Massachusetts Towns Scramble after Hospital Sheds ALS Service

A Norwood hospital's decision to drop its advanced life support ambulance service has some area towns scrambling to find alternatives when gravely ill or injured people need to be rushed to medical care.

Fire chiefs received a letter from Caritas Norwood Hospital last week, informing them that the hospital would be phasing out its 911 service.

In the past, a group of towns around Norwood, including Millis, Medfield, Wrentham, and Norfolk, have relied on the Caritas ambulances to intercept local basic life support ambulances en route to the hospital. The Caritas service has been especially important to towns with few or no paramedics on staff.

"I'm very concerned," said Lieutenant Vincent Howley of the Millis Fire Department. The firefighters who man Millis ambulances can provide only basic services, such as CPR. They cannot administer drugs or insert breathing tubes or IV lines, as the paramedics who staff advanced life support ambulances can.

"Right now, if we have somebody call in with a chest pain, automatically we're calling for advanced life support," Howley added. "Ninety percent of the time, Norwood gets our call." Millis used the intercept service 78 times in the past year.

As larger area towns have added paramedics to their fire department staffs, the service has become less necessary and less economically viable for the hospital, said Bill Fleming, senior vice president of operations at Caritas.

"The 911 business did not perform positively in a financial sense," Fleming said. "Frankly, we were losing a lot of money." Fleming said that dropping the service would save the hospital about $300,000 annually.

The breaking point came when the town of Norwood, which accounted for more than half of the hospital's 1,139 emergency intercept calls in the past year, began staffing all its fire shifts with paramedics.

"Our volume is going to drop significantly," Fleming said.

Medfield Fire Chief William Kingsbury said that the decision was disappointing, but "it's just something we have to deal with." Medfield used the Caritas service 136 times in the past year.

Both Howley and Kingsbury said they are exploring other options to provide advanced life support. Although Caritas is the primary provider of such services to both towns, they also sometimes use American Medical Response, an ambulance service with an advanced life support unit based in Natick. Howley and Kingsbury said they will work with the company to see if it can provide more service to their towns.

Even fire officials in some towns that are hiring more paramedics are worried about Caritas's decision. Wrentham currently runs 75 percent of its shifts staffed with paramedics and calls in off-duty paramedics for backup. Still, the town used the Caritas service 51 times in the past year.

Wrentham Fire Chief Robert Morrill said he hadn't yet developed a plan to make up for the loss of the Caritas service, but he said it could involve relying more on another hospital or on nearby communities with paramedics.

Norfolk Fire Chief Coleman Bushnell said he was initially upset with the decision, as well as the fact that it was communicated through a letter. However, he said, he has moved on.

"You can't waste your time and your limited resources looking at what could be done differently," Bushnell said. "The decision is obviously cast in stone."

Norfolk currently runs about half its shifts with paramedics and used Caritas's intercept service 92 times in the past year. However, the department will be running all of its shifts with paramedics by January.

Fleming, the hospital official, said that he didn't know exactly when the service would stop but that it could be as soon as the end of the year. Caritas will continue to use ambulances staffed by paramedics to transport patients to other hospitals.

Fleming said he is going to meet with area fire chiefs at the hospital sometime this week to discuss the hospital's decision.