Brattleboro firefighter Helder Ferreira, an EMT, puts things away inside the Golden Cross ambulance after it was used on Friday, July 1, 2022.

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BRATTLEBORO — Prompted by the town ending its relationship with Rescue Inc. and exploring the potential for a joint fire-EMS service with support from Golden Cross Ambulance, a feasibility study provides insight into several paths forward and potential price tags.

“This is a complicated subject and there’s a great deal of information before you,” Rich Buchanan, senior project manager at AP Triton, said at the Select Board meeting Tuesday.

Since the start of the town’s new fiscal year on July 1, the Brattleboro Fire Department has partnered with Golden Cross Ambulance of Claremont, N.H., after the town split ways with Rescue Inc. of Brattleboro following a dispute over contract negotiations. AP Triton, made up of EMS and fire experts from around the U.S., was hired by the town in May for $38,721 to conduct the feasibility study.

AP Triton looked at four options: reinstating the funding and contractual agreement with Rescue Inc., entering a contractual agreement with a private ambulance, creating a fire-based EMS and ambulance transport by the fire department, or having a public/private partnership as is currently underway with Golden Cross.

Annual costs are estimated to run about $288,000 to return to Rescue Inc., about $91,796 for the town to have a fire-based EMS service with one 24-hour-a-day ambulance and one 10-hour-a-day ambulance, about $629,000 to go with the current model of contracting with a private ambulance provider, and about $309,000 for the town to have two 24-hour-a-day ambulances staffed with one firefighter/paramedic and one firefighter/EMT for each of the three shifts. Buchanan said a third ambulance could be leased or rented by the town to cover rare calls where a third ambulance might be needed.

The level of EMS care is anticipated to remain high with any of the models and can be considered a minor factor in future decision making, according to the study. All four options are considered sustainable and could be adjusted to meet the needs of the community.

Regardless of which one is selected, the study says performance benchmarks should be required. They should include minimum response time metrics and ambulance resources allocated to the town.

Another recommendation is to have more staffing in the fire department. The number of firefighters responding to a structure fire was below national standards before June 2022, according to the study.

“The staffing change to cover the ambulances resulted in increased shortages,” states the presentation. “AP Triton recommends returning staffing to fire apparatus and increasing future staffing.”

The study can be found at brattleboro.org and includes recommendations for the department on training, data collection, analysis and planning.

AP Triton found no statistical or documented deficiencies in patient care by any agency involved in the study. Care would be consistent between the four options, Buchanan said.

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His group found that average response times in nine incidents out of 10 in Brattleboro averaged about seven minutes for Golden Cross this year, about 11 minutes and three seconds for Rescue Inc. last year, and about six minutes and 13 seconds for BFD last year.

During site visit interviews with Rescue Inc., the report states, “there was a concern that the current dispatch system/software caused a delay of up to two minutes in dispatching Rescue Inc.”

“A review by AP Triton staff of the current system, did not show any indications of a system problem resulting in a delay in transmitting the medical incidents to Rescue Inc.,” the report states.

Rescue Inc. provides “excellent service” but the town had issues with its lack of accountability and transparency, Buchanan said. The organization should show its cost of doing business and what it is billing for transport, he added.

The report says Rescue Inc. would not give AP Triton incident data from its internal records management system. Buchanan said his group was told they could not get proprietary information or anything that could not be given in a public forum.

“They are a private business,” he said, confirming he runs into similar situations with other private ambulance services. “I think you have the information to make a judgement.”

Buchanan noted how hiring a private group requires contract renewal every three to five years. Proposed in the report is a resolution for the town to adopt that would tell any EMS agency the town contracts with or employees what its expectations are for service.

Select Board Chairman Ian Goodnow expects the report will be discussed at upcoming meetings.

“There’s a lot here,” he said.

Board member Elizabeth McLoughlin thanked Buchanan, adding that the information in the document is needed for decision making. Buchanan offered to answer further questions in the future.

Brattleboro’s contract with Golden Cross ends June 30.

“If we choose either of the two fire/EMS options, those are going to take time to implement,” Interim Town Manager Patrick Moreland said, urging the board to be prepared for “a lengthy implementation process.”