Harford County Executive Barry Glassman has a vision that, perhaps as long as 10 to 20 years from now, the county government will be in charge of emergency medical services, a system that has been under the purview of independently-run volunteer fire companies and their governing bodies for generations.
But while it might take that long for a full transition, some initial steps will come much sooner.
"Eventually, the county will be buying units and staffing them," Glassman said Monday, as he explained some of the basics of his plan during a meeting with editors and news staff from The Aegis.
The transition to a county-run EMS system, which Glassman also discussed in his recent State of the County Address, will first involve hiring a medical director who would work for the Department of Emergency Services and oversee EMS providers, purchasing Advanced Life Support Surge Ambulances and hiring EMS workers to staff them and creating an EMS Standards Board to handle the planning and transition processes for a phasing in of county staff units "in service areas which may require supplementation."
Those proposals, which Glassman called "baby steps to begin that transition process," are based on recommendations from the University of Maryland's Center for Health and Homeland Security, which the county hired last year to review prior EMS studies and conduct interviews with all parties involved in delivering emergency medical services. Some are likely to be funded in the budget for fiscal 2017-18 he sends to the County Council in April.
Glassman stressed that he does not want to immediately replace the current system, but much of its command and control will be phased out over time to a predominantly county-run system.
Eleven out of 12 volunteer fire and EMS companies currently provide medical services countywide with volunteer EMS workers and paid paramedics – the Susquehanna Hose Company, of Havre de Grace, does firefighting only, and the Havre de Grace Ambulance Corps provides EMS service in the city.
Money to pay some of the paramedics comes from the Harford County Volunteer Fire and EMS Foundation, which gets annual allocations from the county and the fire companies. The Foundation has been in place for about a decade.
Many of the larger fire companies with a high volume of calls – Bel Air, Abingdon, Joppa-Magnolia – staff their ambulances with paid paramedics, with salaries and equipment being funded through collection from patients' medical insurers.
"It's a strange patchwork," Glassman said. "It has worked, but it's probably gotten to the point that it's outlived its usefulness."
The planned county-owned Surge ambulances, staffed by about eight crew members working in shifts, would be dispatched to calls when needed, such as to parts of the county where the volunteer companies have more calls than they can handle, and be available for disasters.
The EMS crews will report to the county's Department of Emergency Services, and the county would handle patient billing.
"It will begin to give us some experience in managing a couple of units, managing the personnel," Glassman said.
He expects it will take a year or two to implement his first proposals. Glassman will be up for re-election in 2018.
"I grew up in the service," Glassman, a longtime member of the Level Volunteer Fire Company, said. "If I can't get this done, it's not going to get done."
He noted "all of this is going to create some ripples" and will be "an earthquake" for some people, while others will say the transition should have started 10 years ago.
If he doesn't start changing the system now, Glassman said, he fears a situation where he or a future county executive would be forced into a sudden transition to a county-run EMS system, done by executive order, if a disaster happens.
"One of my goals as county executive is to try to do it in a methodical transition, to get us to where we can have a service that will last another 20 years," he said.
Glassman stressed the county EMS units would not compete with the fire companies and would initially pick up only the calls the fire company units can't handle. The volume of calls has been rising for several years, according to a prior student the county did of the fire and EMS service, and there has been much debate in political circles if EMS units are responding on some calls as fast as they should.
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Over time, Glassman said, the county EMS force will grow and county-employed workers will take over for those paid by the Foundation.
He noted the Bel Air Volunteer Fire Company, which serves the Town of Bel Air and surrounding communities, and the Joppa-Magnolia Volunteer Fire Company, which serves Joppa and Edgewood, are "doing a good job" providing EMS service in their communities and handling patient billing.
He said county officials plan "to leave them alone [during the transition] until they need the help."
"In my vision. we don't want to compete with them – they're handling it, they're doing a good job," Glassman said. "As long as they do that, I don't think the county needs to circumvent or take over."
His plan for changing the EMS service does not include the volunteer firefighting operations, Glassman said, but he continues to work toward changing the county's relationship with the fire companies.
Last year he circulated a draft bill that would have placed more county administration control over the fire system through the Department of Emergency Operations. Leaders in the fire service wouldn't support it, however, so Glassman pulled back.
He has another draft in the works. "We're still working on that," he said.