Delaware paramedics, pressed by state funding, see challenges ahead

New Castle County paid $1.4 million in overtime for paramedics last year — just like it has on average over the last three years — because there aren't enough of the frontline medical workers to keep up with the growing demands of old people, addicts and violence victims.

And because of the way the state budgets their funding, there's not likely to be much relief soon for any of the three county paramedic groups.

NCCo Paramedics Chief Larry Tan asked the county last year for 12 new positions, but he won't be getting them. The county executive said that's because the state won't cough up more cash.

"When the state restores funding, we will put more paramedics in your communities," Meyer said, answering a question about Tan's request.

The problem was underscored last year when the New Castle County Police Department applied for a federal community policing grant this summer and the county pulled back before it could be processed. The $2 million in federal aid would have put 15 officers on foot patrols in the county's troubled neighborhoods, but NCCP won't get them.

It would have cost the county about $1.4 million in matching funds, and then-Chief Executive Officer Kathy Jennings said the county already was struggling to keep other services online.

"You have a paramedic service that is very stressed," Jennings said then. "We really need to make sure we're fiscally responsible and that we take into account saving lives and public safety."

MORE: Without grant, plans for more NCCo foot patrols canceled

The number of calls paramedics answer has spiked across the state — in New Castle, as much as 65 percent over a dozen years — and there's no indication Delaware's population will get healthier.

And there's not much hope the state will spend more on paramedics.

"We're to a point where we need some help in the field," said New Castle's Tan. "We have a tradition of excellence and, quite frankly, we do not want to see that degrade."

Reimbursement from the state once made up more than half of the budgets for the state's three paramedic services. Now, through a convoluted payment system, the state pays less than a quarter of their budgets.

In New Castle County, that means paying overtime to keep paramedics on the shifts they have to run.

In Sussex, shrinking state dollars means holding off on plans for paramedics to better reach rural areas.

Kent's paramedic boss is holding the line, but without relief he says the system is stressed and, one day, something will have to give.

"It hasn't gotten better each year," said Kent County Director of Public Safety Chief Colin Faulkner. "After a while, you get conditioned to that trend."

Cash-strapped

The statewide paramedic services were created following the Delaware Paramedic Services Act of 1990 with a 60 percent state reimbursement plan for their expenses. Now, 24 percent of the county paramedic budgets come from state coffers.

And the state only reimburses old budgets.

To avoid having to forecast expenses, the state repays paramedic services based on last complete fiscal year of expenditures, usually two years back. For example, 2017's payments were based on 2015's expenditures.

But paramedics' expenses increase each year, so reimbursements never meet actual expenditures.

"It has put a hardship on the county," said Sussex EMS Director Robert Stuart. "They've had to come up with the difference in reductions each time."

Statewide paramedic expenditures for FY17 reached $42.4 million, but they were given $1.92 million less than 30 percent of that year's total.

The three paramedic services instead received 30 percent of the $36.03 million they spent in FY15, which is $10.8 million.

The gap is further exacerbated by the reduction from 30 percent reimbursement to 24 percent started in FY18, so paramedics have been receiving less in their quarterly reimbursements since the end of September.

But fewer state dollars can't mean less service, and hasn't meant fewer calls.

Calls for service to New Castle County Paramedics went from about 24,000 in 2005 to nearly 37,000 in 2017, according to county statistics. In that time, the county population increased by about 17,500 people.

In Sussex, paramedics saw a 55 percent increase in calls for service between 2005 and 2017, according to county statistics. There were almost 18,000 more calls to Sussex County EMS last year than 12 years before, during which time the population grew by nearly 21,500 people, many part of a growing retiree community.

Faulkner said calls for paramedic services in Kent County rose 6 percent between 2016 and 2017.

"We're just busier than we ever have been in the history of the program," Faulkner said. "If the money disappears and each county agency is left having to keep the service together, it's going to be difficult."

Picking up the slack

Bound by the law to operate a paramedic service, there's been no option for the counties but to pick up a larger portion of the paramedics' tab.

"The challenge going forward is to maintain those critical services while figuring out a fair division of the costs," read a statement from the Department of Health and Social Services.

And there's no guarantee of relief in the budget recommendation filed by Gov. John Carney.

His recommendations for FY19 includes about 10 percent more for grants-in-aid, from which paramedics receive state funding. But the Joint Finance Committee makes the final decision. Some lawmakers are calling for the 2018 cut of 20 percent grant-in-aid money to be restored, which would give the paramedics more.

State law requires a minimum of 140,160 paramedic staff hours per year for New Castle County; 52,560 for Kent County; and 87,600 for Sussex County, and they all exceed it.

But as reimbursement has declined, counties found themselves on the hook for the costs.

Last year, New Castle County rerouted more than $1 million to help make up for the difference, in addition to the overtime.

"It's an underfunded mandate," said New Castle County's Meyer. "This is in a world where the expertise of a paramedic is increasing, therefore the salary and wages and benefits of a paramedic are, rightfully, increasing."

The pay for paramedics in New Castle County starts at $40,753 and can be as high as $63,225.

It can take a full year for a paramedic to achieve National Registry Paramedic certification and another three to nine months to receive a Delaware paramedic certification. Cost for entry-level paramedic training is about $92,000, including salary and benefits, tuition and supplies.

Paramedic candidates hired for entry-level paramedic training in New Castle County sign a five-year service obligation contract with the county.

Paramedics in Sussex County are offered a starting salary of about $45,555, though employees with college degrees and prior experience are given a bump. Kent paramedics get a $44,043 base salary which goes up to $48,043 for experienced hires.

MORE: Carney proposes pay raises for state workers, no tax hikes

Calls never cease

Medical calls are the bulk of the work for Delaware paramedics.

"If the state's looking at what they see for a reimbursement investment, think about the downstream healthcare cost if you didn't have paramedic-level services," New Castle's Tan said.

In 2016, NCCo responded to 716 patients in cardiac arrest and 4,220 patients with chest pain, representing some of its most frequent calls for service, according to county statistics.

The opioid epidemic also is driving calls, including at least 795 overdose incidents in 2016 in New Castle County. And NCCo Paramedics also service Wilmington, where there were nearly 200 shooting victims in 2017.

Staffing at NCCo Paramedics has increased by only eight positions since 2005.

The job leaves paramedics drained, Tan said. They're at risk without relief, and that can lead to burnout and turnover.

"You're walking in and out of vehicles every day. The latest generation monitor you carry is about 25 pounds. The drug bag you carry is another 25 pounds. Your patients vary in pounds," Tan said.

And a part of their burden doesn't disappear after a good night's sleep.

"One of the requirements of the job is an ability for reasoned judgment while under stress. We're asking people to make some very important decisions that can determine the outcome of your medical emergency," Tan said. "That's a lot of stress. That's a lot of responsibility."

Sussex's Stuart has one open position on his service of 116 paramedics and support personnel, and he said overtime hours aren't eating up his crews. There were 14 vacancies last year, he said, and he has 10 new paramedics in the middle of training which could have them on ambulances by spring.

"This looks like a good summer for us, compared to some in the past," Stuart said.

While day-to-day operations haven't been affected, Stuart said plans for growth have stalled.

Sussex EMS was going to shutter a rented facility in Dagsboro which served as a paramedic station and a special operation station. The plan was to move the special operation station to Georgetown and the paramedic station would have gotten a new facility.

The Georgetown move already was underway when the most recent funding cuts came down, Stuart said. So while that plan is going forward, the new paramedic station is on hold, he said.

The mean age of Sussex paramedics patients is around 65, Stuart said. Chest pain and difficulty breathing are among the top calls his service answers.

And because his county is more rural, it can take longer for his paramedics to get a patient from the scene of a medical emergency to a hospital, Stuart said.

"Your units are tied up more frequently during the day," Stuart said. "We are going to have to deal with our under-served areas. We're going to have to make some adjustments in the future, and funding will affect how quickly we can do that."

Contact Adam Duvernay at aduvernay@delawareonline.com or (302) 319-1855 or @duvINdelaware.