Pennsylvania’s emergency medical services face two problems statewide: a personnel storage and shrinking funding.

And while finding EMS workers and firefighters isn’t a new problem, it’s long been a significant one.

“It’s a dire situation,” Rep. Martin Causer, R-Bradford, said. “It’s a crisis situation and the system is very fragile. While I think the public is starting to understand more, I don’t think they fully grasp the situation.”

Causer held an EMS task force meeting in McKean County on Thursday to collaborate with local leaders and officials on the troubles they face.

State law requires local governments to provide emergency services, but Causer noted some township supervisors and county commissioners might not realize the full extent of their responsibility.

“The future is going to be engagement with these local officials,” he said. “Some of them planning for that provision but not providing financial support. Others are providing significant financial support.”

Though local governments must provide emergency services and respond to every request for an ambulance — be it a life-threatening car crash or a mildly irritating fingernail — insurers are not legally required to pay for those services.

EMS workers quickly discover that getting paid for their services is not a quick or easy process.

“Insurance won’t pay unless the bone’s sticking out,” said Nathan Burgett, director of operations for the McKean County Department of Emergency Services.

Many ambulance trips don’t get billed, other EMS officials noted. When they do get paid, the revenue can often be below the cost of supplying the service in the first place.

In some cases, municipalities free-ride on others.

EMS officials raised concerns about free-riding at a Senate Health and Human Services Committee hearing in June, as The Center Square previously reported. The state’s EMS bureau obligates local EMS services to respond to calls “regardless of location,” Altoona Mobile Emergency Department EMS Chief Gary Watters said.

“The unintended consequence of this interpretation is that it is causing agencies to respond farther from their districts which deprives their own services of resources,” he said.

Causer heard similar complaints of townships refusing to fund the services they use.

To stabilize financial support, some areas have turned to EMS authorities, where municipalities band together to share resources.

In February, eight localities in Lancaster County established an authority. Forest County, one of the most rural areas of Pennsylvania, used an EMS authority to bring back ambulance services to the county’s eastern half — something missing since 2018. Service consolidation has been more common in western Pennsylvania to deal with budgetary squeezes, and it’s not uncommon for ambulance services to ask townships to assess an EMS tax to cover costs.

The authority model is a voluntary approach; municipalities vote to opt in or deny to join one, and their structure varies depending on the needs of an area.

“County and municipal authorities — that model seems to be working in some parts of the state,” Causer said.

Officials also noted some possible solutions, including a fee attached to driver’s license renewals that would support EMS services, or adding a fee to traffic citations. The General Assembly is also considering raising Medicaid reimbursement rates.

To establish financial stability and recruit more workers, lawmakers don’t have one bill in their pocket to move on from the past when a fire department could “BBQ their way to a new fire truck.”

“At the state level, we’re looking for every avenue that we can,” Causer said.