Carson Kessler, THE CITY
This article was originally published by THE CITY
On July 12, a 1-year-old boy was fatally shot at a family cookout in Brooklyn. Just three blocks away, an empty ambulance sat outside of the Bedford-Stuyvesant Volunteer Ambulance Corps headquarters.
But the EMTs couldn’t answer the call.
The crew’s operating certificate renewal was tied up in bureaucratic red tape inside the state’s overburdened and underfunded Bureau of Emergency Medical Services, a division of the state Department of Health.
A routine inspection in November 2019 identified three deficiencies: Personnel records were not accessible. Plus a roll of aluminum foil and six sanitary napkins — all required — were missing from the corps’ sole ambulance.
While corps members tried to address the issues, COVID-19 hit and they were allowed to continue working — at least at first.
“When the pandemic started to calm down, they [the Department of Health] want to say, ‘You don’t have enough tampons on your truck, so your truck is not good enough to run, even though crime in the Black community skyrocketed,’” Antoine Robinson, commanding officer of Bed-Stuy Volunteer Ambulance Corps (BSVAC), told THE CITY. “It was ridiculous.”
Without the ability to operate, the corps’ situation is dire.
In September, Marie Diglio, the head of the Regional Emergency Medical Services Council of NYC (REMSCO), the authority for all EMS operations in the city, said in a meeting that BSVAC would be “limping along on their way to nonexistence” without help.
Meanwhile, the path to recertification is paved with tedious paperwork, integration of a new quality improvement plan and making necessary changes under the eyes of several outside agencies — all while the volunteers work other full-time jobs.
An already overwhelmed Bureau of EMS, charged with integrating new COVID protocols into the emergency medicine system, also adds a lot of watching and waiting to the process, experts say.
Filling a Void
In the age of COVID, some volunteer ambulance agencies are becoming increasingly more difficult to maintain as fundraising revenues dwindle, new regulatory requirements pile up and volunteer numbers drop. That’s especially concerning to the neighborhoods the corps were formed to help.
There are currently 26 active volunteer ambulance corps across the five boroughs. From a single volunteer corps in The Bronx to 13 in Queens, a total of 138 volunteer ambulances are on the road. Nearly 64% of those vehicles belong to one volunteer corps — Hatzalah, which primarily serves heavily Orthodox Jewish neighborhoods.
“Volunteers serve significant needs within their respective communities,” said Jerry Gelbard, a district officer at New York State Volunteer Ambulance & Rescue Association (NYSVARA), a nonprofit that represents volunteer groups. “They fill a void.”
When coronavirus cases first overwhelmed the citywide EMS system in March, the Bed-Stuy crew’s inspection woes were put on hold to save lives. The FDNY reached out to ambulance corps across the city, including BSVAC, and told them to jump in wherever they could.
Ben Fractenberg/THE CITY“It was just disastrous,” said Tamsin Wolf, BSVAC’s vice president. “If we took people to the hospital, it was a traffic jam. You couldn’t get them in. The morgues were overflowing.”
Robinson said BSVAC ran its single ambulance “24/7” while responding to an unprecedented call volume.
“If the public [had] seen what we saw on this ambulance, they would take [the coronavirus] so much more seriously,” said Robinson, who was on the pandemic’s front lines until his crew was grounded in June. “Now the numbers are rising and they’re coming back up. That’s very troublesome.”
Volunteer ambulance corps across the city proved critical as overwhelmed municipal ambulances took longer to reach patients.
A Rise in Response Times
EMS response times in March hit an all-time high in some parts of the city, according to the FDNY: 31 minutes in the Bronx and nearly 20 minutes in both Brooklyn and Queens. Manhattan’s response time was little over 15 minutes, while Staten Island’s came in at about 11 minutes.
During the same period last year, EMS response times across all five boroughs never surpassed 15 minutes.
“It is true that poor communities do not get the same level of service as wealthy communities in New York City,” said Scott Phelps, who has been in the EMS field for 37 years and has held high-level emergency management positions in both New York City and New Jersey health departments.
“And that’s why we have Bedford-Stuyvesant volunteers,” he added. “The city simply doesn’t have enough funding to provide enough ambulances so that every community gets a decent level of service.”
Ben Fractenberg/THE CITYThe Throggs Neck Volunteer Ambulance Corps (TNVAC) serves a similar role as the only unpaid crew in The Bronx.
“There were times where we responded to a call and the person left and went to the hospital because they were waiting for over an hour and 40 minutes for the Fire Department,” said TNVAC chairperson Erika Newsome.
Normally, the corps’ two ambulances only operated in the Throggs Neck, Pelham and Country Club neighborhoods. With permission from the FDNY in March, the corps has been taking calls from all over the borough.
But with an increase in operations comes higher gas, utility and insurance bills, which have been difficult to cover with in-person fundraising shut down. It costs BSVAC $25,000 a year just to insure one ambulance.
The Throggs Neck crew had a fundraising event scheduled for late March that was expected to bring in around $21,000. It was cancelled due to COVID — after the corps had spent $4,000 on it from an already tight budget.
‘We Don’t Have Resources’
Similarly, BSVAC’s main three revenue streams — neighborhood fundraising, charging for in-person EMT standby services at local events and paid training courses — have been halted due to the pandemic.
“All of our sources of funding were squashed dead like a bug and that’s been difficult for us,” said Wolf. “We’re not a sophisticated organization, we don’t have resources.”
The poster child of a sophisticated volunteer ambulance corps is the well-funded Hatzalah, which has nearly 90 ambulances at outposts across the city. A single branch, Hatzalah of Williamsburg, raised over $2 million in May.
With over 1,000 volunteers, Hatzalah has become an aspirational model for squads like BSVAC, which face greater financial challenges operating in historically low-income communities.
“A lot of people inside the community don’t have the capability to be able to donate extra energy or financial support because they live on the edge as well,” Robinson said.
Robinson also noted a sharp drop in the number of volunteers willing to help out during the early months of the pandemic, scared off by the virus.
“Being a volunteer chief is the hardest job you can imagine because you’re trying to get volunteers to do stuff they don’t always want to do so that you can make sure the organization functions,” said Phelps.
And new regulatory requirements related to clinical care, operations and reporting on COVID cases are putting an “additional burden on those volunteer hours,” according to Phelps.
‘Underfunded and Understaffed’
As volunteer ambulance corps get hit hard by the health and financial crisis, their governing body, the state DOH’s Bureau of EMS, and the municipal ambulance system could use a boost.
“Paramedicine has been almost universally underfunded and understaffed despite continual call volume increases over the past four decades,” Phelps and other field experts wrote in a May essay outlining the state of mobile healthcare.
Even before the pandemic, the number of certified EMS providers — both paid and volunteer — in New York had declined 9% in the last 10 years, according to a 2019 survey conducted by the New York State Emergency Medical Services Council.
This is partially due to the “declining financial health and negative fiscal outlook” of the Bureau of EMS as it faces a shortage of funds and personnel, said Phelps, the assistant commissioner of emergency management in the city Department of Health from 2002 to 2004.
Ben Fractenberg/THE CITYOrganizations like REMSCO and NYSVARA say they are doing their best to assist the bureau and help volunteer squads keep up with regulations and stay on the road.
REMSCO’s Diglio and NYSVARA’s Gelbard have been providing technical assistance to BSVAC. Most recently, Gelbard and his team did a headquarters walkthrough to prepare the corps for re-inspection “as soon as [they’re] ready.”
Staying Alive
Robinson said he understands the regulations and high standards, but both he and his staff are constantly short on time.
For a volunteer commanding officer who also works 12-hour shifts, four days a week as an FDNY paramedic, flawless bookkeeping isn’t always a priority. That can mean unmet deadlines, incomplete forms and what he characterized as minor operational deficiencies.
The death of Robinson’s father, BSVAC founder James “Rocky” Robinson, in September 2019, hasn’t helped internal operations run any smoother.
“If we were a well-funded organization, we would have electronic records,” Wolf said of the organization’s failure on the personnel record front. “There’d never be an issue of some piece of paper not in the right folder.”
Neither the Bureau of EMS nor the state DOH replied to requests for comment.
In his 41 years in the EMS field, Gelbard has seen plenty of volunteer ambulance agencies go bust.
Some can’t fix what is broken internally, others get shut down by the Department of Health through inactivity, he said. To remain a part of the city’s robust EMS landscape, volunteer squads must constantly adapt — or risk extinction.
“It’s going to take consolidation or collaboration with partner agencies,” said Gelbard. “If the agencies don’t stay in that lane and change from years past to a better and stronger business and membership model then many of the squads will continue to fail.”
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