EMS system accountability. I recognize there is a need for regional coordination, collaboration, communication and planning. And I will very much endorse the idea that it is in the public's interest that we can say definitively, at some point in the future, an ambulance is on the way when requested. I'll close with this. The EMS district has not failed. Like other aspects of the EMS district system or other aspects of the EMS system, the district model needs to evolve. And with that, I will turn over for questions. Thank you, Will. I'll start in the government operations room. Does anyone have any questions? I've seen any hands yet. Thank you. Okay. Anyone over here? Leslie? Thank you very much. And thank you for the report. And I saw you at one of the regional meetings. That was very cool. So thank you for that too. You mentioned the framework that the department is working on a framework. Could you talk more about that and when we might see it? Yeah. So I'm not prepared to offer details of that today. There's a few things that would need to occur. One, there's a need for more opportunity to collaborate with the EMS community. When I reflect upon how EMS has evolved in our country, right back in the late 1960s or late 1970s, the federal government was at a place in time where they were trying their attempt was to push down across the country hundreds of regional EMS systems. And what they found after several years was that didn't work and that they were the systems would be better coordinated designed and developed at the state level. So that authority that responsibility was transitioned to the states. What the states figured out is that they were also not in the right place to design and affiliate affiliate regional EMS systems and they moved to a system where they essentially were developing public and private partnerships and looking to regional not-for-profit organizations to administrate EMS systems on a regional level. So the reason why I take the moment to share that information is whatever the future of the EMS district model is, it has to be developed in collaboration with our EMS community. So we are prepared to put forth a vision. But before I think we talk about that broadly, it would require close collaboration with our EMS community and it would also likely require the creation and proposal of policies during the 2025 legislative session. So someone is not needed. Okay. So if I may. Okay. So let me just make sure I understand. So you're, I get it. You have a sort of draft framework. You're going to work with your EMS community. That is our intent over the rest of 24. And then in 25, you're going to come back to us with a framework. Is that what you're suggesting? Yeah. So working with our policy folks, what we've discussed is that we would continue to work with the EMS community to refine the vision and ultimately that would inform policy proposals that could potentially be brought to the legislature during the 2025 legislative session. So if I could follow up on that. If I, I'm just one of these people that was rescued by I mean, I can walk now because of the EMS who got me to a place where I needed. So it's dear to my heart. The work that you do is the beginning of the continuum of care and I really appreciate Lori bringing that up. So I really just want to say thank you for that. So in the report, there's one line for a recommendation support EMS workforce retention by ensuring EMS clinicians have access to mental health and wellness resources and support. I will say the report overall, I think does a really excellent job of outlining and you did hear today with your testimony what the issues are within our system of care. I'm a little concerned that we have a one line for a recommendation as part of the report. Sure. So can you explain why that is and why we have to wait until 2025 for your vision? I think you're referring to two different things. The last line referring to EMS mental health, mental wellness and health supports. Oh, okay. So I okay. Yes, sorry. That's the one that's the same line. Okay. So then if you have all these recommendations, can we not move faster than the 2025 legislative session? I would defer to our policy folks to better answer that question. I think our vision of what the EMS system looks like in the future would require statutory changes. And to follow our department processes, such proposals would need to work it through our policy proposal and review by various levels of state government before a policy would be endorsed by the state and presented to the legislature. Okay. Thank you. Government operations. Any questions? No, I think we're all set here. Thanks. Okay. We'll do two more and then we'll go to the stakeholders topic at the top of our melody. Thank you. Yeah. In your presentation, you talked about the district model has to evolve. Can you just elaborate on that a little bit and that look like in terms of the response time? Sure. So let me address the first part of your question first. So how would it evolve? So what needs to change? So what we heard very clearly over the course of the eight weeks of this study was that the EMS district model from the standpoint of a historical framework that relies upon folks at the local level almost exclusively serving and volunteer positions who are also heavily involved in delivering EMS care in through their own services, right? This filling a position within an EMS district board is an add-on to their already mounting workload. They're asked to do it in a volunteer capacity. Some of the statutory authorities granted to EMS districts are out of date. And what we heard from folks is that when it comes to things like ambulance licensing or the recommendations on licensing, they would just assume the stadium S office handle those responsibilities entirely. And those aren't the only ones. So what we heard from folks across the state is they want to focus on the clinical aspects of delivering EMS. They want to focus on the boots on the ground work, right? They want to work with their colleagues around their region to develop response plans to make sure there is mutual aid and to make sure there is response, right? They want to focus on the nuts and bolts of actually pushing the buttons and moving the levers to make the EMS system work. They want to focus less and they don't want to be burdened with the responsibilities of things like reviewing license applications and administrative work like that because they're often doing so in a volunteer capacity with no support and that piece of the model we heard loud and clear needs to change. They want that relief. And so when we talk about an EMS district system of the future and removing certain authorities out of statute to alleviate that burden, that's sort of what that's that is what we are leading to there. The response timepiece I think is actually a really important role for EMS districts to not only play today, but to play in the future as well. Folks at the local level, many of the EMS service chiefs sitting in this room today are the subject matter experts of what is needed in their community and what is happening in their region of the state. It is vitally important that they are collaborating and communicating and coordinating their operations to ensure that there is overlap so that we can ensure or move to a place where the vast majority of EMS calls are going to be responded to within some type of agreed time frame. You know, there are EMS systems across the country that that very much mostly pay attention to performance standards. You know, oftentimes we hear or it's common to say in a more urban setting that you would have an ALS unit on the scene of an emergency within eight minutes or less. In some rural EMS systems, they change that to 20 minutes, right? Because of the inherent struggle, the inherent challenges we have just really based on on geography and you don't have the same density of ambulance resources across the country. So the folks at the regional level are the folks best positioned to understand the nuances of their communities and of their regions. And I personally believe their continued involvement in that type of work to address things like response times is not only important now, but will be vital in the future as well. Yeah. Melanie. Thank you. Thank you. We made Medicaid reimbursement changes in 2023 and CMS has been collecting data since 2022. Just curious of what are you seeing? What is the financial picture right now? How are we doing? And you have recommendations for where we need to go if they're sure enough. I don't have any insight into the numbers around CMS. Melanie, we can ask that of the... Oh, okay. Yeah, that's fine. I mean, that's fine. Before it's, I wasn't sure. What I can speak to is more anecdotal, right? So what we hear year after year and for more than a decade is that government programs, Medicare, Medicaid to use common terminology, right? Don't pay their fair share, right? So they under reimburse for the services that are provided. We, the folks in this room and others within the American Ambulance Association have worked very diligently with representatives in Congress and others to move towards something like cost data reporting, which CMS is in the midst of right now and collecting that information to ultimately inform a decision around whether or not Medicaid, Medicaid reimbursement rates are sufficient. We don't expect those results for a few more years. So that's, I don't have specific numbers. All I can say, this is what's happening out there. And then I would just add, and I think others would speak to it as well or agree with it in this room that the industry consensus is that government reimbursement rates for ambulance services does not equal the cost of providing that level of care or available service. Yeah. All right. We have a question in government operations. Yeah. So I have just a couple of questions. So the first is one of the things that we've been focusing on that's touched on in the report, but doesn't the report doesn't delve into very far as around the communications infrastructure that supports public safety. So we've been following pretty closely the public safety communications task force. There is an EMS representative on there, but I'm wondering if to what degree some of the budget pressures and challenges with EMS are really about them being kind of bolted on to what's more of a law enforcement focused communications infrastructure for dispatch, for instance. So do you mind just asking your question one more time? It wasn't entirely clear to me what you're asking to speak to. So the report doesn't delve into some of the communications issues in a lot of detail and our committee has focused a lot on public safety communications and the future of regional dispatch. And I wanted to know, given that you had so much interaction with the different agencies, if their ability to afford communications infrastructure and get the dispatch services that they need and participate and collaborate with municipal agencies and law enforcement who are running dispatch is part of the challenge when it comes to budget and funding. I would only I would offer that the inside questions. Yes, you know, I think in today's emergency communication system, right? EMS is essentially relying upon a system that was not designed for the EMS system. It's really a law enforcement based system, right? We are oftentimes utilizing law enforcement based communication networks to support EMS operations. The type of modern communication our EMS system needs to find efficiencies, ensure that we have adequate response, identify available resources, track resources, and ensure patients are getting the most the most, you know, most appropriate unit for their medical condition as quickly as possible. That's only possible with communication and based on a system that is designed to support EMS operations. You know, when we look at other EMS or other emergency communication systems that are specifically designed to support EMS operations, especially some of the more modern examples. They are we do not compare to our near peers who are you who have invested in those types of systems to support EMS operations, you know, a very simple example is so much of EMS work today is the transfer of information is by voice. Someone is picking up a microphone and talking into it and relaying information as someone who has spent my entire career as a licensed EMT and paramedic. I can't tell you the number of times I've heard folks asked to for information to be repeated. It's entirely inefficient and not effective. Right. We there are systems that exist today and are on the shelf that make the transfer of information seamless that take that removes the burden of voice communications and expedites the sharing of information without folks waiting for clear air to make a transmission. Now, look, I am not naive to the fact that that comes with a cost and you know, to truly have an emergency communication system that serves the needs of the EMS system, not only the folks who are out in the field delivering the services, but also the emergency communicators who are manning our communication center, right, who need more technology to make their job more efficient and easier. It also lends itself to a public that would be better served by an emergency communication system that actually also works for them and that will come at a cost. I have no doubt about it. I have heard loud and clear in the more in the last few years and we've talked about changes to the emergency communication system. The additional financial burden pushed down on to EMS services and other first response services to pay for the existing network that doesn't necessarily serve them the way it needs to serve them like that is a substantial burden. Investing in a system that does more today than what our existing technology can offer us is going to be an additional burden. How that cost, how that is paid for will require careful, conservative and collaborative approach to do that. And I think it needs to be shared not only by our EMS services, but by the broader first response community as we collectively invest in a 21st century solution to support emergency operations. But just to be clear, what you're saying is that we shouldn't change the governance structure. We shouldn't try to move beyond or formalize the shared resources in the state. There's nothing in this report that suggests how to structure a funding mechanism that would make those big investments like a shared telecommunications system that was efficient and interoperable and fall over that. What there's no recommendation here in terms of changing governance in order to accomplish those kinds of big budget items together. Yeah, I would say that we or I would offer that we did not have time to dive into an issue to that depth. Is that something we can look at in the future? I think that is important work that needs to be looked at in the future, but that would have been outside of of what we had time to address during this this study. Thanks. All right, let's do art and then we're going to move to some of the stakeholders. We're going to do our Leslie and then we're going to move to the truck. So we want to make sure we get to that before they get called out quick. Okay. Thank you very much for your work. I enjoyed it. I'm just looking here at last biennium. We passed s 42 the wellness commission. Yes. Act. Has that taken effect to your knowledge? And what's happening with that? I think what I'm going to do, we're going to let you answer, but then we can I think you're going to testify and I think you can provide some more information as well. But go ahead. Well, I may actually to the wellness commission is active today. Okay. And there they did produce a legislative report that is available. And I my recognition is to let the report speak for itself. But yes, they're up and running. They're making their recommended. They have made a round of recommendations and provided information. They're nothing implemented yet. Nothing I didn't from the top of my head. I don't think so. Okay. I don't think so. Yeah. Maybe. Well, we can talk to you. So I think my question might be going to the chairs of our mutual committees is that what you said was that you were going to say it's now up to the policy people in VDH to decide the timeframe of how we could move and looking hopefully to move a little quicker. How do we get the policy people involved quicker is my question. So I think that's a question we can talk about offline. I'll just give you what will happen after this is Mike and I will talk about how we move forward. Great. Thank you. Thank you very much. Well, for your testimony and the work on the report over the past eight weeks or over the summer. All right. We're going to move to some folks on the screen. Bill Mates are you there? There we go. Madam chair, I would prefer to defer to my colleagues that are live in the room with you. Drew and Adam. Well, I actually I actually managed to stay home today and not have to not have to be on a truck. So I would defer to Adam and Drew. Okay. And and to Cody who's also online and then I would prefer to comment later as necessary based on whatever you know the testimony they give. Okay. Great. We'll come back to you at the end. Thank you so much. You're welcome. So Cody Marsh, are you there? Great. Hi Cody, you can introduce yourself for the record and say where you're from. Yeah, absolutely. Can you hear me? Yes. Yeah, sorry. I'm actually at work. So they've been gracious enough to let me take some time off to speak with you all today. And I share an office. So I'm trying to find a free space where I can speak to you all. Well, thank you for the effort. Um, yeah, good afternoon. My name is Cody Marsh. I'm a select board member for the town of Cambridge. I've been a select board member since March of 2019. My professional background is actually not at all in the EMS industry whatsoever. But actually in the construction industry where I'm a Vermont licensed professional engineer building some of our states, roads, bridges and other infrastructure. I'm here today to share my perspective as a select board member in the town of Cambridge where we've been forced to deal with many of these challenges facing the EMS industry on our own. I knew nothing about the EMS world when I was first elected and I still have a lot to learn, but I have learned a great deal these past five years. Cambridge Rescue Squad is a 5013C nonprofit organization that receives funding from the town of Cambridge. Their primary coverage area is the town of Cambridge in a portion of the town of Fletcher. In 2019, the town of Cambridge appropriated $135,000 to Cambridge Rescue. In 2023, that number had risen to $233,950. This year, they're asking for $476,000, more than double last year's amount. That equates to a per capita cost if for the town of Cambridge at $125 per resident. As a frame of reference, our neighboring towns of Fairfax, Johnson, Morristown, and Stowe pay approximately $24, $41, $103, and $135 per capita respectively based on their fiscal year 24 budget numbers in their town reports. The reason for this massive increase is because Cambridge Rescue can no longer rely on their volunteers to fill the coverage gaps. During the winter of 2022 to 2023, Cambridge Rescue was missing 60% of their calls, mostly due to no staff coverage. The only way that they could correct this issue was to hire full-time personnel to fill these gaps. Once they had hired the full-time staff, they were able to make 96% of their calls for the remainder of 2023, a marketable improvement. Meanwhile, our neighboring EMS agency of Fairfax Rescue offers much lower rates per capita to their residents because they are able to depend on their large group of volunteers to make a lot of their calls, which greatly reduces the burden to their taxpayers. Cambridge Rescue also collects income from their service billing. In 2019, they collected roughly $120,000 from their 391 calls. In 2023, they collected $131,000 from their 467 calls. This averages to just in rough figures about $300 per call in revenue, which means that every time the ambulance leaves the building, they lose money. Why is this? A large majority of the calls are not built. In the EMS industry, if patients are not transported, there is nothing to bill. Over a four-year period from January 1st, 2019 to December 31st, 2022, Cambridge Rescue responded to 1,669 calls or about an average of 417 per year. Of those, 49% were billable. That means on average, roughly half of all the 911 calls in the town of Cambridge are billable. To make matters even worse is when you consider that two-thirds of the billable calls are Medicaid or Medicare patients. The rates of reimbursements for these programs are not even close to meeting the cost that EMS agencies are having to expend. And with the average age of Vermont's population rising, it's not hard to think that these percentage of Medicare patients are going to continue to rise as well. But that's what's happening specifically in my town. I have seen many reports and news articles in other towns across Vermont that are also seeing the very same issues regarding their local rescue services financial instability. When I read the regional emergency medical services coordination study 2023 report to the legislature, I was reassured that the very first study funding was the, quote, cost of service in existing funding models. But upon reading the recommendations for the sections, I was admittedly a little disappointed. The recommendations did not appear to really address the financial instability that they mentioned. The first recommendation was to establish and enforce an EMS service performance requirements. I am curious to know how the Department of Health thinks that enforcing service performance will address the costs of service in current funding models. I was kind of under the impression that the Department of Health was already monitoring the performance of Vermont EMS agencies. I'm not even sure what the enforcement piece would even look like. The second recommendation was to incentivize regional coordination in those areas of the state that are at risk of losing access to high-quality pre-hospital care. I would like to learn more about what the Department means by, quote, incentive. Would this be a monetary incentive? Monitored and enforced by whom? As I stated earlier, I do work in construction. Not only is coordination of construction companies frowned upon, it's downright illegal with very strict price-fixing and pright-than-bid-rigging laws. We are often competing for the very same, construction companies are often competing for the same contracts, equipment, supplies, and labor. How is EMS really any different? They are also competing for coverage areas, staff, equipment, etc. What is the incentive to coordinate with your competition? When Cambridge Rescue was struggling at its most desperate hour, two of our neighboring EMS agencies filed complaints against them to the Department of Health. It has taken several months to try to mend these relationships, and even today, they are still a bit strange, admittedly, strained, I should say. As you can imagine, this has certainly made regional coordination in our region a challenge. The third recommendation is to provide EMS services with technical assistance. I do happen to agree with this recommendation. Smaller agencies have very limited resources at their disposal. Cambridge Rescue is certainly in that category. At times, they could certainly utilize a part-time human resource position, a part-time financial advisor, a part-time IT technician, just to name a few. I'm sure there's probably more, and I could certainly see a scenario where these positions could be a full-time position at the state level and made available to all EMS agencies to utilize on part-time basis as a shared resource. The remaining three recommendations all revolve around workforce development and retention, which are certainly issues facing the EMS industry, but are not anything that I can really speak to confidently today. The report does acknowledge a current proposed piece of legislation that is looking to increase the reimbursement rates for Medicaid patients, as well as adding reimbursements for Medicaid patients that are not transported. Both are welcome improvements, in my opinion, and I would encourage all state legislators to vote in favor for these changes. I do feel strongly that neither will change, that neither change will solve the financial instability that we face. When I speak with Cambridge Rescue's billing agent, Jeffrey Spencer of MBS LLC, we would anticipate that this, this no-transport change for Medicaid patients may add approximately $8,000 a year to the revenue for Cambridge Rescue. And that's assuming that the reimbursement rate would be at the BLS emergency rate of about $400. This is not that much money, but it's certainly better than nothing. So where does that leave us? I will pose the same question to you all that I'm asking my fellow taxpayers here in Cambridge. What sort of value do you place on your local rescue squad? I think we can all agree that when we dial 911 that we expect to qualify at EMT, AEMT, or a paramedic to show up quickly and help us in our time of need. This makes EMS an essential service. Do we really want to continue to ignore the financial instability that the EMS industry is, is facing and has been facing for many years now? The report by the Department of Health refers to the industry as quote, under great stress, but quote, not in crisis. Respectfully, I disagree. I think the crisis is only being prevented by the hundreds, if not thousands of volunteers and municipal taxpayers who have been filling the gap every single year and are being asked to fill a wider and wider gap every year. This needs to change. I'll end my statement with a feel good story. Maybe some of you saw a recent news story here in Cambridge about a Vermont state trooper who dove into a freezing cold pond to save a little girl from drowning. That trooper was on the scene within mere minutes of the 911 call going out. She undoubtedly saved this little girl's life. A Cambridge Rescue ambulance pulled into the scene right behind the trooper. Cambridge Rescue transported her to the hospital and provided the care she so desperately needed. That little girl is alive today thanks in large part to the heroic actions of ESB troopers in the quick response by Cambridge Rescue. Our first responders do so much for us. It's time that we start doing more for them. Thank you very much for your time. Great. Thank you for that very powerful testimony. We appreciate it. Any questions in government operations? Representative Morgan has his hand up. Yes, excuse me more of a commentary but I'm listening to Cody's testimony. I'm a select one of the town of Milton and we we've gone through a pretty good evolution Cody in the last several years where we went from missing on having to drop a lot of calls that went to other neighboring communities. You know between vehicles being down or lack of personnel is the biggie. So we've migrated slowly and it's it's an expense for more full time staffing in that world which has helped tremendously and we've even gone to the point where we're beyond the MTAs and bees to where we are now paramedic certified which is huge. And so yeah here what you're saying but it does come at a cost and so you know certainly if there's anything in this as we go down this path that to help us all get there. It's tough with the way you know we're over month structured and people are told you know it's the old I think the old added to our communities is like a lot of them there's it's it seems like a common core group of people that do a lot of stuff in the communities are not you know saying people don't step up but it gets hard. I mean there's a lot of competing interests for families out there for people that for volunteerism and and so forth. So it's stuff that we all have to be mindful of and and then just kind of a cool note you referred to Trooper Michelle larger her. She went to school with my kids and I'm friends with her parents and she's from Milton originally a Milton individual and so pretty proud of what happened like in the words of Public Safety Commissioner Morse and she said when you watch the video make you cry the cheer. So if you haven't seen it go watch it it's good. Cody I have a question and I'm a little embarrassed to ask it because I think the $8000 gave us our answer but so we did and the last budget increased Medicaid rates to 100% of Medicare and my understanding is that Medicaid is now paying for the no transport but not at the BLS rates. So if I can ask of favor to you for you know this now to go back to the gentleman you mentioned and just see if that if he's able to see an impact that would have started on July 1st. So I would I would definitely have to ask Jeff I'm not I have I was nominated many years ago well four or five years ago I guess to be the liaison from the Cambridge select board to Cambridge rescue which is how I was kind of forced into learning more about the EMS industry. Like I said I'm admittedly no expert in any of this. Jeff is definitely Jeff's Mr. Spencer is definitely the go to guy that I would ask any of these type of questions. We don't we had to kind of guess a guesstimate I'm a professional estimator so I do it a lot but I had to kind of guess on the eight thousand dollars because I guess I would there was been so much turmoil at Cambridge rescue. I don't know if we have been even billing or capturing that costs to date and if I do I don't know what those are off top of my head in order to even get the eight thousand dollars because we don't currently ask in my understanding is we don't currently ask. Hey we're not transporting you but are you a Medicaid member by chance right. So we only have some statistics to go by by the percent of calls that appear to be Medicaid patients so we're extrapolating kind of the current percentage over the number of calls to try to back into that number. But my understanding is that last year's rate was about a hundred dollars maybe a little bit more so which is you know for the you know 20 or 30 calls that the town of Cambridge might see is you obviously that much less. Right exactly. Okay. Thank you. Any other questions in this room. Any other questions in the box. One quick question is I was just wondering for Cambridge rescue do you have a sense of how much of the spending that you're doing now is paying for dispatch services. So actually I do because we're currently talking about that so Cambridge rescue does not pay for any dispatch services whatsoever the town of Cambridge pays for it exclusively for Cambridge fire and Cambridge rescue and we're currently paying about a hundred and eight thousand dollars a year to the oil dispatch which I'm told is. A lot. And this is why we're currently looking at a different model. That's the little oil sheriffs runs the oil dispatch. Great. Thanks. I appreciate that. Great Cody. Thank you very much. We're I'm super happy that you're the volunteer and the liaison because your testimony was excellent and it will help us as we move forward. So I appreciate your time today. Thank you all for listening. I don't know who who in the room wants to go first. All right. Adam. Thank you. I'm not a big public speaker. So I apologize for studying through filtering through all those things. I'm better at answering questions and then coming in prepare some reason. So my name is Adam Houston. Been in Vermont EMS for 30 years been the director of Glover Amelons for 25 of those years and rule two up in the Northeast King. It's been a wild ride in 30 years. So I participated in several EMS studies over the decades. I feel that as a member of the regional study this report missed the mark on several issues facing EMS. The report does not address the concerns and equally important the solutions that are peers working in the field and town administrators have offered. However basic and generic this report turned out there are some very good points that were common themes from those that provide input and have a vast impact on delivery of EMS and Vermont. As I'm sure you've heard people mentioned before and you'll hear more testimony on EMS needs to be an essential service that we're not an essential service. Now I'll let them discuss more about that continued ongoing funding for EMS education is paramount to the success of the future of EMS House Bill 622 by representative Sims helps address some of that reimbursement does not come close to matching the cost of doing business. Although the report discussed legislation being taken at the federal level there's a little chance the funding structure will change leaving a false sense of security when you hear you know there's the cost out of collection and is Medicaid accurate and what we get raised well arguably will we get a decrease it all depends on the data is submitted by all the services nationwide. Although special funds was identified as a component of EMS district operations 62% of the districts have not had access to the funds allocated to business due to policy and and business office regulations. Modernizing EMS communications is a critical part of pre hospital care and should be considered by this body as well as go ops. The report mentions that the system is not in crisis. I think most every EMS agency will tell you otherwise and is going to be represented in the EMS advisory committee's report that is being submitted with an increase of call volume declining number of volunteers and reimbursement rate reimbursement rates that do not cover the cost of service delivery. We certainly are in crisis. Few items of this report failed to mention the report didn't gather comprehensive data from all services. We still don't have data as to what we need to understand what's working. What are the gaps and how do we identify the resources needed to stabilize them. The common theme we heard the regional meetings is that the EMS office is critically understaffed agree 100% is imperative that the staffing level of the department be aligned with the needs of emergency medical services across the state. As long as that additional funding and staffing is utilized to help support EMS agencies collect data to improve the system and bolster the care ultimately provided to Vermonters. We still don't know how any of the recommendations set forth in the report will be funded placing greater financial responsibility on EMS services across the straight across the state will strain the system further. I disagree. We do need an overall and we need to stabilize the EMS system and funding. Although the report mentions a task force and the respect of task force in this report versus H622 there's already it would be a colossal waste of time and money. There's already mutual aid agreements. There's already response mechanisms in place and mechanisms in place to address that. So I like to see that money get utilized better. Representative Sims introduced 622 and although the bill will not solve all of EMS problems. I think it is a critical step forward. The bill would turn emergency medical services advisory committee into a board and revise its duties to include developing and maintaining a five-year statewide emergency medical services plan. Creating the emergency medical services task force will help oversee and manage the phases of development design implement and implementation of a statewide emergency services system in Vermont. It's modeled after the great work done over in government operations with dispatch modeled by other and surrounding states around us. Beneath it will help expand the circumstances under which ambulance service providers are reimbursed for delivering services to Medicaid beneficiaries and will help appropriate files to provide training sustainable long-term training for emergency medical services and personnel. In conclusion EMS have been around for 50 years. You've heard that earlier 30 of those years. I've been involved in Vermont and enroll EMS. I've seen several reports commissioned and participated in most of them. There have been many changes over the years most for the better some for the worse. None came with additional sustainable and attainable funding. In my 30 years I've never been more scared for the profession than I am right now. I feel the current administration seems a bit disconnected from the reality of EMS delivery in Vermont. The suggestions offered by subject matter experts have fallen on deaf ears. There's little to no support financially or administratively from either the department or the governing bodies. The pre-hospital healthcare is going to continue in Vermont. We need your help to help others. I off script on this. I want to go I don't think that any one individual at the department isn't listening. I think policy gets in the way. I think the process gets in the way to make change gets in the way you heard it earlier. You know, we want to make change on district structure and how to redo it. We got to run up through our policy folks. I don't understand it. I run an ambulance service. I don't understand the politics. I don't understand a policy. But to me that seems ludicrous. If you have 79 ambulance services or 13 districts saying you want this make it happen. I tell you so. So in closing, I ask that you guys consider H622. It serves as a valuable role in keeping the discussion open productive and meaningful. I encourage this committee to review H622 and weigh your time and energy into meaningful change for this profession. And thank you very much and thanks for the 30 years. We hope you have. We have you from any more. It's going to be great. We're a small service. We've got three paid people running our call volume increased 52% since 2021. And we're doing it with less staff now than we had before. But most of those being three paid people and about four key volunteers. Many volunteers. We've got four key volunteers on paper. I've got about nine. Some were active than others. Let's see if there's any questions government apps. Any questions from the city? Okay, Frank. Oh, I'm sorry. Go ahead. I think you said no. Go ahead, Mike. No, I was just going to ask what's driving that 52% increase in call volume. Aging population and tourism. Part of our service area is Westmore Lake Willoughby and the hiking trails around there. So we've had to invest immensely in the the remote rescue aspects of our operation. And unfortunately about 80% of the calls that we do out there for that are non transportable. And I was going to ask sorry, Mike, I'm going to jump in real quick of the calls you do take. What is the percentage overall that's non transport? Do you know? So it breaks down by town overall. I'm about 42% overall. My mutual aid I'm about 58%. So if I go on mutual aid to other areas it tends to be a higher no transport rate. Okay, so sorry. Let's go back to go up because I cut Mike off. Mike. Oh, I was just going to ask how whether your EMS services are just for the town of Glover and how you all do dispatch in your agency. So we cover three towns within the Northeast Kingdom. Dispatch. We are the last hold out have been the last hold out and will continue to be the last hold out hopefully with state police doing our dispatches. We've shopped around for dispatch and at minimum I can take about 12% of my income will be have to be dedicated to dispatch if I change. So we're we're looking about 20 to $30,000 for dispatch just for us. Thanks. Right. First, I want to thank you and all the other witnesses for for sharing your testimony. And then I have one question someone else asked about what was I think it was the chair of gobs asked about what was driving the increase and I'm just curious in your and what you would call area of service like do you see any increased use of EMS due to the opioid epidemic or do do the overdoses or any or mental health cases meant mental health there has definitely been an increase in mental health responses which time to respond and has a trickle down effect. I think we can have that conversation all day long about mental health responses and how it affects not only our local services but a trickle down all the way. We in our area I got to knock on wood have been very good during the opioid crisis. I can tell you that three of my surrounding towns routinely go to overdoses but we don't seem to have the population that they have in those areas so we aren't seeing it as much as others on a routine basis. Newport 20 miles to the north of me average is quite possibly a few a day up to you know there I think their best one was not best one their their recent one was 13 a day. Thank you. It varies. I think that that just illustrates the importance of taking into account but whatever decisions we're making how the new mobile crisis intersects with the work of our EMS because it sounds like you're you're honest about in your area you may not see it but you're aware that it's a problem elsewhere and I think that's what probably going to find is there's like inconsistent hot spots. And because of our distance to a hospital and normal call for Glover Amherst from time of call to the time we're ready to go back home is about two and a half hours. With a mental health call that can be anywhere from that two and a half to four or five six hours depending on you know does patient need to go to a hospital right now will they go what services can we get how long does it take to get them there and in the meantime calls could be stacking up or relying on ambulance services from other areas to abandon their territory to come help fill the gap. So absolutely it I think it's conversation that should be involved with the EMS trigger another question just there's one that I have that I'm not going to ask you because I don't want to put you on the spot so I'll wait for editor no no no without the one I want to ask you is how do you feel like the partnership is between current EMS and crisis for mental health like do you feel like it's coordinated or uncoordinated do you think we could do more to improve that I hear stories across the state on how some services are great I can tell you I don't see that in the Northeast Kingdom that makes I die here Central Vermont being one of them I hear has a very strong robust system I don't experience that in our area thank you it's good to know thanks for the question that wasn't the hard question I'm going to say I don't want to put you on the spot okay we heard you say that you don't get really very good for you well with Medicaid if you don't transport is there any other areas that you do not get any reimbursement for general thumb if we don't bring you to the hospital we don't get so like with my remote rescues if we go bring somebody off the mountain because they've twisted their ankle because they're wearing flip flops we bring them down they go in their car and they go home you know I I've expensed a dozen people payroll wise I've expensed 12 hours of a day and hundreds of thousands of dollars of equipment to get them off the mountain to assist into their car so they can drive off not if tourists come with you mentioned tourists we're going out of state a car accident can you build their insurance companies if they're from out of state a car accidents on occasion we can build that we aren't transporting on either so if we're transporting in the hospital yeah we can build our insurance getting reimbursed by out of state insurance companies is very problematic and time consuming we try our policy we try to build the auto insurance first it's usually a little bit easier to get paid from the auto insurance company than it is a healthcare industry my question is an easy one kind of following up on a kind of these non-transportable means you don't get reimbursed with transportation correct correct okay you can transport but you don't you've transported but you don't get the money for is that what non-transportable so not non-transportable would mean there's there's a whole bunch of variations so non-transportable would mean she calls an ambulance for you because you were having chest pain we get here you say no I'm good have a nice day we do a set of vitals we do a workup on you if because of the bills you guys just passed if the patient has Vermont Medicaid we can bill pennies on the dollar to help us for for that assessment if you're Medicare out of state anything like that we still come we still did that assessment on you you say nope I don't want to go to a hospital or I'll go on my own car we turn around we go home we can't bill you can't bill okay so that's what you mean okay that you don't I'm sure there's a million bills there's all kinds of scenarios on it but yeah we have one more question in our room yeah I wasn't sure who to ask this to if you're not the right person but you can be throwing a lot of insurance stuff so I'm thinking about this in your guide students we're having this issue in other areas of our healthcare system Medicare rate reimbursement rates we know are not great however I'm wondering do you know Medicare advantage if those if they're paying at the same Medicare rate or they being less or more is that Drew is that under the 108 dollars and 11 cents or are they not paying at all that great days difficult it's not and to answer one of the questions I think already you had earlier about how much is being reimbursed on those that Medicaid so the initial proposal that that drew work really hard on was to bring it to the BLS emergency rate our understanding is that the at the 11 hours couple dollars over a hundred dollars that we just looked it up 108 dollars and 11 cents yeah all right operations any questions for Adam I think we're good thanks so much okay and Adam I just want to say I love the phrase you use of prehospital health care yeah I think that's really important for for people to hear so thank you for that and thank you for your service good and I'm happy to come back for me thank you send us your testimony so we can post on our trip or give it to give you to however you want to do it you can make happen okay this will be a first for me so I'm about as nervous as Adam was but I'm not happy to say for a friendly group if you can start with your name and where you're from yeah I'm going to read my testimony if that's okay and that that introduces me so thank you for the opportunity to testify in front of this committee I have been asked to outline my statements from and I've been asked to make sure that these statements represent myself in center Vermont but they do not represent my work for thank you for taking the time and dedication to improve Vermont EMS as an essential service and public safety and Vermont I'd like to take a quick moment to introduce myself my name is Scott bag and for 32 years I've been a proud responder in central Vermont for both fire and EMS I started my journey as most do by earning my first responder certification and by dispatching my local agency over the years I've exceeded to become an EMS educator I currently serve the town of Northfield as well as the Champlain Valley exposition up at the Champlain Valley Fair but most importantly I serve as the training coordinator for Vermont EMS District 6 which is a conglomerate of ambulance services and fast squads serving central Vermont in both Washington and Orange counties I've been fortunate to teach hundreds of EMS responders over the years and was recognized as the Vermont EMS educator the year unfortunately due to my work related injury I've been sidelined for a few months but normally I serve my local community by giving 24 to 30 hours of volunteer service each and every week I will only take one minute to discuss the regional EMS coordination report I'm limiting my comments to one minute because I feel it is best to look forward and not focus on what could have been or what should have been in this report. The report process thus disappointed and frustrated immensely I was fortunate enough to be selected to represent rural EMS services as part of the EMS study and I thank those who selected me I recognize how important this study was and how it could start significant and necessary change in Vermont EMS I went all in encouraging participation by attending in-person sessions contributing to surveys and encourage responder and stakeholder participation but unfortunately it became apparent early on that both the contracted agency that was publishing the report and certain leaders had their own agenda and plans this was further complicated by meanings that were on late Wednesday evenings that sometime lasted until past 10 p.m. the sparse number of those meanings without planned agendas and the fact that the individual running the meaning and it was in charge the study spent more time talking than in my impression as we worked through the charges of the legislature to identify issues with the cost to service and existing funding models coordination across agencies and EMS district structure and configuration it became apparent that a decision on how these would be tackled had already been made I could vote a very active chief a fire chief of the one the busiest services in Vermont she said I did not feel expecting I wasn't expecting to spend so much time in a meeting going through those points individually I left the meeting after an hour and a half because I felt my time was better spent putting my kids to bed by November many members of the committee had become irritated with the purpose in the direction the study committee with many giving up and just walking away for example an EMS leader said I'm having a hard time understanding the role of this committee identified the top issues or problems that came out of the regional meetings and then in mid November everything stopped the committee was not supplied or given a draft of the report or even the points or tenants that would be recommended attempts to reach out to the individual running the report or Department of Health about the report that should be that was going to be recommended here today were met where were their fuses to discuss or participate any further many members felt it was their only way forward was to demand public records request finally the poor was definitely distributed by the division chief the Department of Health on Friday less than seven days before I was to testify in front of this committee as you can see this is not the way to treat leaders and from on EMS who are dedicated enthusiastic about the potential of this report and how it can finally deliver that cost tens of thousands of dollars and has middle amount of actionable recommendations that could make significant change is quite unfortunate if I was to characterize the report as published I would describe a huge mess and a colossal wasted opportunity and I wonder if those who prepared this report should be held accountable but moving forward I emphasize that Vermont rural EMS excuse me that rural EMS in Vermont is in crisis and I want to emphasize that the report list that we have 79 licensed ambulance services with one ambulance per 8,290 people what it does not emphasize is the rural landscapes that most of Vermont consists a single volunteer ambulance may respond to just a couple hundred instance annually using volunteer forces that community recognizes this service were to close its doors the next closest ambulance could be dozens of miles away this would increase response time incidence times and transport times thus directly harming those in the most rural regions of our state recently I witnessed an ambulance service with nearly 50 years of dedicated time and effort live up and close its doors being gobbled up by a regional agency ultimately this did not save money this did not improve response times and it decimated the volunteers that had given help list number of hours over the decades to maintain that service some of the Department of Health think regionalization is the answer to all things in Vermont the fact that is patently not true and I would encourage those to run in rural Vermont to get a taste of how it is to try to maintain an ambulance availability on top of two or more jobs that EMS providers maintain this is a fact I am the lowest paid paramedic in Washington County there are members of the public who can get hired at my local fast food restaurant and start making more than I do for me it has never been about money and I'm committed to serving my community and my neighbors but I'm fortunate to have a primary career if my primary career was an EMS I would have been required to leave Vermont and seek employment in EMS elsewhere to just make a sustainable living EMS providers make less than those that are serving hamburgers think about that for a wallet the person who has your life in their hands on the very worst medical day has chosen to make less and work for more than those that are flipping sandwiches many of my EMS colleagues work two or more ambulance services to make ends meet locally officers and responders of my local ambulance service have been forced to join larger services just to pay for groceries or meet demands of rent in Vermont there are very very few services that pay enough to sustain a family and in the impact of this has a direct impact on the welfare and well-being of EMS responders the age of our community neighbors serving each other is a dying breed my volunteerism is a thing of the past and newer members of EMS are making that hard decision to either work many jobs or just gotta get out of EMS altogether the cost of EMS education further complicates this situation in strains our system during and DMT described how she was forced to attend a paramedic program outside the state of Vermont because it was more than half the less of the cost than the in-state program as an EMS provider struggling to make financial ends meet she inquired through the Department of Health about the EMS educational funding and the million dollars allocation in 2023 she was denied because she went to a cheaper program that had a higher success rate and better match her career requirements she was not allowed to seek financial assistance she's going to be bogged down with loan payments for years even while a million dollar allocation was out of reach we've been asked and have been not been provided a copy of where those funds have been distributed however I know that they did not reach local responders who are attempting to approve an educational program and the fact of this is a downright shame EMS education both initial entry licensure programs and advanced licensure programs should be free in Vermont EMS responders we are an essential service Vermont law enforcement at the has the police academy Vermont firefighting has the fire Vermont fire Academy students at both of these schools do not pay a dime for their training why is it acceptable that we are asking local responders some in their young twenties to shell out 30 to $40,000 become paramedics and birding them with loans is it surprising that in-state programs have not been the primary path for education and it is surprising that many paramedic students once they complete their licensure programs that can take nearly 2000 hours leave our state for higher paid services. This brings me back to the primary purpose of this report. Specifically issues related to the cost of service and existing funding models. EMS has relied on reimbursement funding models along with local funds using taxation and municipal budgeting to sustain operations. Unlike other essential services such as law enforcement or firefighting EMS has been forced to struggle for pennies to make things meet I think we have heard that today organizations and fundraising have all become essential parts of many EMS and ambulance services. We are struggling with how to keep equipment up to date train responders pay personnel and just simply keep the lights on. How and why this was not emphasized in the report was surprising. Look at the recommendations of funding from this report short of closing up shop and regionalizing everyone it does not provide a workable acceptable actionable items moving forward. One of the common things I heard at almost every meaning that I attended and I attended five of them was that local leadership needs help. My local EMS chief does not have the bandwidth or comprehension to develop a reasonable strategic plan. She's directly assigned to emergency response for each and every hour that she works and must drop what she's doing for any incident. She struggles with meeting daily needs the organization and as little availability to move past to think about planning or organization. In our public meaning many central Vermont EMS heads of services stated they need the Vermont Department of Health to provide help and do it now. They need technical help and messaging budgeting leadership quality improvement and strategic planning. Furthermore regional leadership needs help even further our local physician contributes to medical oversight quality control independently with no financial support. She does not have the support of local additional hours to review and keep up with quality trends. She struggles to provide her various ambulance services and fast quads due to not having technical assistance. District leadership is completely involuntary. I am one of them and usually consists of overburdened and overtax leaders of local services. It has been extremely disappointing to watch DOH not provide personnel and technical support. As a fact DOH leaders have indicated that they were local problems and required local solutions from the individual select boards. Imagine my disappointment. Many of our services have left various meanings feeling unsupported unrecognized and is one chief of central Vermont described it drowning without a life reading from the EMS office. Finally, the chief of EMS has stated many times in various meanings that she's demonstrated that her office does not have nearly enough staff to accomplish all that is needed. This was one of the primary recommendations I repeatedly made throughout the study process. I was shocked that it was not included in this report. In comparison to other New England EMS office staffing or similar Vermont is dead last. And is the smallest. The EMS chief has stated that she is unable to process vouchers or issue educational grants due to lack of staffing and capability. She explained that she is greatly in what she can accomplish due to the amount of staff that she has her. Now, I don't want to dis I don't want to negatively impact her staff. They are working tirelessly and are stretched thin The first strong recommendation is to look at the staffing the EMS office and develop positions of employees that can be regional technical support for local EMS needs and local EMS districts and agencies. Next, I would strongly advocate that the Vermont EMS advisory council be elevated and empowered as a governmental board. This body would have authority and oversight of the EMS office and be able to tackle some of the various issues that are overwhelming Vermont EMS and has been building for decades. Currently, the recommendations of the Vermont EMS advisory council have seen little acceptance or action. Furthermore, this council has struggled both with transparency and collaboration with DOH. It has been suggested and multiple meanings that the Vermont EMS advisory council is advisory only. This is limited to systemic issues. Elevating this council to a board and ensuring it has authority and accountability for sustaining and improving EMS and Vermont is extremely important and will allow for dedicated individuals to finally enact processes of real change. Next, I would recommend that we update statute 24 of ESA 2657 the governing of EMS districts. I would concur and I say this offline with many of what Will Moran has said about districts today and the importance of their oversight of local and regional issues that they are facing. These are extremely important. I recommend that authority for districts accountability of their work as prescribed in statute 2657 and encouragement to address local and regional issues be supported. Specifically the Vermont EMS office be directed to send technical help to get many of the flailing districts back up to speed and arm par with some of the positive districts that currently exist. I'm unfortunate that my central Vermont EMS district 6 is a thriving agency and I resist the star push to remove that district in its entirety. I do want to share that there should be this report should be compared to some reports that came out of Maine and New York. The excuse me the time frame and rapid turnaround of this report was a barrier but it should not be used in his excuse. The plan for sustainable EMS system in the state of Vermont which I have excuse me in the state of Maine sorry I apologize and New York state 2023 evidence based EMS agenda for the future are both great examples of groundbreaking work that has directly impacted EMS in their states for the near and broad future. There's no reason why Vermont should not expect a similar product. To achieve this goal I recommend that Vermont EMS board the board that we have just talked about be recommended that they develop a technical action group to develop and publish such a plan numerous points in the main report and in are highlighted and are very similar to Vermont EMS we struggles that we are facing every day. This technical action group should be comprised of Vermont EMS leaders but also equally comprised of providers who are boots on the ground and no local challenges they are facing. I submit part of that as my testimony today and when encouraged the committee to compare the report that they received one week ago to what Maine is moving for. Finally, I want to strongly support and advocate House Resolution 622. I want to recognize Representative Catherine Sims who participated in our EMS study and has been a strong ally for Vermont EMS this session. Numerous sections of this legislation will positively impact Vermont EMS and will finally change and allow Vermont EMS to tackle some systemic issues barriers and challenges that have been breeding for decades. Please strongly consider supporting voting for House 2622. I want to thank the committee for the opportunity to speak today. I want to thank those in EMS in Vermont who have supported me to come here and share my opinions and my journey. I want to recognize all those hard-working EMS providers who today are running on ambulances and basically serving their neighbors in their greatest time in need especially in Central Vermont. And I want to thank all those members of the Vermont Regional EMS study committee that diligently participated even late into the night. And I submit their list of those members as part of my testimony. A list of those individuals is provided. I especially call out Representative Catherine Sims and her tireless work to improve EMS in Vermont. I hope that this brings recognition that EMS is in Central Service. And it desperately needs funding technical support recruitment retention and sustain of growth that the challenges we are facing for the future. And I would end my testimony with this final thought. We heard about the wonderful recovery of the Cambridge young girl that was drowning. I would ask what would happen if that ambulance did not show and the next ambulance which was coming would be over a dozen miles away. What happens if EMS doesn't show up? That is our crisis. Again, thank you for your time and allow me to speak. Thank you. Thank you so much to say the first thing I want to say that if this is your first time touch the meeting you were amazing. I was practicing the mirror. Thank you Scott for your candor. I really we really appreciate that we are I think I can speak for the our committee at least that we are disturbed by some of the statements made in the process that you all went through so thank you for bringing that forward and I also want to echo our thanks for everyone who did participate with the study over the summer. Government Ops Questions or comments? I would say I agree that that was some very powerful testimony and you've given us a lot to think about. Does anybody have any questions? We're going to continue. Now Representative Hooper is asking if you didn't hear if you will be submitting your testimony. Yes, I I have a print out and I can also provide an electronic copy. That'd be great if you can just connect with Claire at the end of the be glad to great she helped me give directions to this room so just a shout out to her any questions Mike? I don't see any thanks so much Scott. Leslie very quickly you reference the New York report. Yes I will send those to you I have them all perfect yes sorry and I've since gave them to me so forward that's on thank you Brian. I just want to thank you because without keep knowing my questions you answered them all I would also like to I know you asked Adam this question I'd like to answer Adam's question as well about the impact of opioid epidemics and mental health in in central Vermont we have seen an overwhelming increase we and especially our local I would say city Montpelier and City Berry have worked tirelessly with our mental health colleagues and our substance abuse colleagues and central Mont Medical Center to help and give resources to those that are struggling with a substance abuse. We have a great partnership that has been an example for some other areas so I want to give out shout out to those agencies that are working tireless believe opioid drug abuse and mental health in every area of our services. Thank you. I see I see yep so I'm going to Cody go ahead to put your hand up. I'm sorry I wasn't sure if I was allowed to ask a question apps absolutely Scott I might be leading leading you took to an answer that I already know but do you do you get reimbursed for a call for an opioid overdose where you issued Narcan is that is that a is that a billable call if we do not transport the answer the simplistic answer to that is no I do want to give a shout out because I think this is a I've been pretty critical the Department of Health here and this is one area I'd like to give a shout out to the Department of Health that they provide EMS services free naloxone on a regular basis so that we can be ready not only to administer that medication but to leave behind that medication and the work from the EMS physician director of the Department of Health Dr. Dan Wilson has been significant to improve and make sure Narcan is left behind with that family member or that patient so that if they struggle or get that situation that it would be immediately available so Department of Health has has led that charge and again I want to be fair if I'm going to be critical I should also recognize their their positives great thank you so we are crunched on time a little bit so we're going to manage this a little bit I'll come right back to you so Maury thank you for your testimony and I'm one of the committee members that is very disturbed to to hear the testimony I've also been a champion for EMS and have followed since my first bienium I believe when working to with a legislation that required to get $150,000 a year and that process was problematic and I think didn't happen so as a legislator I want to make sure that if we do I do support the the bill in front of us and I want to make sure that we have all the teeth in it that we need to make sure that whatever we the legislature passes actually happens on the administrative side and I just want to close with Cody Marsh I I believe I work with your wife Christy at the hospital and you too both rock and I'm just so grateful for your testimony and for the work that you do thank you great thank you thank you we had a couple questions we're going to go fast anyway art yes I'm wondering what percentage or how much marijuana use affects the calls you get if any you know I we we legalized a number of years ago and I wonder if you've been about this you know I'm going to say I'm not prepared to answer do I see patients that have have been using marijuana yes have I seen care patients that they have been injured because of marijuana yes I'm not sure I'm prepared to say it has increased but I would say its presence is there okay thanks Daisy thank you so much for your wonderful testimony and I'm sorry that your profession is in crisis that it is and I'm glad that you're here right now thank you I'm concerned with the amount of time that you're spending helping our neighbors who are having and I wonder if you can tell us a little bit about whether you are coordinating for any resources supports or warm handoffs with folks in the designated agencies or the Department of Mental Health the answer especially in local and I'm going to call out Washington County Mental Health is a now recognized partnership with us I would say and again this may not be so light to the Department of safety but now that law enforcement has taken a less response mental health that has put a lot of responsibility on EMS and we have struggled to help meet that responsibility especially in the concern of EMS safety but we have worked with Washington County Mental Health and developed the partnership and we've taken a step further to develop training that normally we go to law enforcement and is now being expanded out team to training and CIT training providers to help address even more the challenges that I expect will be increasing for us especially in the near far future great thank you so much for your service and your time today and definitely get that testimony to Claire we'll do helpful and oh I'm sorry Brian did have one last question it's fine just a statement I'm also a healthcare worker and it's frustrating when everything that we've gone through and then people say thank you for your service you know thank you over and over but I but but it does help me when people can look me in the eye and and say that it's unacceptable you know like the way you've been treated is unacceptable if this reminds me of how we treat our veterans after a war you know we had a pandemic and and so it's just completely unacceptable and upsetting and I just want to acknowledge that and for what it's worth like you know I I think that myself and others will do will will keep working with you to do what we can to make things right but it's but it's completely wrong the way that you were treated during the study that was not our intent so I'm sorry and thanks so they brought me here today so there's a lot of good you did now you know you you become an advocate like a witness all the time you know what what did I get myself into your how you know watch all of that thank you very much we appreciate your time and I also want to say Will Maran let me know that he does have a breakdown of the training so he will also send that to Claire we'll get it out to everyone and I would we'll take a look at it if we have more questions we will obviously reach out to VDH so we're going to try to stop at like 10 of three so Drew and Bill I don't know who wants to go he's right still you've buried the dark thing about the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the you some as well. So I don't want to repeat what you've already heard but I think there's some important things that I want to add to it and that is really just to remind everybody that EMS is part of the healthcare ecosystem and it is really the word system I think is most important. We heard about questions about response times and services that are provided and EMS is about a system it's about making sure that our patients have access to the healthcare that they need where they are all the way through their healthcare emergency so that means from their home or from their accident scene to the hospital from that hospital to the specialty care center and all the way back to rehab and sometimes end of life there and quite often we don't realize that EMS has a much larger role than just that 911 call and in a lot of areas it's the system that is really broken. We may have pieces in parts of our system that are functioning where you know we have a municipality that's invested heavily into their local 911 response but yet the system of moving that patient from the community hospital to the trauma center doesn't exist that link is broken so you can't look at any one piece of this on its own we really need to look at the whole thing. As part of that just to you know in my own organization down in Brattleboro we've been working very closely with our local hospitals specifically you know what I'll call out is is the Brattleboro retreat and that's because with the increase in wait times and patients that are requiring additional mental health treatment that are local hospitals EMS services around the state can't get those patients to the retreat for the services they need. We partnered with them a year ago just over a year ago we were able to cut the amount of time they're spending the years by more than 50% and get those patients for 300 patients in the retreat faster and I point that out because that is you know a development in our system that's new but it also shows the stress that exists in our system so we're traveling from Brattleboro to St. Albans the St. Johnsbury to Burlington on a daily basis because the local system can't support the need of the patients as a whole. We talked about dispatching I've heard the dispatching a lot priority dispatching modernized dispatching I absolutely agree with you before that's a huge thing for EMS as we move forward and move forward into the future of EMS we need to be able to provide priority dispatching. What that really means and I think everybody can wrap your head around that not every time somebody calls 9-in-1 do they need an ambulance screaming lights and sirens to them. Right now today if you dial 9-in-1 I think I said this last year there's one of three buckets we're going to put it in it's going to be a fire bucket a law enforcement bucket or an EMS bucket sometimes we send multiple buckets but we need to modernize our system so that we can send the appropriate resource at the appropriate time with the appropriate urgency. So that person that is is struggling to break the cardiac arrest absolutely needs timely response of highly qualified EMS providers but the person that's suffering from a mental health crisis does not need nine people with lights and sirens screaming down the road and piling up on the front lawn they're very different so we need to develop the system in a way redevelop the system in a way that it meets the need of the people um and not just arbitrary numbers like response time numbers or how fast again it's a system that we really need um all the way through the end of um of their care. I know we're running out of time today um there's not a lot of there's not a lot of numbers not a lot of data in these reports I do have data that I can share with you at another time about the cost of the system what it costs to educate EMS providers we've done a lot of that research we have that information so as you continue this conversation I'd be glad to come back and share you know what does the EMS system in Vermont actually cost and certainly what is the education for that cost but again I know up against time I want to give time for questions time for questions and more testimonies is there anything else and like so I'll be glad to come back and help and we um we will have you back without a doubt and I appreciate you understanding our time constraints um government ops any questions? Reverend Woodward, water's up in Tasman. Thank you I just have a quick question um hi thanks about um when you said there are um what would it look like um or do you have examples maybe of what that different response would be rather than the nine ambulances on the front yard are there other cities or states that have a system that works that way? Yeah so um there's lots of different examples around the country um where uh patients are triage so the call comes in they they actually triage the acuity of the patient and they may send a for example a specialized team of mental health workers to the house as opposed to EMS it may be a single community paramedic that goes out and does a wound assessment if the person called in because they think they have an infected knee um well we may not need an ambulance we certainly don't need it to run lights and sirens through town to check the infection but they do need healthcare and the best healthcare is delivered as close to home as possible and sometimes that is in the home and you know as EMS providers we're serving these patients every day and quite often we're faced with the decision to take them to the hospital which may not be the best decision but it's really our only decision other than leaving them at home so an infected knee you know may not need an emergency room but they need healthcare services and we don't have the right options so um there are many examples and we could certainly share kind of what that looks like um for modernizing the system it not only is it better care it also reduces overall health care costs which is another concern that that you guys have yeah and we go topper isn't that some questions i'm sorry shane was it was that good did that look exactly it thank you okay thanks topper um i do have a quick question uh you like i keep hearing about regionalization and um i heard i haven't heard and i've tried to read to find it um there is a regional ambulance service right here itself a lot it's a very town regional thing and is there a recent life it's not mentioned or not talked about as a way to go so there are um differing opinions so everybody if you if you've got a whole bunch of administrators in the room and you ask them what system is the best system they will tell you the system that i'm part of and you know i think that's the reason why you're not seeing a recommendation because that's the hard part right we know the challenge but to to point to a certain model and say this model is better than other models um is is challenging so i'll take off my hat as a as a chair of this committee i manage a regional ems system we serve 14 communities and i can tell you that i am absolutely 100 sold on regional i you know regional delivery of ems services and i'll do the reasons why we have not had to change the assessment to our communities more than 1 percent in the last decade we've made 100 percent of our calls without mutual aid we run 11 ambulances so we can take the surges that happen with 120 staff and volunteers during the pandemic we were easily able to um increase the scale of our operation to support vaccinations across the entire state in every single county and we did that without interrupting a single 911 call or inter-facility transport in our area our hospitals receive all of their hospital hospital transportation from us at the same time we're providing statewide mental health transportation i believe the regionalized model will not only save the state money but create a more robust system that is not universally accepted um my experience again managing a regional system is it's very stable very reliable and very cost effective our per capita rate just putting a perspective is is $25 i think the rural nature of our state maybe plays into some of the discussions about whether regionalized or not well and the key to this is a system so we cover 500 square miles and the way that we cover 500 square miles effectively is through um partnerships with very strong local first response squads our patients get the care they need very timely it may not be by the ambulance but it's through a system a regional system that we've built over the last 60 years where we have first response squads in every single community that come out and they support the patients and we support them as the regional ambulance service provider we take it our responsibilities seriously we provide them their training we help with their supplies we swap one for one when they use things because we know they can't get reimbursed so it does work in rural Vermont as a system thank you so it's kind of i think i'm gonna suggest that i know we will have the group back in we'll be continuing this conversation in this committee and and i'll let mike speak for himself in a moment so just thank you all from the health care perspective we appreciate the focus that this is health care what you do is health care and it is a vital essential part of our system here uh mike did you have anything no i just wanted to thank you chair hodan for letting us do this together i think we learned a lot and um we're going to be picking up this work um and continuing to think about governance on some of the shared infrastructure issues related to dispatch this year and i imagine in the coming couple of years based on the the path we have before us and the importance of having all of ems and dispatch and uh other public safety systems working together so thanks for uh letting us do this together today yeah i think it was great thank you thank you everyone and we can uh end the joint hearing and go off live thank you bill and kody