Inside an old New England house, medics from the Wethersfield Emergency Medical Services Association (WEMSA) go over their plans for the day.
EMTs and paramedics chat as the station’s dog barks and the ambulance siren rings.
Ryan Thibodeau, a pre-med student at UConn who works for WEMSA, readies the ambulance for the day ahead and remembers first starting out in emergency medical response.
“Wethersfield took me in when I was pretty new and they gave me a shot and I kind of fell in love,” Thibodeau says.
Across Connecticut, emergency medical services providers like WEMSA are jumping into action. When a 911 call comes in, an ambulance responds. But what’s less clear is who decides which EMS provider shows up.
For police and fire, towns have a lot of control over who gets dispatched. But the world of EMS response is more murky – a network of companies, large, small, and volunteer, licensed to respond to many emergency calls.
What’s more, towns don’t actually have the ultimate authority over EMS response. It’s actually the state.
The law is to ensure “the quality and safety of emergency medical services" in Connecticut, according to the Department of Public Health.
But in Wethersfield, the law recently made for complications when WEMSA announced it was changing how it operates.
'I was very concerned'
Thibodeau says most emergency calls WEMSA gets aren’t life and death – someone’s fallen and needs help getting back up.
But when it comes to life or death scenarios, and growing call volume, Dennis McMahon, WEMSA’s head and an ambulance volunteer for decades, says his small company is more than ready.
“We’ve handled this since 1956,” he says.
Last year, WEMSA announced it was shifting away from a volunteer model. As part of the move, it wanted to drop its contractor Aetna, and replace it with East Windsor Ambulance Association.
But the move made some Wethersfield leaders concerned.
“It would be easily 20 minutes or more before we would have any kind of response,” said Frederick Presley, Wethersfield’s town manager. “If that’s a heart attack or stroke, I was very concerned what would happen.”
He filed a complaint with the state in January to block the move, asking the Department of Public Health to force WEMSA to keep Aetna in place.
State officials are now considering the request, which may take months.
'Not going to sign my own death warrant'
It’s common for Connecticut towns with small EMS services to tie up with other providers to pool resources and provide more advanced care.
For years, WEMSA operated as a volunteer service, partnering with Hartford Healthcare’s Aetna Ambulance Service.
Aetna had the staff, equipment and the capability to provide advanced life support – interventions that stabilize a patient in a critical condition while preparing them for transport to a hospital.
But when WEMSA switched to a for profit model last year, Presley says it proposed dropping Aetna, replacing it with East Windsor Ambulance Association.
“Without telling me what they were going to do, [they] filed the paperwork with the state to say ‘This is what we are doing now,’” he says.
Presley says the move left him shocked.
But WEMSA’s McMahon says the change is necessary if the decades-old ambulance service wants to survive.
“I have 40 years of experience, a lot of my partners have 25, 30 years of experience, we have very good EMTs here, these kids are incredibly smart,” McMahon says.
He says he’s open to working with Aetna, but is concerned they will ultimately try to drive his small organization out of service.
“I’m not going to sign my own death warrant,” McMahon says. “I’m just not going to do it.”
In 2022, state data show there were about 4,400 EMS responses in Wethersfield. WEMSA handled less than half of those calls – all for basic life support. Aetna responded to more than 3,600 calls in town.
If WEMSA went out of business, Aetna would eventually raise prices, McMahon says, “which is not fair to the people in town, the patients in town, the taxpayers in town. I've worked my whole career here, trying not to get into the pocket of the citizens.”
Aetna disputes that claim, saying 80% of the total responses in Wethersfield are for patients covered by Medicare or Medicaid, and those rates are the same for both WEMSA and Aetna.
'A messed up system'
Wethersfield’s EMS problems are not unique.
Tom Varanelli, whose company, Northeast Fire Rescue, staffs EMTs and paramedics across Connecticut, says call volumes have increased so much that EMTs need to be at the station 24/7.
Across the state, he says big ambulance companies are driving smaller ones out of business – exerting a market dominance that makes it difficult for smaller EMS services to compete.
“Some of the larger hospital-based entities [like] Hartford HealthCare, they’re becoming a larger competitor in the state,” he says. “You’re seeing that play out in Southington.”
In Southington, town leaders are asking the DPH to approve an alternate EMS plan. They’re citing slow response times from an ambulance service owned by a global investment firm.
Across Connecticut, other town officials are also pushing for changes – saying bigger doesn’t always mean better.
In East Haddam, State Rep. Irene Haines says its state-licensed volunteer ambulance service is struggling.
“If the volunteer service can’t provide the service it goes out to mutual aid,” she says. “And in a town such as mine, which is 57 square miles, the response time is lacking. That person who’s called 911 because they’re having a cardiac arrest doesn't get help in time and could die.”
As in Wethersfield, Haines says it's frustrating that towns don’t have more local control over EMS providers.
Wethersfield Town Manager Frederick Presley says he was shocked to learn about the lack of local control over EMS providers when he arrived in Connecticut.
“I was county administrator in Stafford County, Virginia. EMS services were a function of the town just like fire and police. In Rhode Island, I was town manager in West Warwick. And again, EMS was a department we had under the town just like any other department,” he says.
“I'm sure that 60 years ago [the WEMSA model] worked fine. Populations were a lot less, the issues were a lot less, cars didn't go as fast. It's a different world now.”
While he’s appealed WEMSA’s proposal to the state, Aetna will remain in place, for now.
But the future of EMS response in his town is still in limbo. All parties – town officials, Aetna, and WEMSA workers who’ve responded to emergencies for decades – find themselves waiting on a response from the state, which could take months.
“This is such a messed up system,” Presley says.
Towns, he believes, need a much bigger say about who provides their local EMS service and how they do it.
“It’s not just Wethersfield,” he says. “We need a new law that gives control to the locality on dealing with these public safety issues – just like we have control for police and fire.”
