Editor’s note: This is the second in a three-part series dealing with the financial problems currently facing the ambulance service, as well as the implications of and possible resolutions to the shortfall. Part one covered the causes and extent of the budget crunch. Part three will cover a potential merger between the ambulance and fire services and other proposed solutions to the problem.

For the Summit County Ambulance Service, operations are as tight as they can be.

In the years since the economic downturn and a changing health care landscape plunged the once-profitable agency into the red, director Marc Burdick has had to find a variety of ways to reduce spending without impacting the quality of care delivered to patients in the back of the ambulance.

“SCAS has made numerous cuts to positions, capital, medical supplies and training,” he stated in an email to the Summit Daily. “Whenever possible, if the EMS system is ‘slow’ we will send extra ambulance staff home early to save money. We do everything we can to reduce costs.”

Until recently, the ambulance service operated without any cost to taxpayers. It was one of the county’s few enterprise funds; a department that is administered publicly but funded entirely by the fees it charged for services. But revenue began to dry up during the Great Recession, when call volumes declined and an increasing number of patients were uninsured or underinsured. SCAS’s collections for service have dropped from 69 percent to as little as 63 percent in recent years, and Summit County government has begun subsidizing the department with taxpayer dollars to allow it to continue operating.

To help make ends meet, the agency has scaled back ambulance coverage across the county, removing one 12-hour-per-day vehicle year round, and cutting another year-round vehicle that served Keystone 10 hours per day on the weekends.

Five positions have also been eliminated, including three paramedic II jobs.

“As staff left for a variety of reasons, we did not fill those positions,” Burdick stated. “The paramedic II position is fairly unique and SCAS uses these positions to fill a variety of specialized areas such as supporting training, quality improvement, disaster preparedness and the public access defibrillation program.”

Training budgets have also been cut, and the agency is holding off on replacing aging equipment and ambulances.

For members of the staff, the financial pinch is always there. Now, with Summit County officials exploring ways to resolve the ambulance service’s financial problems — including privatizing the agency or merging it with the fire service — so is concern for their jobs.

“This is tough for them, what they’re watching and seeing,” Commissioner Thomas Davidson said. “They’ve been so professional.”

Paramedics and emergency medical technicians (EMTs) with the ambulance service, like Billy Hanley, have worked hard to get there. Hanley worked for another ambulance service for more than five years before he says he was “good enough” to sign on with SCAS.

“That was a personal challenge,” he said. “This is my own little paradise.”

Today, he is also a member of the Summit County Rescue Group, is raising a family in the county and, like most of his co-workers, holds a second job.

For him, being a paramedic in Summit County isn’t a job, it’s a career.

But the future of that career may be in jeopardy as county officials weigh a number of different options to handle the ambulance service’s current financial situation. No decision has been made, or is even imminent, Davidson said, but options on the table do include merging EMS with the county’s fire services, a course that could mean an undetermined number of layoffs.

Sitting in the small, comfortable living quarters provided to SCAS paramedics and EMTs during their 24-hour shifts, Hanley said the budget crunch, as well as the lack of job security does weigh on the staff. But it does not distract them from their responsibilities as medical providers.

“I think people are striving to make themselves better in light of the situation,” he said. “Because what are you going to do, start to crumble? That’s not the kind of people we are. If someone’s near cardiac arrest, that’s where we shine.”