Keeping ambulance services running is not a part of the county’s “circus,” Commissioner Kevin Boozel said while speaking at the State of the County panel on Thursday, March 19.

But the people affected? Those are the county’s “monkeys,” he said.

Because the ambulance services that provide such a vital service to Butler County residents were struggling, the Butler County commissioners used $690,000 in federal grant funds to create an EMS Academy that could train emergency medical technicians in 2023 and a paramedic training program in 2025.

The initiative put about 20 people in the backs of ambulances across Butler County. Following training at the Butler County Community College, students from the short-term programs were required to work at least one year within the county.

The programs have had a positive impact on county ambulance services, Boozel said, but those dollars will run out at the end of 2026.

“This is not a county-level issue. We put a Band-Aid on a boo-boo,” he said at the Thursday event.

He recognized that Butler County’s ambulance services may be doing better than some across the state, but “for how long,” he asked.

VA Butler Fire and Emergency Services discontinued its ambulance service in February, and Boozel pondered if another EMS agency within the county could shutter by the end of the year, too.

The county-funded emergency medical service training programs have chipped away at staffing shortages plaguing local ambulance services and helped improve emergency health care in rural areas by placing emergency medical technicians and paramedics in the field.

Both programs taught at Butler County Community College were created to address what officials called the “EMS crisis.”

The crisis was brought to the commissioners’ attention by the county’s emergency services department, said Leslie Osche, commissioners chairwoman.

Emergency 911 dispatchers reported having to contact as many as six or seven ambulance services before finding one with enough staff to respond to a call, Osche said.

That information came on the heels of a revenue problem that came to light during the drug overdose crisis, which peaked in 2017 when 92 deaths in the county were attributed to overdoses.

Osche said ambulance crews often administer naloxone to overdose patients. The medicine rapidly reverses the overdose and revives the patient, who would then refuse to be taken to a hospital. Medicaid and other insurance providers don’t reimburse ambulance services if they don’t take patients to a hospital.

“If they don’t transport, they don’t get paid,” Osche said. “That’s doing a job you’re not getting paid for. That was exacerbating the situation.”

Another issue was that traditional EMT training programs last six months and require students to pay in advance and then pay to take the certification test. Many students dropped out of those programs due to the strain of working while taking classes, she said.

There was talk about the EMS crisis in the state legislature, but no solutions emerged, Osche said.

“We just knew the cavalry wasn’t coming. We knew we had to come up with our own solution,” Osche said.

So the commissioners got together with EMS providers, BC3 and Butler Memorial Hospital and developed the EMS Academy.

“We were familiar with workforce development programs where people get paid to train and promise back to work for some time,” Osche said. “That’s where we got the idea for the academy model.”

Independence Health System plays two roles in the EMS Academy and the paramedic training program, she said. The hospital schedules EMTs and paramedics to work for ambulance services having staffing problems, and EMT students who don’t pass BC3’s test, are put to work in the hospital, she said.

“(The commissioners) really were just in search for a solution to a problem that was far and wide,” said Jenna Enscoe, director of emergency services at Butler Memorial Hospital.

She recalls the essence of the commissioner meeting with the hospital and BC3 about establishing the training programs.

“How can we all work together to make this work,” Enscoe said.

The hospital, she said, was “ready to hit the ground running due to past relationships with educational institutions.”

Enscoe said it is refreshing to see demand for training.

“It hadn’t been that way for some time. We’re delighted to have them,” she said.

BC3 began providing EMS training soon after it became a profession.

“Organized EMS started in the United States in 1970. We started teaching here in 1973,” said Tom Buttyan, coordinator of BC3’s EMS and police training programs, and an EMS program graduate.

BC3 began a hybrid EMT program in 1973 and then transitioned to EMT and advanced EMT training programs in 1996, said Buttyan, who teaches in the EMT and paramedic programs.

He said the same lessons taught in the traditional 15-week part-time EMT training program are condensed into eight weeks in the EMS Academy. Four days a week are classroom instruction, and one day is an eight-hour shift in an ambulance. The training includes the Emergency Vehicle Operators Course, which state law requires for ambulance drivers.

The academy is set up to have 12 students in each class, or cohort, but some classes have had fewer. Four classes have gone through the program, another class of 12 is in session now and the last class covered by the county grant begins in June. Buttyan said 43 students started the first four classes, 32 completed the course and 18 passed their certification tests and are working in the county.

Students get six attempts to pass the certification test, but all students have to work in the county for a year whether or not they pass. Those who don’t pass work at the hospital or for an ambulance service in nonemergency positions, he said.

“EMS isn’t for everybody,” Buttyan said.

After the EMS Academy started, Butler County emergency services director Steve Bicehouse approached the commissioners in May suggesting that another training program was needed to address the shortage of paramedics, Osche said.

Paramedics who go through the training program must work full-time for one year or until 2,080 hours is reached, Bicehouse said.

Butler County 911 coordinator Robert McLafferty is one the instructors in the paramedic program. Impulse Training Academy, which is accredited in paramedic training, teaches the program at BC3 through the county contract.

EMTs are trained in basic life support, which includes administering oxygen, assisting with medication and using automated external defibrillators, but paramedics provide advanced life support, McLafferty said.

To begin paramedic training, students are required to be certified EMTs, he said. The paramedic training starts with 12 hours of classes per week for 15 weeks followed by 500 clinical hours in a hospital emergency department and clinical time in an ambulance, he said. The 12 students enrolled in the paramedic program are scheduled to graduate in December.

He commended the commissioners for taking action to address the EMS crisis in the county.

“The EMS crisis is real. This has been a huge step to making sure the general public is taken care of in the county,” McLafferty said. “Butler County has been on the forefront of this. We certainly hope we can continue with these programs.

“Although the crisis is nationwide, we’re much better off than we were and much better off than other places, and that’s due to the forethought of these programs.”

Having 18 people certified and working as EMTs in a year and half is a success, but the county needs a long-term solution to the crisis, Osche said.

After the last EMT class graduates in October and the paramedic class graduates in December, the future of the programs are uncertain.

“We’re looking for a long-term solution to this,” Osche said. “We’re not out of the woods as far as sustainability.

“We hope success leads to financial support from third parties for the future.”

She then reiterated something the commissioners have been saying since the crisis began — municipalities are required by law to provide EMS as well as fire services within their borders.

Many municipalities pay for fire services by imposing a fire tax. The same approach might be needed for EMS, she said.

Butler Ambulance Service should be commended for directly asking municipalities for financial support, she added. Butler, along with many others around Butler County, has gone to the townships and boroughs it serves and to ask for financial support.

Some municipalities have not responded to the plea. Other municipalities have obliged, implementing the allowable half-mill tax that EMS agencies say is still not covering expenses.

“It’s going to take something from everyone. If residents expect response in a reasonable amount of time, as taxpayers we must be willing to pay,” Osche said.

The state would have to take action to allow a higher EMS tax in municipalities.

The county, situated in between, sees the problem, has addressed it via the EMS academy, and as its pocket of funding runs out, is left wondering, what’s next?