 Thanks very much for coming in. I had COVID a month ago so I get a little bit nervous but I want to thank you all for the work you do every day. Under enormous pressure with inadequate funding and that's what I want to discuss. And thank you for traveling long distances to get you. Bottom line is that in a rural state like ours when somebody dials nine will run. Pretty good idea to have somebody answer the call and get to the house in the short of time as possible. And I sometimes think you know when we talk about the health care crisis in America something that I get involved in a whole lot with some chairman of the committee that deals with it. We talk about the high cost of health care. We talk about the inadequate number of doctors and nurses and dentists that we have but we don't talk about what first responders do. And at the end of the day if I have some kind of medical emergency in my home in a rural community if I don't get the care I need as soon as possible that's going to have a significant impact on my outcomes, right? And I think we don't pay enough attention to that. And I think we have a very bifurcated system which I want to talk about. How we improve it. I know some of you are paid, some of you are volunteers, some of you are fired departments etc etc. We have taken this issue seriously over the last couple of years. We've managed to get some not enough money into the fire academy. Who's with the fire academy? Alright so you're going to double the number of cadets we have, is that right? Alright so that's a big deal. We didn't you know there are a lot of young people who might want to work at volunteer fire departments. You haven't been able to train an adequate number is that a fair statement? Alright so hopefully we'll be able to do more than that. I don't know if you know that we got some money for Dr. Wilson who couldn't be here with us now he'll be here later actually it's been a great job. And he's going to be training paramedics for virtually for very low cost. One of the impediments has been if I'm going to be a volunteer and I have to pay thousands of dollars to get training that doesn't make a whole lot of sense. So we got him some money and I think he is developing a program which is starting off well. We got some money for Waterbury here. Senator Maggie Bird. Hey one of the students in that program. How's it going? It's going great. Thank you very much. Okay good and we got some money for Waterbury to hopefully help build a new facility there. So we want to stay on this issue. I want to get your ideas as to what kind of federal programs could be most useful and how we can improve the situation in Vermont. So it's a just fire away and tell me what's on your mind. I start off and then I also want to talk about you know EMT services often run out of fire departments and that's an historical thing but fighting a fire or dealing with chemicals in a house that fire departments do it which is enormously one is a very different situation than going out for somebody who's overdosing with drugs. What's the connection? How do we develop a rational system? Is what we have rational now? I talked to the fire chief here in Burlington. I think he said Katie what the three-quarters of the calls now are medically related. It's a different world than fighting a fire right? Fighting a fire is enormously important. We got to be prepared to do that. What's the connection? So let's think short-term what we do to help immediately. Let's think longer-term what is a more rational system. All right that's kind of what's on my mind. What do you got? Good to see you today. I've seen you in a while. We've been getting together for what 20 years isn't it? Yes usually in Washington. The one thing is it's not exactly short-term where it is but the extender bill runs out and this this year you haven't signed on to the bill S3236 which it always gets passed at the end of the year but the extenders and forandans and the Senate bill that you have actually adds a little bit more than it was before 3 it goes to 4.3 I think for the world. Okay we'll be on it. Good thanks. The other thing is on the workforce bill if you could I know you if you can have hearings that include EMS but add some language somehow that adds EMS for the future so that bill has not been completed yet and that's a good point. All right we my committee we deal with apprenticeship programs we are working on a big one which absolutely should include health care and EMS. Thank you. Thank you. All right why don't we start short-term and then we'll go to long-term. Senator Dan Dean. S930 which is the bill that would make cancer a line of duty death. People that die of cancer their family would be eligible for the PSOV. That's been almost a year now since I was introduced. I'd love to have you sign on to that. Okay good thanks. Hopefully we could get that through because it was it's a retroactive bill and it would certainly help families we have a family in Addison County that the chief died of brain cancer. Senator that was on cancer. And we think it's related to the work that he was doing. After 45 years of his family him and his family giving to the to the service to be ineligible for benefit just doesn't make any sense. Okay now I don't have to tell you that the Congress today is not the world's most efficient operation and we have to we only have a budget we have to extend it until continuing a resolution until March but hopefully there will be a decent budget and some of these things can be included. Okay other thoughts? Let me get around the table. We're in St. Johnsbury we're actually right now been working with our local EMS agency to combine our two services because there's been a drastic falling off of staff availability people that are interested in this line of work and so let me ask you why is Brett why is you're not why are you not I mean there's a label shortage all over the state why are people not attracted to line of work? I think there's a variety different reasons but one of the most glaring really is it's just when you look at the wages it's just not competitive it's not close to competitive and there's people that leave the service they go to New Hampshire because you can get quite a bit more in your salary and they go to other states. Let's stay on that point is that is that an issue that all you guys are running into? Yes the wages we've increased our wages over 25 percent in the last year and of course the payments from Medicare and Medicaid can't keep up with that but the real problem is in a rural state like Vermont where you have an aging population with not as many young people staying as one thing but then once you start to train them into the EMS actually a lot of hospitals because their shortage are hiring them. We lost 17 I think in the last two years. You've lost 17? Yeah that's what you know they're moving up but we can't afford to pay with hospitals. Is that a statewide problem? Dan you want to jump in on that? Yeah I think so I think we've certainly seen that I think certainly retention is not all about money but it is when you when there are exit points that give you a lot more money in other places nursing working in the hospital as an EMT I think that's always going to be a pull away from our system so we've seen that not just with you Jim but with lots of other services as well. So if I wanted to drive an ambulance for you how much are you going to pay me? To start not as a 24 hour course it's $19 an hour you become an EMT it's 21 50 an hour you're an A EMT it's 24 50 an hour a paramedic this is just the starting wages is 26 29 dollars an hour so the pay isn't terrible but again when you were in competition with the hospital next year it gets gets harder and it's not putting anything on the hospital but we have to have enough money to be able to pay enough to retain them. Regionally our to answer your question for central Vermont our regional first in the door basic level providers getting $15 to $16 an hour there are signs on our Barry Montpellier Road advertising for $17 to $18 an hour just to flip burgers but these are the people who we are putting our communities our neighbors our lives in their hands to get us to the hospital when need even more alright well that's one indication of a crisis in a system that is not working well the cost of readiness to you know what's the what the cost of readiness so our service as a call volume about 800 calls that doesn't mean we don't still need to pay those folks we're responding to those calls so the income that we're getting from the calls that we're going on doesn't supplement the cost right that we need to pay our employees I understand there's different reimbursement rates for Medicare for Medicaid for private insurance what happens with somebody doesn't have any insurance you eat it well you send a bill and then you write it off is that a decent percentage of your calls that no people don't have any insurance on your community you can be as high as 30 to 35 percent there are some agencies in central Vermont more of the city or large-town agencies that are writing off between 25 and 35 percent just because they don't see it all right let me ask you you know what we are seeing in Burlington we're seeing in Vermont we're seeing all over this country is fentanyl and you know but we have hundreds of overdoses who would believe that I mean if we were here 10 years ago we would not be saying that in the state of Vermont this small state we'd have several hundred people dying of overdoses right nobody would have dreamed that and that's about the national average we're losing about a hundred thousand people a year all right who wants to talk a little bit about what's going on there how do we how all we were responding to it who wants to say a word on that yeah I will so senator a hundred percent a hundred twenty-one thousand actually this year is actually two thousand twenty-three number yeah so I think EMS has a lot of potential in that right you saw during the pandemic the capabilities of us stepping up to do vaccinations and testing and all that and people at this table here certainly were deeply involved in that I think there's some really interesting we were just down at a national governor's association a collaborative meeting talking about what EMS can do we talked about the lead behind kids the connection to resourcing one of the big challenges that we have is some of the confidentiality requirements around this stuff like HIPAA and some of the other legislation around that which means that if Drew goes and takes care of the person who overdosed and the guy says you know I don't want to be referred to treatment we're done dead in the water can't can't give his name off to somebody else to even a recovery coach to call him up and say hey have you thought about coming in there's even some more that's pretty irrational isn't that well what's what's especially especially irrational is the notion that he says yeah I'd like to get a call from a recovery coach and we can't share his data from our state system to the to the substance abuse advocacy groups and that's been a significant impediment to doing any of that sort of thing so there's some of that pieces but I think there's what you're sitting around the table and I want to go back to what Maggie said senator and said we don't get paid for readiness the model of reimbursement is flawed in that you get paid only for putting the patient in the back of the stretcher and taking him to the ambulance like you don't get paid if you don't try and spark yeah so that means when Maggie goes out and gives that person Narcan on the scene wakes him up to a point of consciousness and decision-making capability and he says I don't want to go she's eating the cost of that of that call so that's a fundamental challenge there as well but the other piece that I think weaves into this is that system the way we're reimbursed right now favors the the agencies that have high call volume right with a lot of transports you have more income coming in when an agency like Maggie says 800 calls a year that's difficult that's difficult to cover their bills if we could find some things that are reimbursable for her to do in the downtime like give vaccines give a venture testing think about some of the some of the other models around opioid addiction and quite frankly about a lot of other things so the community paramedic the mobile integrated health model let's make sure that her people are being reimbursed and doing good for their community and available for emergencies at the same time I think in a month or so within the next month I'm going to go to Baltimore where Johns Hopkins has a nurse outreach program and they literally knocking on doors in their undeserved areas you know trying to get to people before they end up in an emergency room that makes sense that type of thing you should also go to Bennington talk to Bill Komarta and Bennington rescue because they're doing a very similar out really I didn't know that okay look I don't have to you don't want to hear a two-hour speech from me the health care system is dysfunctional we tried by the way on my committee to put a whole lot of money to revolutionize primary health care in America to make sure that we spend on money keeping people healthy responding to people's crises rather than get sick and then do you know major operations in the hospital that is what we do right now so there's a lot of work to be done but I agree with you I think you guys have well what do you think I mean is Dan right about that can we be doing more outreach stuff who wants to say a word on that please so we're doing some of that now me were you from rescuing down in Brattabereau okay so not only during the pandemic did we you know do the outreach with vaccinations and monoclonal antibodies but we're active in the mobile integrated health environment going out and seeing patients ahead of appointments at the hospital in order to help keep them out of emergency rooms and try to help them make the right decisions towards all right you know we also got some money for the community health center FQHC gonna be a they move it along they're moving along they're not active yet but getting there eventually that'll be I think help to win them county yeah absolutely access to primary care is is critically important and I think EMS can play a huge role in that you know we are the kind of the ultimate safety net yep 24 hours an a7 days a week people can call 911 and receive EMS services one of our challenges is right now we don't have a lot of options our options are to take that person to the hospital emergency department or to leave them at home there's not there's not those are quite often not the right options so as we hopefully expand what we can do in the world of mobile integrated health we can provide other alternatives such as mental health counseling substance abuse coaching and I don't have to explain to anybody here they're going to an emergency room is an extremely expensive proposition ten times more than cost to go to community health center let me detour a little bit it's also our emergency departments are overflowing there there are people there waiting days there to get out of the emergency department so the rooms that would normally be available for us EMS we are now forced to sit on a wall for hours on end we just to get our patients in the right yes sir and what is that is that because of drugs and it's because of psychiatric illness it's because of overburden of our health care system that is seeing more and more patients that are seeing sicker and sicker and our hospitals that I just had max capacity and cannot afford emergency departments in the funnel for the system senator you know if you can't get an appointment of your doctor's office I know you go to emergency right and it's easy and it's fast and it's simple and I think what Scott's talking about is exactly that I think the other point that I wanted to make is that you mentioned before about health care systems and I think what we're describing to you is integrating into that health care system instead of being the standalone redheaded stepchild of the health care system we need to be part of that and that's not I wish there was a system that's not they can grow with the fire departments either because there's fire departments are doing good work on that front as well all right let me ask you we put a lot of money in the state into expanding community health centers do you have any involvement with them are they playing any role in this should they be playing a more active role thoughts Mike the only area that it put that it doesn't help today is Medicare only pays to go to a hospital you may be able to have them take some less you patients when they're open if we were able to be paid to take them there okay so you are that's an interesting point Scott I didn't realize that you're having a hard time getting the care you pay the immediate care your patients need because the ER's are well let me can add to that yeah so one of the other challenges that we face in all our community hospitals is when you have a serious illness you have to go to a higher level of care okay so it's what documents well you would think but because we've had had such a shortage in the hospital staffing areas quite often we're headed to Connecticut main medical center in Portland out into what you're taking people to Portland main those are the closest available beds in our health care system so that's taking ambulances and crews that are out of service now for six eight hours at a time mention of all my patient I'm not necessarily want to be banging along to me right so you know the the ripple effect from our health care system on to the ambulance services is huge as well right so dog that is unable to accommodate some of units quite often Dartmouth so we go to Albany Medical Center a lot Albany is one where we quite often wait two hours to unload our patients like said Hartford Connecticut is is a daily occurrence for us Bridgeport Connecticut really so again that has a huge effect on our ability to serve the rest of our patients I'd like to echo one thing that Dan just said at the end in that we and I'd like to say if we want to do broke bolt stroke especially at the federal level we need to be have EMS recognizes in the central service and some of it may be just words but those words really matter to us law enforcement firefighting are all essential parts of our public safety EMS is essential part of public safety and our health and yet we feel like in especially our local ambulance services that are scrambling personally I'm selling Christmas trees to get two to three dollars to fundraise just to make things meet these are not sustainable products and so if we want bold strokes we need to be recognized as an essential service and then fund and recognize and support our EMS office give that and then the opportunity of staff to be able to do these broad strokes and leadership right now they're the lowest the smallest EMS office in New England and nothing to against their hard work people but they really could use some help I don't have to tell anybody here but in the midst of all of this you're living in a country that spends twice as much per person on health care as any other country on earth I think we can agree it how that money is spent it's not where it's going insurance companies drug companies not particularly rational our Danielle you've been so this is a young lady we did a video with what a couple years ago right two years ago today actually and you know we were struck by Danielle we bumped into her and my staff did and you know we're trying to attract young people into a volunteer fire departments EMS stuff and Danielle struck us as somebody was very excited about the work she was doing one of you how does the world look from your perspective Daniel well not just being a volunteer firefighter I'm also a registered nurse in Middlebury at Porter Medical Center now and it is really sad seeing people flow into the emergency rooms and we've maxed out down there and I'm on the med surge floor and seeing people have to get treated in the hallways and when they finally do wait a few days to get up to our floor which we can hold 25 and that is if we have an adequate amount of nurses up there and by the time you get up to Porter in the med surge unit many times they have to be transferred up to UVM and that's only if you can take them I had a patient recently that was needing to go to a higher level of care and the wait time was 24 to 48 hours which is horrible for someone that slaves on the line but I've been a firefighter for a few years but I started when I was 15 the cadet program thanks to men like them over there it was scary to start out and not knowing what you're doing I don't have a parent on the fire department so I really just kind of dropped in it was actually after cheerleading practice my mom dropped me off at my first meeting that I could and it's it's really critical to have someone take you under your wing especially when you don't have a family member on the fire department and I know that in a lot of trainings they try to start you off at like the the bottom of the line because I had no idea what I was getting into but I think it would be really critical to have more cadet programs where you're in a training with other people that also have no idea what they're doing it's a lot less scary did your involvement with the fire department end up influencing your decision to become a nurse I actually wanted to be a nurse because I was a patient in the hospital I'm not sure what made me want to be a firefighter I honestly think you guys were really cool and I did an eighth grade challenge you got to just study anything and I chose volunteer firefighting so then I knocked on the doors of the new Haven file volunteer fire department when I was 15 but are we having success in reaching out to young people I think we are I mean we're seeing interestingly enough the smallest demographic in the fire service right now is that under 21 age group so we're working hard at trying to raise that programs like the Cadet Academy which you experienced you know we're trying to grow that and Dean and Peaker in the room and can can attest to that infusing that money that you secured for us before the that program is going to be a help we see a lot of students start in those cadet programs and then continue on in either fire or EMS or some other you know not even sometimes law enforcement it's just hooking them into emergency services giving them that exposure we see them continue that into adulthood so so they're all good things are you getting into schools to talk to kids about the opportunities that are available word we're not we need to that's an avenue that we need to start approaching interestingly enough you know a lot of folks think that the the answer is technical centers and we've had some struggles in technical centers because in Vermont there's such a large volunteer force in the fire service that it doesn't help them achieve their goal of career placement so there's there's so there are so many fewer career positions career opportunities for firefighters in Vermont that that hasn't been one of the big targets of the technical centers but I mean it as chief recon attest we're seeing I think right now we're seeing more fire service career opportunities than I've seen in the last 20 years in Vermont so it's growing it's becoming more popular but we need to find those people that you know we all know that the age of Vermonters is increasing and that's you know as a small town fire chief I can tell you I've knocked on so many doors we need more people in the age group that can serve we need to grow the workforce so that I mean that's that's the focus you know are we reaching out to young women as well absolutely yeah and we're starting to see increases in the numbers of of women registered in our entry level programs which is good and that has continued to climb over the last several years so we're we're we are seeing some successes in pulling women into the fire service I think you made a good point with the technical schools because they actually stopped offering it when I got into high school but I wanted to be a nurse and I knew I didn't want to be a firefighter to get paid for I wanted to be a volunteer firefighter so why would I waste my like class time for something volunteering when I had to go into biology in Latin to become a nurse and but there needs to be something like after school I know I've mentioned before if we could have enough training hours for those cadets that they could get an incentive to not have to do physical education or something like that just so that they can still get like the training hours aren't just adding up for the fire department but they can get some kind of incentive for that in another way so we opened a EMS training Academy down in southern Vermont last year and we have our first where probably have new fame Vermont so Vermont EMS Academy down there and we have our first cohort of high school students this year wonderful they're doing it as for credit as part of their education program so they could then was it hard to attract them or it was very easy so we're looking forward to the outcome of this program and another I mean what's great about that is the immediate problems that you're helping to address but also getting young people into health care I mean there is you've indicated we don't have enough nurses we don't have enough doctors we don't have enough paramedics to get young people interested in health care in general is a major step forward and if you get someone hooked when they're 15 16 they're gonna want to keep going I've been on the fire department for now 10 years and it's just kind of getting your foot in the door because it's a lot harder to start something when you're older when you we got to build a system to keep him it's it doesn't God bless him and nurses are wonderful but I want to build a system where a person who decides they want to be an EMS provider or firefighter who says I can get a job I can keep a job I can make a living wage I can have benefits I don't have to work 10 jobs to do this that's another important piece of this as well and we need an educational program that is free for cost our firefighting program at the Vermont State Fire County is free and you can get all the students in our EMS academies are not and that is an impediment to so far I want to be how much does it get across me 1200 to $1,500 for this is what we're trying to adjust with Wilson right exactly 12 to 1500 just to get any empty license we're beginning to try to address that and I appreciate your help on that really do you know what drives me crazy I gotta tell you when we sit around the table is it's clear we don't have a system alright nobody in the world would deny that the work you're doing is enormously important you're sometimes you're going out and doing something you don't get compensated a nickel for doing it right you're paying people 16 bucks an hour to do very important work but not training the young people that we need we need to really be thinking immediately but we need to be thinking big term big is the state appreciating these problems and addressing them in the bold way do you think is there some yeah I mean listen everybody who works at the state offices of EMS Robotters come up through the system they understand this as much as anybody I think the challenge of course senator is there isn't a simple lever to pull or a switch to flip to make it better you know there's not if it was simple we would have fixed it already but you know I think I think so I think we're making some strides it's complicated unfortunately it is it is our other thoughts team you've been senator thinking of the younger people the cadet programs I think one of our biggest drawbacks is they go out and train with their local fire department and they're going to do ventilation tonight and all they can do is stand back and watch the ventilation being done they're not around because of their age to actually do the definition we take up somebody using a chainsaw in a forestry class at the age of 16 they're allowed to use that because it's educational but as a firefighter they're not allowed to do it because of occupational so we need to change that we've brought this up many times who to see it just we need to be able to train them the same way that we're being trained because sometimes you lose yeah they are being set aside to watch and they want to do hands-on Daniel may want to jump into this discussion but I think we underutilize our young people I think a lot of young people who want more responsibility and we don't give it to them we treat them like little kids and they're not they're adults and who can help who will enjoy doing the real work and help the community doing it I don't think we take advantage of them as much as we should so that's a good point and that's that that was the problem with the career centers they take the course and then they couldn't test out for firefighter one until they turned 18 because they weren't a by-state law they're not allowed to run power equipment or be involved with live fire regulation this is a federal regulation it's an OSHA regulation and bullshit follows it and when you're 16 two years is a lifetime you know so you find something else to do you know that they're not going to want to sit around and I believe me I got it you show up to a car accident and you were told to stand up on the bank because you can't go near the person or at a even just a training you smoke out of building you're out on there on the edge doing nothing which is discouraging and kind of insulting when you show up to help to do something to learn and you're told to just sit there so the same thing in our ems licensure the 18 year old environment they can't become an entee until they're 18 they can't even test until they're 18 national registry will not allow that either so we we face the same battles on the ems side of educating these individuals getting empowered at 16 and 17 and then asking them to wait till their 18th birthday to finally test out Katie we all know about I shouldn't job sorry I said Katie Vanhase is our state director and Haley Perot does our outreach work Katie I Haley do you want to jump into this anything on your mind Haley Haley's been getting all around the state what what do you think I think a lot of what you said that there's a lot of challenges but a lot of untapped opportunity I think I was hearing from Drew about kind of what EMS can do and I know fires similar really beyond sort of what we traditionally have thought of us as EMS and fire and folks that when there's an emergency like COVID or even the flooding I know that it was folks like you all who are out in communities so I think thinking creatively and then also thinking about how we pay you for it and then really interested in getting young folks involved and people seeing themselves as someone who can join a fire department I think what Danielle said about if you don't have that family connection how do you knock on that door I know you did Operation Mayday to try to encourage folks but really just making it very approachable and real for people was that successful operation may day it was for the first year for the first year out of the gate we did an early survey after that event and we counted over 30 new responders entered the fire service so for the first year it was so and I've been working with you on that or we Haley helped us do some outreach to get spread the word you know we have a thing I don't know if you're familiar with called Bernie buzz which gets around the state I think we have 150,000 people on the list and the Bernie buzz did advertise this okay so uses if you think there's something that would be of use statewide with it to try to work with you there's two grant programs to that are critical the fire service AFG right which today's grant so yeah so I know with a continuing resolution sometimes things are up in the air but reauthorization it'll happen all right it but it's totally it but what is the what's the federal contribution how much is AFG how much how much is how big is that part you call I think it's 360 million something like 360 each yeah and usually the local cost shared depending on populations 5% so it's a pretty good so we ended up applying for a safer grant just you know we've recognized staffing at such a crisis right in the state so we put in for a safer grant and we weren't successful unfortunately made it through peer review it just didn't go on the technical review but you know like the city fell off you got $22 million we're asking for 800,000 one firefighter I know I know it gets frustrating so that you know continuing those programs we have had I think some luck in Vermont yes some departments have received grants all right here's what we're trying to do that we had some of you were involved you remember a couple years ago we were on the phone with fire administrator after Biden came in we begged them and I think we ended up having some success I mean given the bureaucracy that if you are a small department filling out these forms is like impossible right 10 to 30 hours of work right for people don't necessarily have the training of other work right right you know we begged them to simplify the process I think they did yes a little bit a little bit and they've created this micro grant program as well so they explain that okay there's a as many of you might want you guys sit up here on my program program that has been around and this year they increased the maximum to 75,000 so again this grant program that's a little more accessible consigns be regional now has more money in it so it's not limited to I think previously 50,000 yeah anything you can do to make the program bigger because there were 8,000 applicants last year less than 10 awards in Vermont I know and which probably was good for Vermont by the way 10 of what's relatively speaking it was good for the 10 that received that right but no way near enough I know yeah is it still limited 2% for EMS yeah so yeah that's why EMS again being 80% of the call volume they do present the money and after that discussion online the center introduced a bill to create essentially an AFG program for EMS because there's a need across the board for fire and EMS instead of competing against and we try to put some money I think into the primary camp bill as well one of the struggles for fire fire departments municipal fire departments and where they differ a little bit from EMS is EMS can bill for their services we don't bill for our services so we're strictly funded by taxpayer dollars so there is a revenue stream for EMS to recover some of their costs it doesn't it's not enough for sure but that's fire there is a difference EMS and fire gets the bill if you had an ambulance you'd build yeah so making sure it's not that different yeah and if fire departments had the able service they would be able to go for some of those services but standalone fire departments don't have that so you're competing for tax money that is really a struggle in some of these small communities when you add in the school budgets and highway funds so it's pretty that's a double-edged sword though too in that for us standalone EMS agencies our select supports look at our hey you can get revenue so I'm going to focus tax dollars on those entities our law enforcement or firefighting and other priorities of the town that can't get revenue I'm going to focus on really trying to increase them and you can go find your revenues in your reimbursements well we know reimbursings for Medicaid and Medicare are really challenging and nowhere near equate to what we need operationally so it's a dual-edged sword I'm not gonna talk about reimbursing remind me again I know that you got the private you got Medicaid Medicare all different that's great private is the best is the highest reimbursement rate we unfortunately to try to shift the amount of money that we can get in from Medicare and Medicaid we have to shift our costs to private insurance so they can pay more so that we can just fund and put the lights on we are fortunate to have our Medicaid rates increased locally in our state legislature so I want to call out all the hard work there but that hasn't solved the problem and that's only a temporary stopgap and Medicare Medicare and drew can speak better to this number I'm not sure if it's 55% or 60% of what normal private insurance would pay and we are forced to come up with 35 40 percent of that funds from somewhere else tax payers fundraisers somewhere we have to do to pay the lights to stay on and 60 to 70 percent of your business is Medicare and Medicaid always all right so you're talking about all 70% of your patients are on Medicare and Medicaid and some have no it's really hard to make up a difference okay and then some have no insurance at all no and I also want to make sure I mentioned it appreciate you being the major co-sponsor and working with Senator Wells to pay for the trips that we talked about that we don't transport but just you know when we talked about you're writing off 20 to 30 percent for people can't pay 30 percent of your call volume 20 to 30 percent more of your call volume is going to and not transporting and this is tried the right factor that's impacting us of mental health drug abuse and homelessness is all well relatively new in Vermont impacting our bottom line and making the when we call we show up whether they pay or not and we will transport always all right so all right let's talk about the trifecta and you know you all know it's it's bad in Vermont it's worse than many other parts of the country all right let's talk about I mean this drug thing is is horrible and I guess you're on the front lines of dealing with that all right give me some examples of what you're experiencing yeah so sometimes we talk about the the impact on the people that are suffering from addiction I want to just kind of highlight the impact on the healthcare workers that are managing it it's not uncommon for us to see the same patient repeatedly and you know just a personal story after doing CPR on the same person four times to show up too late the fifth time and see this person that we've tried to get into the system we've literally gone through the the motions of resuscitating them taking him to the hospital to see them over and over again and really the the end of that is you know on a number five we were we weren't called early enough and it was a negative outcome so there's a huge impact not only on the the people that are suffering from addiction but everybody in the room and the staff that we represent that are going out there every day is seeing these patients over and over again all right let me pick up on Drew's and that's a very important point I mean we do we talk about how we deal with the addict but we're not talking about how we deal with the folks who every day are out there trying to address the problem does what you said resonate? I can recall an instance just recently where my crew responded to a mental health patient who decided to ingest cocaine and took on my local law enforcement officer and they assaulted each other for over 25 minutes and we were having to get our EMS crews get involved and get injured just to be able to safely transport this patient who only in turn after three and a half hours was discharged from our emergency department and reabused for cocaine and called 911 system so that same crew that was just assaulted just injured had to go back and take care of this guy again where he is again swinging at EMS providers this is the system that we're asking people to join to people to stay in to retain I don't know how that's sustainable firstly all right further I think I know the answer to this question I'm gonna ask anyway do we have the kind of treatment available for that person who OD'd on four occasions so that is it so somebody is ODing and ODing what do we do? The patient has to make the choice themselves in order to get the help we can't force them right you know to make that choice I know in rural areas these are people we know on a first name basis when we go to see them like you said you know in in Waterbury the police force that we have are coming from the state police and so they could be two and a half hours away at three in the morning when we're going to give me an example I give what you're dealing with yeah we go to a patient who has overdosed and they call 911 we only say hey is there where are they home now or are they both with those somebody's called 911 what happens are there police available that can come follow us they're aware that it's it's happening and they're gonna send some women they can and so our crews then will stage and wait until it's safe for them to enter the home to take care of that patient wow which is not good health care I presume huh the other thing from the outside looking in I don't do a EMS but from I'm on the select board in our community and our police chief says the biggest the only place to send people in mental health crisis is to call the ambulance and send them to the hospital and then when they get there there's no treatment for you got it and like she says they're right back home and and within hours you're dealing with the same thing again the CEO UVM will tell you they don't have the capabilities they just sit in the emergency room exactly in days because there's no room for places and when they put them to a room it's enormously expensive in there they don't have the capability of treating people what about Prattle bar is the retreat doing much now or retreat treats very very busy we actually have a partnership with the retreat in order to help I know they went to difficult times yeah they're they're back up to about a hundred beds now let's say we work with the retreat every day of the week to help get patients that are stuck in emergency departments around the state so we'll actually go out with ambulances and transport those patients in the retreat to try to bring the amount of time that they're waiting in er's down we've been successful at at cutting the er wait times once they're accepted from about 20 hours down to about eight hours but that's still a long time even after being accepted for mental health can you draw a call to southwest hospital bennington was building some were you thinking of building some capacity as well yes i believe that that is that true down in bennington excuse me senator i was going to add i think there's opportunity here for ems and fire as well first of all i think we have to seize these opportunities when we have a more intimate relationship with these folks who are overdosing and in psychological crisis and perhaps any other arm of the health care service so we need to be able to make that connection immediately it's absurd to think that we're going to give you a narcotic antagonist that is to block your your overdose put you into withdrawals and then say okay see you later right we've got to be able to do something to either connect you to treatment services to connect you to detox connect you to something do we have does anyone here think we have any way near the capability no we need but but i think there's an opportunity um we've begun it we will begin very soon an ems buprenorphine project where our ambulances are carrying medication assisted medication to assist this moment so i think that's a piece that's there i mentioned before about the connection to treatment right away we can't say call me back in five days to get treatment we've got to say this is rock bottom here's somebody that can help you and these peer review these peer coachings are exceptionally important in that time they're they're saying hey we're here and we're ready let's go if you don't seize that and then the other thing i wanted to mention is that i think there's an opportunity especially around psychological crisis to begin to triage where these folks go how we respond to them senator if you and i sat in an er for four days as sane as we might be we will be well talk to yourself i don't want to but the point is nobody can exist in that environment and what our response is generally escalating the situation so we're working on some creative solutions to try to uh for example with dru's team down at the um what's the barracks down there westminster westminster barracks we're triaging people who call for mental health crisis to say look is it the appropriate resource to send state police which sometimes it is is it an appropriate resource to send ems or is it a more appropriate resource to to send you over to nine eight eight the suicide hotline back we have a meeting this afternoon to talk about just that how do we put that intervention point into our call taking system to say look if we can have you talk to a clinician that's better trained more appropriately trained let's get you out of this number of police departments are beginning to do that yep i was for example the state police we just put we're going to put 12 new healthcare workers into our barracks next year so i think there's opportunities i think i think and ems and far can play an important role in that all right all the thoughts senator oh i'd just like to first i would like to say thank you for what you do for us but thank you also for what hailey does for us hailey has is well respected throughout the state in the fire service and i'm sure in the ems and we're we're super happy with that thank you very much my question is is over the years we've introduced on the federal level several bills we were in shellburn that we did a benefits type thing that we introduced and we've always included although it doesn't say ems we've included first responders so that it did include ems but we don't seem to and there's been other states that had their senators or representatives introduced bills for the fire service and ems we just don't seem to go anywhere what can we do to to push these things see we're going to get arrested if we show up on the on the floor i'm pretty sure that sounds i don't want to get political here i really don't but there are some folks who would rather give tax breaks to billionaires and large corporations than funds the enormously important work you're doing and the irony here is this is not just a vermont issue i suspect there are 49 other states that are dealing with exactly the same issues rural health you know we talk about the health care crisis rural health is even worse uh and who is the backbone of rural health is what you guys all over the country are doing right so the irony is you talk about this everyone nods their head and their support all right all right well i can tell you dean is we're going to stay on it and do our best in in all respects uh the safer program is inadequately funded the afG program is inadequately funded the ems stuff is inadequately funded um yeah dan jim just wanted to see if possibly rural states have a lot of power in congress and seem to do well and that's in on your favors yeah our favor you're also very powerful chair of the health committee health education is there maybe some hearings where you can get people to support some things that we could get the word out yeah i mean how they know it but if you could get them to come the hearings are good but that you gotta go and the answer is yes and i'm sure we can get folks not only for vermont but your compatriots from all over the country to make the case and put pressure on the congress act so it's a good idea and i think it's something uh we can do um but we'll also need the help of your national organizations because i am correct i know it's saying this is a national problem none it's not just a vermont problem especially for rural states uh i've talked a little bit about drugs being a new and not new but a significantly increased uh crisis for you guys right mental health covet player role in that do you think is that was that a stimulator what's going on with mental health why do we see so much you know i go into the schools occasionally and the kids will acknowledge that they are dealing with a lot of stress and anxiety daniel is that true yeah i would say so i mean if you don't get to be around your peers and you're not stimulated and you're not used to that schedule that you knew for the last however so many years it does play a big role and when you have to go into a house and you have to like gown up and be scared of what you're walking into and i mean it does adds a whole other factor of stress okay what is on your minds that we did not discuss gone over a lot of stuff so kind of a move towards regional departments and at least discussions about that are starting to come up that makes sense to you that's to me spreading out the resources over a larger population yep to the extent there is something that could be done more long-term maybe discussion about how we could have a federal government or man that's not so much a federal i mean federal government is money but how that money is how they could how it's you know the structure of how who gets the money that's that's the state's decision we are we are no great secret we we're not into county government very much yeah right but you know i could tell you you don't get musky over there and you got south brought in on three separate entities really five minutes apart from each other makes sense and that's so sure it does i think there's creative ideas though senator and i don't think it's entirely incongruent to think about it in the way we think about health care from federal level we have fqhcs we have critical access hospitals that are federally funded i don't have a mature thought on it but but i think there's a process to think about it in that way of of here we have an expensive resource that we're simply not able to pay for it some of these most rural places how do we scaffold that in a way that it's sustainable i'm not saying that it can you know be entirely underwritten but we do it in other arms of health care uh and maybe that's going to be thinking about me as well good brad touched on regionalization it's a conversation that we've had for quite a while now at different levels and i think that we're starting to do it without calling it back because everybody has their own little kingdom that's our biggest problem is we all have our own little kingdom and we don't want you coming into our kingdom and telling us what to do so regionalization is is a tough pill to swallow but i think it's the only way that we're going to be able to afford to be able to have fire service and ems in the future homeland security was probably one of our biggest flaws in that everybody got the same toys so now we don't need you you know where we might have used brad's department to come in and assist us because they had a certain expertise now we have got the money through homeland security to get the material to run that and we we don't have the ability or we don't have the people to staff it so we're no further ahead and then once that piece of equipment is no longer viable we have to figure out how we're going to fund it again if we want to keep that going and i see that as a you know one of the biggest things was uh 9 11 being able to communicate across lines and we're no further ahead really our communication than we were when that happened i mean it is it is terrible and we have these discussions all the time and we don't know the answers but i think we're moving as the cost goes up i think we're moving more towards regionalization and and understanding that we don't all need all the toys um you know the cost of a cost of a new pumper is is upwards of five hundred thousand dollars now you know how do you know i was mayor of the city a long time ago and that was one of the shocks that i discovered god that was expensive it's worse i think regionalization could be formal and informal and um a formal model like drew's model that he's using down south but i think there's also informal models such as up here in ginnick county where the local entity agency may be able to get its first uh ems call out the door with its ambulance but the next call coming in is probably pulling in the town will come over and that happens dozens upon dozens times every single day and that it's a web of individual organizations but they just thought decided to help all of each other out in the name of mutual aid and that's essentially a regionalized model so i don't think it formally needs to have the big old agency come in sometimes there's other local options that can achieve that but i think that's what we're trying to achieve one last thing i want to call out is the health care and wellness of the individual responder um retention is great and important but if they get that one call which drives them out the door that could be decades of learning education and expertise that we will not be able to replace um do we have the counseling and the help for that individual i think on the short term maybe on the long term i'm not so sure we have it but getting us getting me to admit that i have that weakness is the first problem getting me to admit that a call bothered me and that that i want to sit and talk with you to tell me about it peer support is a big thing that we're pushing to you know tell your members to talk to the person that was at the call with you and and get it out well you guys see a lot of dreadful stuff i mean i think every one of us that sits around this table knows at least one person probably more that have left emergency services because of their mental health yes because of what they've experienced because of what they've experienced and how and how uh there wasn't a mechanism for them to manage that and it's a thousand paper cuts too right i mean it's not always the awful and tragic call it's the awful and tragic calls plus low wages plus long hours plus getting up in the middle of the night i mean it's it's not one thing it's a lot of things and they all are cumulative four agencies to make ends meet each of those getting up at three in the morning only to turn over to get to the next agency to try to keep keep my bills paid and losing people to that doesn't help our personnel crisis right i mean we can't afford to lose those people not you know beyond that we can't afford for them to to leave feeling that way because that that's just the start of what they're going to experience in their life and the public can't afford to have us lose them and i think we have seen a culture shift for the younger generation coming in being more cognizant of mental health talking about it being more open about it and how can we support financially those individuals coming up that will be more open and will help advocate for that for us as an industry and the pity of it is it's not that as a nation when i spend enough money spending a whole lot of money that's how we spend we don't spend it on prevention we don't spend it on primary care we don't spend none of the work you're doing but if i end up in the hospital on some surgery i'm gonna come out with a million dollar bill right million dollars go a long way deal with the bobbin right and not just the hundred and thousand dollar trucks is that like my fire department right now we only have a handful of interior firefighters and i'm one of them and my gear is older than that i mean we can't afford to go buy brand new gear and how many years is it that it even lasts more ten like that's crazy for a fire department that's has it we only have about 400 people in my town right now but if someone's house catcher's on fire that's still a house that's caught on fire if the town has thousands of people i mean and it's scary to think that if a tone goes out right now and i put on my gear and you're going into a house that has scary chemicals and i don't have the right gear i mean then i'm just putting my own health online just to end up in the hospital yeah and then i have to call this guy to come get me because i'm no longer healthy and i'll take you to Connecticut thanks yeah i prefer main though but all right i think we have probably raised more questions than provider answers but all right let me just say this uh if you think the problems are overwhelming you're not crazy they are if you think the system is irrational you're right you think we spend the money where we shouldn't be and not spending where we should be you're right if you think congress is not addressing these issues you're right maybe the state legislatures doing better i don't know but uh all right all that i can tell you is this number one from the bottom of my heart and i know i probably speak for everybody in the state of remorseless 640 000 us thank you very much for what you're doing all right and you are heroes and heroines and you don't get the recognition that you do and you're doing it every day on the great stress so thank you and some of us not just me but some of us are more than aware of the issues that we have discussed and we're trying we're trying i mean we just a few months ago brought forth a bipartisan primary healthcare bill which would have gone a long way to address some of the problems we're talking about couldn't quite get the support that we needed so we'll have to come down and do much less than i wanted but some of us are aware of this and we're trying so i want you to know that that don't think it's what you're experiencing is not perceived by some of us in congress and your delegation uh becker and peter i think are there with me um are any else that anyone want to raise just thank you to you too and your staff for supporting us oh you got it it's my honor to support you because you guys have done great work it really is and it's a pleasure to work with people who want doing the great work you're doing all right there's a lot of stuff we're trying we're making some progress uh we're going to stay with it we'll continue communicating tell you what we're doing hearing from you uh but um maybe the last word magulate program leader you're working with dr wilson is going well yeah tell us a little bit about it so we're in week two um it's a program that's been in existence for several years in upstate new york to meet the needs of those in rural areas so it's an online so we're in person on fridays from eight a.m to four p.m um and we've got four different classrooms on the screen in front of us so there's and it's inexpensive that training is reasonably inexpensive yeah i believe that i've been told that the cost is going to be covered so that it's not going that's the money that we got okay that's what we want all right so the idea i made of all the crazy things the idea that people want to do the right thing of to spend what a couple of thousand dollars to get dmd training up to twenty seven to thirty two thousand dollar center for the program and a program for forty five and they say yeah does that make any sense to anybody i mean it's it's unbelievable all right so all right we're trying we've got a enormous amount of work in front of us and let's keep working together thank you all for what you're doing thank you