All towns · rindge

Ambulance Services Committee Meeting

Video

Sick of that.
Okay.
That's why we just run the CIP yearly.
We just started that, baby.
What are you doing?
And now it's just nothing but a dream.
That you wake up to her every night.
You don't have to take her a nightcare.
You don't have to sit here a second in front of you.
But I've been in murder almost as long as I was here.
Wow, really?
A little bit longer.
Wow.
Are you ready to flip the switch, Kate?
I flip the switch.
I think if you want to go mad, I don't know why.
You stuck in.
You're not there.
Oh, it's that night or whatever.
We're all done.
I see.
I think.
It should be on.
It takes time.
Yes, it does take about two minutes long.
Oh, look at that.
You can see yourself.
No, I can't see you.
That's even better.
I like that.
I am non-existent.
Almost done.
Yes, but we must think of our vast audience as opposed to whoever on the front.
But we'll do it if they're able to say, back of that little stand.
And they have to hop up and take a call.
There's a bad juju if you sit over there.
No, no.
I have to hop up and take a call.
I don't know where you know who's sitting.
That's the back of the plus.
No, that's the back of the plus.
Show me anything more?
Yeah.
If I scream, just don't run it.
Okay, perfect.
Hi, Dad.
Hello?
I prefer you.
Hey.
Keith, thanks for inviting us all.
I appreciate you all coming.
And hopefully we've got some people online here.
But yeah, so we've been, this is our third meeting.
And we just want to take a little bit of opportunity to introduce the committee.
Dan White, which is present.
And we're with you.
I'm sorry, Dan Whitman.
That's okay.
I apologize.
Whatever.
I didn't have to hear that, so he's doing okay.
Apology, Dan.
Still in our field room.
Budget Advisory Committee, Max, Town Administrator.
I've got my Deputy Chief, Brittany Fahey.
I've got Citizens at Large, Deb Douglas.
Citizen at Large, Marion Harper.
Citizen at Large, Mellon Smith.
And myself, Fire Chief, Robert Foss.
That's part of the committee.
So the purpose of a little bit of an agenda, just some discussion, the concept of what we thought about bringing it to you early on,
was the purpose of the committee, a review of some of the current operations and the realities of what we're looking at moving forward,
staffing and response considerations, equipment and resource needs, future planning and service delivery, options, and public comment.
So, ideally, if you give us an opportunity to get through this presentation, then we'll open it up to public comment, questions, and concerns.
But I'd like to get through everything before we hit that point, if we can.
Obviously, if you have anything glaring that you need me to stop for, please stop, throw something, and we can talk about it.
Just be careful with you through it, because I know where you live.
All right.
So, Percy, can we make that if there is a back tool point and the rest can go on to public?
Definitely comment.
Yeah.
Okay.
Yeah, definitely.
All right.
So, the purpose of the committee is to evaluate future EMS transport options, ensure sustainable, high-quality service,
maintain professional relationships with current providers, which is Jerma,
and provide recommendations to the board of selectmen for moving forward.
Current operations and realities moving forward.
All right.
The Ridge Fire Department, as we exist today, provides initial patient care.
So, we are dispatched out the door, we arrange rescue, and generally, Jaffrey Range Memorial Angles.
Okay.
We're our first responder.
We are, and we'll talk a little bit about staffing levels here in the moment, entirely.
Jerma currently provides our ambulance transport service.
As we are seeing, we are seeing an increase in service demand, as well as an increase in both costs, both internally and externally.
And that's the cost for our equipment, and that's the cost for our equipment, as well as the service provided by Jermyn.
Why this matters.
We have a growing population, which obviously equals an increase in call volume.
There are some cost equity concerns between Range and Jaffrey.
Jaffrey tends to run more calls.
Jaffrey Range Memorial Angles runs more calls in Jaffrey, typically, than they do in Ranch.
All right.
There's occasional response delays due to staffing issues, both here in town, after hours.
Again, people are coming from home.
We don't have staffing in the fire station 24 hours a day, seven days a week.
We do staff the fire station Monday through Saturday, 6 a.m. to 6 p.m.
Need for a long-term sustainability.
So, again, what we're looking at is some options for moving forward.
What are we looking like five years from now, 10 years from now, 15 years from now, in transport services?
Can we go back to that slide for a minute?
Of course.
Okay.
Figuring that there may be some people listening to us other than our direct crowd here.
You want to go a hair deeper into the cost equity concerns.
Yes, and we can, right?
Obviously, both towns pay the same amount for annual services.
Donate.
What's that?
Donate.
Oh, no, we pay a fee.
So, talk to me.
Go ahead.
Explain everyone at the end.
All right.
Max, I'm going to ask you to help me here, okay, for those of you that when we have the article
or the part of the budget, that is a donation, currently, to J-R-M-A.
Why?
I'm...
You do.
That's okay.
No, that's it.
Why?
Yeah.
So, there's a budget line item.
There is a budget line item.
Okay.
And was there also a separate warrant article?
There was a separate warrant article, okay, which is what got us from, and I'm going to
use some round numbers here, because the number in the middle I'm not as sure of.
We were at 40, 43, 45 for a fair extended period, okay?
Then it...
May I keep going, okay?
Then it went from there, an extra, I want to say, 35 to 40 was put in to the budget.
And now the past two years, and again, I'll be waiting for anybody to say it's only...
I believe it's only been two years.
There has been a warrant article that brought the total contribution to 125 for ambulance service,
not specifically for JARMA.
And that was one of the issues the past year, okay, was, I don't want to say misunderstanding,
but I'm not sure that everybody was on the exact same page.
The 125 was meant with, because of the warrant article passing, to cover ambulance services,
knowing the lion's share would go for a JARMA, but that it was also supposed to pay if we had
to use great work.
I believe all of that is accurate, but if somebody else has a different set of facts
and figures on that, if it's not accurate, it's pretty darn close.
Is there a contract?
No.
Then we're in the book on this case.
Yeah, there is also now a contract.
Oh.
Yes.
Sorry, I'm all the way back here.
Keep going.
There is a contract.
Can we get copies?
Yes.
Yeah.
Not right now, but yes.
Great.
Yeah.
Facts, how long have we had a contract?
No, so that was a great question.
End of February-ish, right?
Remember, so before the, yeah, because we were waiting, it went to our attorney.
Yeah.
And then, because we had some questions, we wanted to make sure our attorney cleared it
before we paid on that.
So it went to the attorney.
We got the approval from the attorney.
It went to, back to their board.
Yes.
And there was a delay a bit, a little bit there, and then we signed the contract.
Yes, that's correct.
And that was for the full calendar year, which is important to note because their fiscal year
runs not in.
Concurrent with our calendar year.
Right.
So the reason that I was trying to get to that clarifying question is, this is year one.
Okay?
So when we talk about we have a contract, we do, that has been in effect for under 90 days.
Correct.
Is it a one-year contract?
I believe it's a one-year.
Yes.
Now, it's just 50-50.
Yes.
Which is a sticking point.
It is.
And has anybody reviewed their financial statements?
Has anybody done any analysis on the call data?
Anything like that?
So Britain does a lot of tracking on our call data.
On our end of it, on our requests, on our calls, on our mutual aid to us.
I don't have financial data from Jeffrey, though.
Right.
But remember, this is CPA talking.
But that's okay.
No, no.
It's not a bad thing.
And it is.
Are you now, did you take Chief Dunnivan's position on the journal board?
Yes.
Yes.
So that stuff, I would assume, if we request it, they would provide that for us.
I would.
They would have to provide it for us.
I loosely have been aware of what their finances are as recently as around the time we were signing
the contract.
Are they audited?
I'm not sure.
That's a CPA.
That's a CPA talk.
And you're giving somebody $125,000?
Yeah.
And there are non-profit orders?
I understand fully.
I'm on board with you.
I'm on board with you.
The other aspect of that is, and I'm saying this is the non-CPA, okay?
If we're entering into this, if we're entering into this, if we see this as a potential medium
to long-term answer, every one of the key players should have the same information and the same
awareness.
Okay?
Okay.
Okay.
They make sure that all the doors are open so that everyone, nobody's going in blind.
I will say the one thing that, when we talk about this being a one-year, and we talk about the difference
of the equity concerns, my biggest issue through all of this is I want us looking through the windshield, not the
rear view mirror.
I can't, you've all heard me say too many times, I can't fit yesterday.
Whatever's taken place over the past 10, 15 years with this, about whatever the balance has been, is
relevant if we're sitting around having coffee.
It shouldn't be relevant as we look to what are we going to put on paper, what are we going to be responsible
for, and two, okay?
Because we want to be a good partner in this.
But to be a good partner, you also have to have the best information available.
And are they viable?
We wouldn't be able to get a straight answer out of them.
What's that?
We wouldn't be able to get a reliable answer out of them, because obviously they're an entity
that's trying to move on.
I mean, they're operating in an essence like a business, and their business is going to use
business development strategies and kind of maybe over-promise and then deliver.
It just is what it is, and that's not a comment specific to them, but it's a comment
to what we may or may not be up against.
Yeah, and that's why we're here, right?
That's 100% the reason why we exist in this position, is looking at that sustainability and
looking at the future for you as the citizens of this town are getting for transport services.
For me coming into this, my fear was, because this was right in the middle of this, right,
that we didn't have an angel of transport service when I arrived in the ranch, right?
Not what a fire chief wants to come into a town knowing that we don't have transport for you
guys to get to the hospital, right?
And the reason for that was staffing, mainly staffing.
No, that actually came out of issues that started last year with them not being able to meet the
expectations of the contract and providing a transport service to the town ranch, efficiently and effectively.
They delivered a letter, it was essentially an ultimatum, pay for...
We no longer have a contract with you.
Yeah.
Okay.
I'm understanding.
I was going to say, I was still M.O.E. with that.
Yeah.
It was an M.O.E.
Yeah.
Because that was early enough in the year.
And I can see that if it was a misunderstanding.
I mean, if they thought that they were going to get the whole pot of money, and then ranch
kind of wavered maybe a little bit.
Yeah, but again, I think that was due to a lack of capacity and capability for them to
provide a service to you.
So I know that, you know, when I drive by there, there are days where there are Great
Brook apparatus there.
Yes.
So what does that mean?
And are we paying, I would assume that Great Brook has some sort of arrangement with DARMA?
They're contracted with DARMA to provide additional EMS capabilities for transport.
So that's something they're working out, and I don't have the number in front of me, but
if they're from the meeting last night, they had 623, Great Brook had 623 billable hours
for April, for EMS services, for April alone, for April alone.
Wow.
Great Brook did?
Yes, ma'am.
So then I wonder, are they, you know, goes back to my question, are they viable?
Right.
I guess would be my...
Yeah.
And that's a hard, that's a hard answer for anybody, the answer, right?
Is the police department viable?
Is the fire department here in town viable?
Is the, you know what I mean?
So, it's a little different, it is a little different because it's a separate entity, it's
not a town sanctioned or funded agency, but we don't know that on the short term, right?
And again, I think that's what steers this, where we're at today, is because we don't know
that.
My fear is, I get a phone call at 6 o'clock tomorrow morning, it says we're out of service,
right?
And then what do I do, right?
So, I think we need to get ahead of that and start planning for tomorrow, because again,
Stan says I can't fix yesterday, right?
We need to look at what tomorrow looks like and what moving forward looks like down the road.
But isn't the elements of room to select one?
Yeah, I just wanted to clarify, those hours that grief provide service doesn't change the
contribution that we're in case to Jackford, or we don't have to pay them separately.
Nope.
Nope.
Our contract stays the same no matter.
Yeah, so they're not contracting to.
They're still contracted under Jackford, so Jackford is paying for all services that grief
are coming out.
Yes.
I have a feeling that people are going to want clarity on that.
No, no, you're good.
No, I appreciate that.
The best part of doing this, and the best part of being on here, okay, which we talked
about at one of our meetings is, more people are going to see it, more people are going
to hear it, before they read it on message boards, okay, and there'll be something to go
back to what did they actually say.
Sure.
What we're trying to do is make sure this has sunlight.
Yeah.
Okay, and there's always going to be a story, right?
But I would rather control that story from the get-go if we can, and that's why we're
here, and doing it in front of the public, right?
I mean, we're going to put back the elf in the room, as a result of the select board
to pay that bill.
I can speak to that.
For those that may not know, I mean, I feel like there was kind of two sides to every story.
I understood the select board's position.
I also understood Jarma's position.
They went under, I mean, they were just getting, Adam, who was very good, your director, was maybe
a month in place when all this was happening.
To some extent, you should scrutinize and say, hey, they were really not very viable for a while,
but on the other hand, you've got to let the new individual come and fill things up the way
he wants.
Yeah.
I ended up encouraging the select board to just opt in for it.
I think you did, too, because otherwise you were going to be without the ambulance service,
and I viewed it as an interim for sure the remainder of this year with the intent of the chief kind
of seeing how service was over the year before we committed thereafter, but we needed something
now at that time.
And again, build out that planning process gives us some time to kind of develop a plan
for tomorrow.
Here we go.
Here we go.
We have faith in you.
Here we go.
All right.
Just got to be mean with that.
All right.
Service options.
Do we continue with Jarma?
Where we're at today.
Do we consider alternative providers?
And again, do we look at the possibility of in-service, in-house EMS services?
So just a little bit, and this is an excerpt from an email that I supplied and I sent to
Adam.
Max has seen this letter.
This is what I sent on to there when I made the announcement that we were creating a committee.
I want to be very clear that this process is part of the long-term planning and due diligence,
and it is not a reflection of any dissatisfaction with the services currently being provided.
In fact, communication with Jarma and their staff has been great in my time here.
We value the relationship we have built with their organization and recognize the critical
role that Jarma plays in supporting the health and safety of our community.
Range remains fully committed to continuing our strong working relationship with Jarma.
We look forward to maintaining open communication, ongoing collaboration, and mutual support as
we move forward.
Their partnership is important to us, and we appreciate the professionalism and dedication their team
consistently demonstrates.
So we are working well.
The communication is well for the most part.
We're running calls with them.
Things are going well, right?
We have a working relationship, and it's functional at this point.
So I talked a little bit about staffing earlier.
There are three recognized roles in the state of New Hampshire for EMS providers.
The EMT, which we consider like a basic level.
The AMT is a little bit more advanced, and then the paramedic.
Range is staffed as an EMT-AMT level.
We do not have any paramedics through our organization.
We may have Brittany's husband, for example, as a paramedic, but he is not functioning as
a paramedic within the range fire department.
We don't carry the supplies to run at the paramedic level.
Correct.
There's a lot of medications that have extra requirements for them, and it's just, it's
not sustainable for us to run that way.
And licensure and other components, too, that are behind that process, right?
So the way we currently stand today is we are staffed to the AMT level.
For transport services, there needs to be a combination, two personnel, at a minimum, of
any of that combination between EMT, AEMT, and paramedic for any transport unit.
And is that a state?
Yes.
Okay.
Yep.
All right.
Some of you brought up in the conversation are alternative providers, potential for providers, right?
There are several other services in the area that do provide transport services.
Fitzwilliam, Peterborough, South Egan Valley, and Winchenen, but there is a problem with
Winchenen, and Brittany can speak on that way better than me.
It's a licensure component since then they're an out-of-state entity.
You've also got Cheshire EMS.
Okay.
Okay.
Cheshire County.
Yes.
All right.
Again, my apologies for that one, but yes.
Yep.
Again, so there are other options available, right?
Which is what we went with in Marlboro.
Okay.
So I've got that connection if you decide to ever want to go to that first.
I'm sorry, which one did you?
Cheshire County.
No, no, no.
Oh, yeah.
Oh, we were actually into that, actually.
We were with Deluzio forever, same kind of thing, and then that sort of inflated, and
so Cheshire County developed an ambulance service, and it has picked up all the towns that were
serviced by Deluzio, but they're far, you know?
I just want to add, I was extremely impressed with them.
Yes.
They were really great.
They were two and a half times the price of JARMA, but they were really great.
If you wanted quite a price of service only and not cost, that's where I'd go.
And when we, just real quick, and then I'll let you continue.
Oh, sure.
Well, when we were at that point, it was Cheshire EMS and Rescue One out of Vermont.
Rescue What?
Right.
Rescue One out of Vermont, and the thing with Rescue Inc. is the price, right?
They're like, this is what it's going to cost, and we would have to get all the towns.
And everybody was like, oh my gosh, oh, the cost.
And Cheshire EMS was able to come in at first, undercut everybody because they used their ARPA money.
And so, from a cost perspective at that point in time, it was cheaper to go with Cheshire EMS.
And now what we're finding is now that they're running their, the ARPA money is slowly going away, Rescue Inc.
had the right price from the get-go.
You know, so the cost of these services, and I'm sure you also saw in the mutual aid budget, that probably skyrocketed.
It did.
It did.
Yeah.
They're finding that, you know, a lot of these emergency services, they're great at providing emergency services as far as accounting and bookkeeping.
Not so good.
You know?
Yeah.
So anyway, if you do decide you want to talk with Cheshire EMS, you can get in there.
Okay.
Excellent.
Thank you.
I believe she's a good person to get on that.
Yeah, you're right.
She'll listen to you earlier.
We're going to see if she earns us first.
We'll see.
Can we go backwards for a moment, please?
Can we go?
Nope.
Say on that screen.
The screen you have.
Truly.
Let's go bottom up.
Okay?
Okay.
So we have licensure issues.
Yep.
The guingen.
Yep.
And the only reason, because these were the things that we talked about, and I want to make sure
that we get a few more of the facts out with it.
Sure.
There's not only licensure, but there is crossing the state lines.
Right.
Okay?
Which brings its own little bundle of joy.
Sure.
As the case might be.
Now, are they close?
I mean, I love where, if I was in Marlboro, knowing Marlboro, not quite as well as you, but
at least somewhat, boy, with Cheshire's foot, theirs is perfect.
Okay?
If that's her.
It's a pretty fair distance from us.
Oh, absolutely.
Okay?
Marlboro.
So, Peterborough, we already know that right now it's $1,000 every time their wheels hit
the ground.
That was part of the brouhaha last year about what amount needed to come out of the $40,000
that was added in the warrant article.
Okay?
South Aden Valley Ambulance, their nearest point to us right now, do they have a barn in New
Wipswich any longer?
They do.
They only have one.
Okay.
All right.
And it's near the high school, right?
And it's near the high school.
And it's near the high school, right?
Yeah.
Yeah.
Okay.
And they, who do they serve as besides New Wipswich?
Is it a bunch of towns?
It's not a bunch.
It's New Wipswich Greenville.
I think Temple.
I was going to say Temple, maybe Mason.
I worked over there for quite a few years.
Peterborough covers Temple.
Yeah.
And then Sharon, too.
Peterborough covers Sharon, yeah.
Okay.
It wouldn't be silly.
We didn't do Amherst.
It might be Mason.
No?
Okay.
What about Mason?
Yeah.
That was, we're on the same page.
That's a scary thing.
You know, since this was a big discussion that we had last time,
and what I was thinking, and I'm happy to at least start the template,
I would like us to create a spreadsheet that lists all the providers,
including Jarman.
Sure.
How many ambulances they have, where they're located,
miles to the intersection of 119 and 202,
estimated time if you're driving like a bad out of hell to get there, you know.
Yeah.
Like we have the numbers down and the other towns they provide,
so we can get an idea, like, in one place of all this data that we need to sort through.
Yeah.
You cannot have Paul start the spreadsheet.
Okay.
I know Brittany can probably fill it out.
Yeah.
Yeah, I don't mind making it and getting the data for it.
Okay.
And there was one other aspect that we talked about in some depth,
and that is there's only so many people certified to do this,
and every Paul is going to run from every Peter to try and have enough people to do this.
Sure.
And I think we're all well aware that there are less people going into intense public service positions
than there were even five years ago, let alone 10 or 15.
And the question is, you know, let's say that we were talking Fitzwilliam.
Does Fitzwilliam have enough people to cover, to add us?
Right.
Okay.
I'm feeling that little primary stuff here.
Okay.
Yeah.
So when we look at who the other services are, I agree with you about the equipment.
But to me, the most important bit of equipment is personnel.
Yeah.
Well, that should be on the spreadsheet, too.
Stop it.
So sustainability is huge, right?
And I can tell you for us right now, I have two lieutenants who are career or soon-to-be career firefighters
in other jurisdictions that are moving up, right?
So just sustainability on our level to maintain a service, right?
Again, paid on call is great, but it doesn't pay the bills, right?
And when a lot of us, someone who was a little bit older, started this,
one single parent in the family was working.
That's not an option anymore, and we all know that, right?
And so if both parents are working, it takes away from that capacity capability for that call member
because he or she has that full-time job, right?
And you're going to go where the business is.
You're going to go where the funding is, right, to provide for your family, right?
The other question I've got is, and I don't know this,
but what is the relationship with the hospital that you're transporting to?
You have some sort of MOU or something with Monadnock.
Yep.
They are our medical resource hospital.
Okay.
So, you know, like Fitzwilliam, would they go to Kean?
Yes.
Okay.
So is that a problem?
It could be.
So right now, if we have a call and we use the supplies that Monadnock would restock,
we can get them from Jeffrey Ambulance,
and then they can get them restocked from the hospital
because we share the same medical resource hospital.
Otherwise, if their ambulance was coming from somewhere that used Kean,
depending on what their medical director decided the rules were,
they may or may not be able to give us supplies because we're not part of their system.
And would there also be an agreement to transport RING people to Kean?
Just say you went with a Fitzwilliam or a Cheshire EMS or some response unit that goes to Kean.
Is that a problem for RING?
No, typically.
It shouldn't be, but they would default to going that way.
So unless you spoke up and said, no, I want to go to Monadnock,
they would generally go to their hospital.
We transport to Haywood.
RING is pretty much equidistant from Monadnock, Cheshire, and Haywood.
It's just that you're tied to Monadnock with the supply.
And that's where our medical director is at.
So that kind of the steers are capacity and capability to function in the field.
So there may be difference in practices, if you would, between Monadnock and Cheshire.
And what about Stauhegan?
Is that Monadnock as well?
They didn't transport just Monadnock?
Yes, they are Monadnock is their medical resources.
Yep.
That's just Peterborough, obviously.
Thank you.
Good well?
So, Bob, one thing you didn't say.
How many staff do you have?
So we're at about 25 right now.
They're certified as EMTs.
Ish.
Right?
We're working on that.
I've got some, a few that are fire only.
I've got some that are EMS only.
And I've got some dual certifiers.
That's an important question.
It is.
Right?
Because, again, the licensure and the certification process for that is pretty timely.
Right?
I agree.
And we have a, we set up a program in town with the department that we will pay for you
to go to class, right?
But you, we get a contract out of you.
We get some time out of you after I pay for you to go to the teaching.
Oh, that's the law.
Right?
So, and then we'll also pay after we get, you get through the program six months, we will
pay for half of the time you spent in class.
And after a year, we will pay for you either for the remainder of the time you put in class.
Right?
So, again, it kind of benefits you to stick around for a year because I'm going to pay you
for your button C for that time in class.
Gotcha.
Makes sense?
Yeah.
All right.
Yes.
I agree.
Same thing.
Scary.
Right?
It is providing our own services.
And, but again, something we have to think about moving forward.
Right?
We would need a minimum of two ambulances.
And why, why, chief, why do you want two ambulances?
Well, when this one breaks down, I have a antifreeze leak, right?
I need another ambulance to put in its place.
So it doesn't necessarily mean that I'm going to put two ambulances on the street at a given
time, but I need something to back up this one if something happens.
It gets in a car accident, 119-202.
I need something to have in its place.
Routine maintenance.
Yes.
Routine maintenance, right?
Equipment.
Again, you know, looking at, it's not just buying an ambulance, a box and wheels on it,
right?
It's the, it's the equipment on it, the stretchers, the AED, there's all the other components
to do it to keep that in place.
When you run an ambulance, there's a state list of supplies that are required to be on
the ambulance.
So you can't be, your ambulance won't be licensed if you don't have all of the things that the
state requires on your ambulance.
And they're probably inspected annually.
I hate to scare everybody, but as we have discussed this previously, gee, we're going to, we're just
going to talk about one ambulance for the moment.
We'll all multiply afterwards.
From the time you begin the RFP till the time that that unit shows up is going to be one
amount of time right now.
And so I'll get to that, but we're looking at 18 to 24 months, easily 18 to 24 months.
And I'll get into numbers here about putting bodies in seats just to stop in ambulance here
momentarily.
I'm really glad you brought up the 18 to 24 months for those, for those folks who are particularly
out there going, oh, you can just do this, you know, when, when Mike's trying to go get
a truck, you know, or the fire department looking for a truck minimum is 12 to 18 months.
And there's only so many companies making them and they have a list out, both of their arms
for it.
I know how hard it is to do deliveries in my particular industry right now.
So if somebody tells me 18 to 24, I'm thinking 24 to 30.
I was going to say three.
And the numbers, right, has drastically increased, right, for the cost of this stuff.
COVID really put a stranglehold on much of the market, on apparatus, on equipment, on supplies,
on resources that we have not recovered from.
And we probably will never recover from.
So you pay with police?
100%.
Yep.
And then the bigger, even bigger is that billing and admin component, right?
Most resources will outsource that billing component.
And if people think this is going to be a money-making, you know, cash cow, you bumped your head, right?
Most of these services make enough money to sustain at best, right?
If they even make enough to sustain their process, right?
Because you don't have to pay, right?
You know, we're not going to execute you in town common because you didn't pay for transport to the hospital.
I'm not paying that bill.
Then you don't pay.
They'll go after you.
They'll try.
But you can say no, right?
And we don't take that into consideration.
On top of that, look at your other billing entities for older people and stuff like that.
You're getting pennies on the dollar for these services, right?
What about if, say, that I'm having a diabetic episode and you come in and you give me a, you know, candy bar or whatever,
and I say, I'm not going to the hospital.
Do you bill me for that?
No.
Right.
Right.
Billing is based on miles.
Right.
So, you all show up at my house because you don't have any idea what's really happening.
Right.
So, you've got the apparatus.
You've got the people.
And they're also taking that time away from other people who may also have an emergency.
And there's no revenue from that.
And it happens all the time.
So, I heard a story today.
Helicopter picks up a patient on the top of Mount Monadnock.
Brings him down to street level to put him in the EMS unit.
The patient's like, I'm not going to the hospital.
What do you mean?
We just took, yeah, I'm not paying.
So, refuse to pay the helicopter service, which is not a cheap, but pretty, you know, that's a pretty penny there.
And then you'll go to the hospital.
Right.
So, there alone, you can make that decision.
I can't force you to go to the hospital unless you are not able to make a rational decision on your health care.
Right.
Then we can get the police involved.
And that's a whole other component.
But again, that creates another issue.
Right.
For your list, we can find out from any, since you were just talking about the truth, you know, you can't get people to pay.
It would be very interesting to know what percentage of the calls as they go out on people reject going.
Sure.
But also, how much of it is bad debt as well.
Yeah.
Because, as you said, when people are looking at it and seeing how much money is going to come in.
And I'm going to say, let's say that, because the last time I think we kicked it around, and I'm going to count on you two, okay, because I think it was just before you joined us.
I thought when the town was talking about it, we were thinking it was costing somewhere $225, $240.
Max, your timing is perfect.
You're asking about the proposal?
Well, the cost, last year when we were, not last year, excuse me, earlier this year when we were talking about the balance of things.
And part of it was how many calls are being done in Jafferty for the amount that they donate and how much was being done in Ringe.
$225, $240, $250, somewhere in there.
Is that what it was thought that the cost per call was?
I can't remember that.
I remember the differential in call volume was basically like a 60-40-ish.
Yeah, yeah, yeah.
It was like 39 maybe even, but it was about 60-40.
It varied some, but the 60-40 seemed like a very fair figure to work with.
Yeah.
Okay.
And you're saying the cost per call is like $240, $260?
Oh, oh, oh.
You can't get an appliance guy to come up.
What it was averaging or what it should, what it really is, subsidized?
Okay.
What it really is.
Like from other companies as well?
Well, sure, okay, and that's something we can get to that, but I think without that part of the picture as to where we actually are right now.
Yeah.
Yes, we've made that donation.
We break it out over the calls.
But like I say, I could be wrong.
Oh, that's how you're coming up with that.
That's how I'm coming up with that.
Paying for calls, not what you'd call cough.
Correct.
Because when it would somewhat, you know, it used to, they are, I will say this, genre is being much more transparent about the amount of calls per town.
I'm seeing it even on Facebook and things like that, and you're like, okay, that's good.
I'm glad that that's out there, particularly as we're to this point in the discussion.
And I think the 60-40 is a fair way to look at that.
If we are at the 60-40 and for the 40%, it's, like I said, 225, 250, 260, whatever that amount may be when you break down across the call.
If that's considered bad hits 45% of the time, then really those calls are almost twice as much.
Because, you know, what is the actual amount for the ones that they're getting something back from?
Knowing that Medicaid, as you say, pays pennies on the dollar to the real cost.
Sure.
And, of course, the pregnatures are only a couple of pennies more than that of us, okay?
And, you know, one of the things we did talk about quite a bit was, I remember somebody saying, you can't fix yesterday.
I'll try to remember who that was.
When it was the VFW ambulance, okay?
And they put out a letter.
They got almost enough money back to do it, and then people made contributions and all.
You always saw when Kenoyers had the OBIT go out that it was either flowers or in lieu of flowers.
Contribute to the VFW.
Contribute to the VFW.
Yep.
Okay?
Yep.
And that was great in 1975.
And it was great in 1995.
And maybe 2005.
But that's not the kind of thing we see or hear being done an awful lot now.
And if you try and build that as one of your pillars, you don't have a real strong foundation.
So I would really like it if we could get that from our partner that we're working with right now, and if we can find that out from some of the others as we do the spreadsheet, I think it would help to look and see what they consider their cost per call.
So we're saying the real cost, not just our contribution.
Correct.
Right.
Is the intent of the spreadsheet to basically just list out all the options?
Yeah.
And track all the data in one place because we keep rehashing it.
I see.
Okay.
And it's the data that almost everybody wants to see to be able to have a meaningful discussion of the issue at hand.
You can't have it without it.
Yeah.
At some point, we'll have a room with a lot more people in this, no matter what direction this all goes in.
Yes.
And we'd best have something that we can point out to be able to say, we did the research that we could.
Here it is from at least two or three entities, hopefully more.
I only asked because if that was where we were listing options, I wondered what, how then we would account for the option of if we think that Jaffrey is eventually going to take this in-house and we know that because they're building the bays with the sleeping quarters afterwards, then how would we account for maybe the likelihood that we propose just actually, so JARN is gone in this scenario,
and now we just jointly administer these together with Jaffrey.
And I think there's going to be more of a likelihood than people think for an outside for that.
Yeah, I think we're going to have a chance about if we have all the data, then we could list maybe a series of comments or concerns about the things that people would want to know about that particular service.
I think it's like Jaffrey is currently staffed by Grapebrook, 50% of the time.
So Jaffrey Fire got the funding at town meeting.
They are currently adding on to their fire station to add that capacity capability in the field.
Ambulance.
Correct.
Two.
Don't know a number yet.
They're adding on.
They're adding on bays.
Bays.
They haven't done anything with ambulances.
Correct.
But again, that's pre-planning, right?
That's looking down the road to the future, right?
Yeah.
Because the question is, if not now, when?
Right?
Right?
Right.
Infrastructure needs.
We talked about that minimum of two ambulances.
Proper storage.
Facility temperature control.
Obviously, that can't be an EMS unit with medications and drugs on it outside, right?
Possible station expansion or new build.
Equipment and staffing investment.
What's that?
That's going to go over like 11 years.
Oh, that's why I don't make that thing.
Yeah.
Again.
How long have been talking?
Yeah.
Again, that conversation, right?
Apparently came up a number of years ago where there was a...
It's come up a number of years a number of times.
Yeah.
To build another public safety complex, right?
We'll call it for a lack of better terms, right?
They lose their minds.
Yeah.
Yeah.
Is this being recorded?
Yes, ma'am.
Recorded and live.
We are live.
There were a few cents of coffee that just went down people's throats.
Yeah, sure.
We're all living rooms and kitchens right now.
Well, it's good to get the information out there.
It is.
And most of you have probably already heard this conversation, right?
In the past, where it's come up.
Absolutely.
And it's going to come up today, obviously.
And it's going to come up next year.
It's going to come up the year after until, you know, something's going to change, right?
The infrastructure, commercial and residential, is growing drastically in the town and range.
Exactly.
And I can tell you there is another subdivision or a development getting ready to go in, which increases the number of bodies.
Yeah, that's another number we need to track.
Right?
New buildings approved for construction and buildings.
But again, the infrastructure in town, our core infrastructure needs to grow to be able to support the infrastructure.
Unless it's not going to support it.
And we no longer have impact fees.
Is that correct?
Right.
That is correct.
That used to be able to contribute to some of that stuff.
Somewhere that fell along the wayside.
It did.
They voted it down in 2017.
It was shocked when we didn't have it here.
They wanted to post it again in one article.
But then I was assured that such one article would be voted down.
I tried.
We tried.
So 2017 it was voted down?
Yes.
Took three years.
Oh, it was on three times.
Took five, I voted down.
Well, I don't know if it was on three times, but it was in the planning stage for three years.
Okay.
It was finally declared a tax, and that's why it was voted down.
So looking forward to being one of the two most popular people, I'll ask an unpopular question.
What about a number one?
I'll make you number one.
Thanks, bro.
Jeez, what's the cheap option out of all this?
There isn't one.
There isn't, yeah.
Okay.
There really isn't.
There is not, there are options to potentially control some of the costs.
What there is not is a lesser cost than we're currently at.
Right.
And there is not an inexpensive option.
Right.
And that cost that we're at, it's only going to get bigger.
Well, speaking of that, sir, I'll let you move on.
It's too bad that Tom didn't buy a personage.
All right.
So I'm going to start talking a little bit about staffing, if we were to go that route.
For a single ambulance operating 24 hours a day, seven days a week, the minimum of staffing depends on the following.
Number of personnel required per ambulance.
The shift schedule.
Vacation and sick coverage.
Training and administrative time.
And overtime tolerance.
Chief, is, would that be a 24-7 person in the facility ready to go on call?
Yes, ma'am.
Persons.
Yes, so, so again, minimum of two, right?
So the basic formula, right?
The 24-7 position requires approximately 168 hours per week, right?
So 40 hours per week per employee, which is the, which equates to about 4.2 full-time equivalents, okay?
So one staff ambulance, one staff seat on the ambulance is about 4.2 FTEs.
I'm going to get a little bit into this.
Two staff seats, again, a driver and an attendant, is about 8.4.
So that's basic math.
I'll get into this a little bit more.
Which you need in order to transport.
100%.
Yeah, I need a driver and somebody to be in the back physically taking care of you as my patient, right?
But your driver also has to be licensed, the licensed medical provider.
Right, so they stop on the side of the road because now it's an individual with cardiac arrest.
It's just not the dude that we picked up at Walmart, hey, you want to drive an ambulance for tonight, right?
We have to have somebody certified, trained, and qualified.
Touche.
All right.
So, again, a little bit more on that.
The build-out usually needs more than theoretical minimum because of vacation, injury leave, sick time, training time,
mandatory certifications, court appearances, and burnout reduction.
All right.
So, that number turns out to be between 10 and 12 providers to reliably staff one ambulance 24 hours a day, seven days a week.
All right.
This assumes two-person crew, again, minimal overtime reliance, and sustainable operations.
So, 10 to 12 persons to staff one ambulance.
How many full-time providers does JARMA currently have?
Do you know?
None.
None?
None.
They're not full-time.
Everybody's all the time.
So, they do staff their station, but nobody is a full-time employee.
They have two EM ambulances from 8A to 8P, seven days a week.
So, what is the preference for DM that they just don't have the money for full-time, or could you explain why they went that route?
For DM employees, you don't pay benefits for them.
You don't pay insurance, vacation time.
They're basically...
Contractor.
Yeah.
Yes.
Yep.
So, if you're going to go to the full-time route, then you have to look at, you know,
all of the other benefits that come with me, the full-time employee.
Retirement system.
Yeah.
What happens between 8P and 8AM?
Same thing as Orange Fire Department.
Beep, beep, beep.
Ambulance and engine, or ambulance and rescue.
Yeah.
And they respond in from home.
And you said last time that the majority of calls come between 6AM and 6PM.
Generally.
Generally.
Yeah.
Okay.
Yep.
That was news to me.
But it makes sense.
Because half that time, people are sleeping afterwards.
That's true.
Right.
Yeah.
All right.
Some financial considerations.
Start-up costs, vehicles, equipment, staffing.
Obviously, a building would be a big one.
Ongoing operational expenses, salaries and insurance.
So, with that being said, some potential funding options would be warrant articles like you guys
brought up, regional cost-sharing, grants and donations.
And Dan, you brought up a term that was new to me the other day, and I'm drawing a blank.
Another means of funding.
Dan's drawing a blank, too.
Sorry to fill that one out.
That's okay.
It was a genius.
I, I, I, I, I, it must have been, do you, do you mean that, Dan?
No, no.
Okay.
I'll try to think back to the conversation.
There's something that we, you guys brought up, and it, and I, um, it slapsed at me, and
I couldn't think of it, that's why I didn't put it on the slide, because I couldn't
think of the term, but I never heard of it prior to life.
Well, there was a time when Jarma had a big, like, pledge campaign.
Sure.
So, you just didn't get a donation, but you pledged to give that same amount for five years
in a row.
Sure.
That was pretty successful.
Yeah.
Was that more sort of purchase an ambulance, though?
Or, whatever they felt the need.
I don't remember.
I think it was just...
So, those are good, but they're not sustainable, right?
It happens at the end of five years.
I mean, I'd hate to pay salaries on a pledge.
We started over again.
You know what I mean?
So...
Yeah.
It's just another source of money.
Yeah.
No, no, definitely.
Yeah.
But wouldn't that only work if it's a non-profit?
It was a non-profit.
I know, but this wouldn't be a non-profit.
Right.
If it's a town sanction function.
It could be a non-profit.
I was just going to say 501c3 for the side stuff, but no, I mean, it's an awkward area.
It would not be a four-price.
The Bridge Firefighters Association.
Yeah.
Right.
Instead, the library has friends of the library.
So, there's ways around.
So, the initial target by the Board of Selectmen was to have a response by July.
Yeah.
Let's have a conversation in reality, hopefully, November, for a full report for this process.
Hopefully.
Right.
And that's also cautiously optimistic.
Right.
Ongoing public engagement plan.
Again, I would like to do multiple easy as we proceed forward.
So, we're looking at that.
So, what have we done so far?
Right.
We began the regional outreach for cost comparisons.
We're beginning to collect call data and response trends, reviewing staffing and certification levels, and identifying system strengths and the gaps.
Key findings.
Again, EMS systems are costly and complex.
Germa is currently our most cost-effective option.
Again, we talked about it earlier.
The disproportionate call volume in Jaffrey.
And the increasing demand will impact future services.
Our guiding priorities.
All right.
Coverage.
Reliable response times.
Control.
Location decision-making.
Cost is responsible or responsible use of taxpayer funds.
And then quality, we want to provide the highest level of care.
What's next?
Continuing collecting of that data for analysis, for any engagement of our regional partners,
and development of the detailed cost comparisons, and then preparing that final recommendation.
So, here's the two big questions.
What are the determining factor or factors for you as a community to find what the threshold for failure is?
And how do you as a community determine that your needs are not being met?
Again, that's something that I think is important for where we stand and where we move forward, right?
What does failure look like in the service, in the system?
So, in my mind, this would work very similarly to a water fund or a sewer fund.
It would be our business, in the system, where we move forward, right?
It would be its own little enterprise fund.
And so, what we do for those types of systems is we do what's called a level of service workshop,
where you all would sit down and say to yourselves, you know, what does the community expect?
You know, do you expect, you know, to a certain response time?
You know, what are the criteria?
Is it a certain hospital?
Is it a certain response time?
Is it a...
What are the criteria that the people in town are looking for, for their emergency services?
Yeah, so the response time is huge, right?
Yeah.
So, in ranch, right, again, 3 o'clock in the morning tonight, tomorrow morning we get dispatched for that call.
People are coming in from home, right?
So, typically, we're getting on scene pretty, generally before the other resources.
Yes, yes.
Generally, okay?
How long are you willing to wait for the ambulance to show up?
Is 25 minutes a reasonable time to wait for a transport unit?
Is 35 minutes a reasonable time to wait for a transport unit?
That sounds like a survey to me.
100%, right?
Because, again, the reality is 25 or 30 minutes isn't out of the question, right, for a transport unit.
Plus, because you have your own people on site sooner.
But there, but, and not to say there's anything wrong with just an EMT or advanced EMT, but there's just that level of care that you can give.
But not every truck will come with a paramedic.
Correct.
Not.
That's not guaranteed.
Right.
Yeah.
So, I think that that's even more imperative.
Whereas, if you had a paramedic, and that paramedic was able to go in, in like a, for example, Cheshire EMS has a, um.
Flight.
Of course.
A cheese boat.
Yeah.
And they dispatch that, that person out.
Yeah.
And they can get there, and they can do some more advanced stabilization.
Yeah.
Which is done, you know, while the ambulance is coming.
Yeah.
Um, I don't know if that would be something that would be an option for.
Sure.
And again, that's something to look at, right?
So, we call them chase cars, right?
Generally, a paramedic.
When I came from Montgomery County.
So, I don't want to speak for this reason.
Right.
All the flyers.
Right?
Yeah.
Right?
So, there's different terms, same, very similar concept, right?
You have a paramedic, uh, provider in a vehicle that comes out of an entity and is able to
meet you on scene to provide higher care for the patient on scene until a transport component
can get there.
Correct.
Right?
Um, yes.
Do you have the data and the response time on it, Jack Reed?
So, so.
Hypothetically, eight o'clock, make it midnight.
What's the response time to having people there getting to a patient?
Do you have that data?
We do not.
I don't have it in front of me, but I have the ability to get it.
Yeah.
That, I think, would be important, too.
And I think, and I think that varies drastically.
Of course, guys.
To keep in mind, right?
I can't guarantee, or I don't think anybody can guarantee you 20 minutes, seven days a week,
you know, AP to 8A, right?
We've got to talk about where we live.
Yes.
That was going to be my next question.
So, like, response times here are not going to be equivalent to what they are in a big
city where you're going.
Sure, I'm looking for that.
Right.
Right.
But, you know, when we're talking, you know, 20, 25 minutes, 30 minutes, you know, what is
acceptable, you know, if someone lives on Wellington Road, they have to get out of bed, drive
to the station, and then, and then, and then, yeah, no, but I think, so, but even in town
providers, for us to get from our house to the scene, it's easily 15 minutes, most of
the time.
Yeah, you can't get anywhere, that's why I transported him, that's why he transported me.
Yeah, but I think, again, and you guys have been around for a minute and kind of know the system
and the way it works, but for people who aren't aware of that, or the people who move here from
Boston, right, because it's nicer, it's quieter, it's all a bedroom town.
Right.
Yeah.
Right.
100%.
People who come from bigger cities, they're expecting less than 10 minutes to have an ambulance
at the front door.
Again, I fully understand.
But that's not here.
Yeah, yeah, yeah.
But my point was, do you have numbers on how long it takes JARMA to have people to the
station pick up the ambulance and get to a patient?
We can get there.
That's important information.
Yeah.
Yeah.
I don't give you a baseline of what it might be here.
Yeah.
I'm guessing that Jaffrey Ridge has to come, what, eight miles from Jaffrey to here.
Right.
And wherever they go in the town of Ridge.
Sure.
Do they have that rule where those who work for the ambulance have to live within a certain
distance now?
Yeah.
For a time?
So you can have somebody who lives out in, like, your borough or wherever, on call.
Yeah.
But to be fair, everybody's having such a hard time recruiting.
If they decided they're going to put another hurdle like that in?
No, I get it.
I get a provision where people can stay in town who live further away.
I don't know the details of it.
But I know they did have an agreement with the local hotel or the Bible camp maybe to have people be able to use a room that lived, you know, in Kenan or wherever.
So that way they could, because they can't sleep in their station.
Right.
They're going to go out to.
This is a two-part question.
First part of the question, because it was kind of floated around the idea of the call staff side of Jaffrey covering our calls at night.
The first part of the question is what percentage of their, or actually they are doing per DM staffing at night even though they can't sleep there,
but they still put people to staff the station there some nights, correct?
They are working on, they're moving towards 24-7 coverage,
but I don't know what percentage of the time it's being realized.
The other part follow-up question to that is, of the nights that they are relying exclusively on on-call coverage,
what percentage of those shifts go completely uncovered?
That's a good question.
Yeah.
Sit up here.
Yeah.
Yeah, no, again, that's the data that we can collect, right?
And that's just a matter of phone call and working on capturing that information.
As far as I know, they haven't been completely out of service since they started working with Great Brook around Thanksgiving.
Prior to that, they were out of service pretty regularly, but the agreement with Great Brook was to help.
And Great Brook during those nights is still posting a truck at their station,
which means they still have paid people staffing something they're not relying on on-call.
Yeah.
Yes, when Great Brook covers Jaffrey, they are parked at the Jaffrey station.
They are not coming from Hillsborough.
There was something that had come up in one of the earlier discussions that I'm really not looking to kick over on its nest,
but I can feel my foot and I know where the nest is.
I said there's no cheap option.
Sure.
There's no specifically inexpensive option.
And I'm going to keep saying we can't pitch yesterday, but I want to go a little bit backwards.
We talked about it being $40,000 and then going to $80,000 and $125,000.
I know we had discussions about where we see Jaffrey, where they are projecting what they would be looking for for a donation coming up.
They've given that number?
Yes, it's about 211 or 214.
Yeah, I was going to say, I remember 211 rings available.
Yeah.
Yeah, ish.
Yeah.
For the services that...
As they currently stand.
Yeah, with the intent.
And that might be the 24-hour coverage for a truck.
But again, we'd have to get more finite...
But that number is, again, just there alone is increasing, right?
Are you saying that's for 2027 or are there...
For our upcoming January 1st, 27 through December 31st, that's their preliminary number.
I would expect after their fiscal year closes in a month or so that they'll really be thinking and then it may end up more than that.
I really do think that they probably are underpriced with the market because I went through the process of speaking with everybody else four or five, six months ago.
And they are underpriced, I think, yeah.
Yeah, that's pretty accurate.
But again, look at that number, right?
Okay, so that number is basically, okay, 100K, 75,000 to 100,000 more than where we're paying today.
With a special warmer hour to do that.
Now, when I kept saying there's no cheap, there's no inexpensive option, okay?
It's not going to go down, no matter what option we all end up choosing, okay?
Or asking others to help choose, okay?
It's a case of how do we, and I know the word control can be a...
You can only control these costs so much, okay?
Because there's so many outside factors that are involved.
But, the greater part of it that's here does mean that we have a little bit more say in how the operation takes place.
But the thing that jumped at me when you went to the FTEs, okay?
And I just want to make sure that I have this clear in my mind because I know I'll get asked about it now.
I saw 24 FTEs were going to be required if we were going to do 24-7.
So, if you had two trucks, you wouldn't necessarily staff both trucks 24-7.
Okay, then can you use 18 then?
Halfway between 12 and 24?
You could.
Yeah, you could, eh?
I'm not trying to overreach.
Yeah.
You currently have how many people, period.
Not whether or not they're all certified for that.
Yeah.
How many people do you have?
About 25.
What are you paying them an hour?
So, that varies, right?
I started about a 17.
17 is the lowest.
Is the lowest.
And what are we, about 24?
It's a high end.
25 is probably the top of it.
Right?
Right?
Didn't you say you're losing two?
Yeah.
So, when we talk about, you know, how all that's going to play, you would need more bodies.
Of course.
Okay?
And not two more bodies.
No.
The people we have now, they all have full-time jobs.
So, those aren't going to count towards your 10 to 12.
Yes.
18 full-time people.
Yeah.
So, since it's on the topic of the full-time staffing for if there was an ambulance coverage,
if you guys are interested for it, I don't know how much you've looked into other towns
of similar size, I do have copies of two town reports, fire department budgets
that are similar size, around two people, 24-7.
That was interesting.
Yeah.
You cannot bring, do an in-house ambulance unless you have a bigger facility.
Okay.
Okay.
If this board of selectmen is still going to refuse to entertain the idea of, I'll say,
of pulling out the plans that were paid for by the taxpayers and putting them out on the
table and having the current chiefs take a look at it.
And pair it down to what you need, not the Taj Mahal.
which it wasn't to begin with.
Does it?
I thought I just came up with that.
No.
No.
No?
No.
Okay.
Okay.
We're going to be discussing it.
You're going to be discussing it.
Yeah.
I don't have the station to put an ambulance in it, as it says today.
So if board selectmen is going to have to make a decision, will they or will they not entertain
a public safety building?
That's the question.
If they say absolutely not, then take in-house ambulance right out of the office table.
I think if people understood the cost of running an actual ambulance service, it would be more
than contracted with an underserved service.
Absolutely.
Like, hands down.
Mm-hmm.
Peter Morrow just bought a brand new ambulance for upwards of $400, $450.
Amherst just bought $200 for over $600.
Well, but our basic premise is our best option is drama.
Mm-hmm.
Right.
Okay.
We don't want to put them on our business.
We do not.
The fact that they have underfunded themselves, they're going to have to do something about that,
their business model.
Right.
But I think it's good to look at all the options so that people can...
Make it informed and educated.
Yeah, I mean, so I still think we should keep the, you know, have our own service on there
so that people really know what that cost would be.
If they say, well, I'm not paying Jaffrey Ringe $200,000, well, you're going to pay a lot
more anywhere else, probably.
Right.
You know, so...
What would happen if Jaffrey did wind up taking on the ambulance?
What would happen to Ringe?
We could absolutely, I'm almost certain they'd be willing to entertain having a joint venture.
Okay.
Yeah.
It would make sense to go ahead.
It would make, it would be, right.
It would make too much sense not to look at it.
Sure.
Now, thank you, both of you, for something that you said that I was really hoping to hear
tonight.
And I want to repeat for those of you out there.
It's up there.
Yeah, I know, but I was watching over there.
Oh, in the air.
Nobody in the room, at least as far as I can tell, is looking for Jaffrey to go away.
No.
No.
Okay.
A healthy Jaffrey helps a healthy Ringe.
Yeah.
Okay.
And, again, you know, before you got here, an MOU, I've always wanted a contract to be fair
to both sides, okay, to be realistic for both sides.
And I think it's pretty obvious that the rates that have been paid may not have been realistic
for both sides.
Sure.
Do we need to look at the 60-40?
Absolutely.
Yeah.
Okay.
But I think that even just with what we've talked about here, as you said, underselling,
okay, and part of that is also not just what they get from the towns, whether it's a payment,
a donation, whatever the case might be.
That's why I'm hooked on what's the bad debt, okay, that never, ever comes back, because that
immediately goes and eats at the bottom line.
And, you know, the part that you put up, I have a friend in the medical profession who has
said that the thing that causes them to not want to be in the profession is how much time
their staff and they have to spend dealing with insurance companies, okay?
And it's just because of the way the system is.
It's not the good old days where Ross and Lisa were over there, okay?
Right.
All right.
Yeah, I'm going back a little too far.
They have a cat with you with me, aren't you?
I'm sure.
We're waiting.
All right.
So you two are too young.
But it was a different world then.
The world we live in, okay?
If you don't have an effective system for doing that billing and then dumbing what you can afterwards.
Sure.
Okay?
If you're not getting 30, 35, 40% of what you're billing, you have to make it up.
Yeah.
As you're talking about the spreadsheet with all the data, which sounds the best idea, but
I think it should be specific for Grinch.
Grinch is data.
The number of people that have used the service, whether it's over a few years.
The amount of uncollectible for Grinch calls.
Refusals.
I think refusals is a huge piece.
Not just here, but I think it's a huge piece here.
Totally, but I think any of the data that you put together, you need to do specific for Grinch.
Sure.
In hopes of having better people have a better understanding.
Yeah.
The other thing that's really important to understand is that this is not just a JARMA problem.
You know, a lot of the emergency services in Cheshire County, like we've been seeing with
the ambulance and mutual aid, like I said before, they're just finding that what they have been
charging the municipalities just isn't enough, and it hasn't been enough for a very long time.
So there's a giant adjustment going on.
And so it's not just this particular ambulance service.
It's just, you know, it affects a lot of these services.
Ever since COVID, everything's gone through the roof.
And, of course, gas is really expensive now, too.
Right.
And diesel on top of that, right?
So, again, that's another thing to look at.
But the ambulances run on diesel?
Well, most of them are gas, but there are diesel ones out there, right?
So, again, just things like that to consider.
Yeah, I mean, all costs are...
Yeah, like financially, they're only getting higher right now, right?
Yeah.
When I heard 80,000 and over 40,000 to cover a community...
Of over 6,000 people.
Yeah, I mean, I can see why they got in trouble sustaining the service.
Sure, 100%.
How many people on Jaffrey?
Less.
I want to say, if I thought it was about 65, 57 or something like that the last time.
Are we counting the school or aren't we counting the college?
It doesn't mean that all the way.
Exactly.
That's always been the question that comes up as I say, are we counting F.U.?
And if so, that number is geographically.
There's not 850 students now.
And there's other things, like, Jaffrey has a nursing home.
And they're building a lot of housing.
In Jaffrey?
In Jaffrey.
Stand by.
We're getting those going too.
There is one thing regarding the screen that you have up there.
Yes, sir.
The second question.
Could we either add a second part to it or make a third question?
Sure.
We're saying, how do we determine your needs are not being met?
How do we determine your needs are being met?
Sure.
I think that's going to be in a survey, right?
I'm going to do a survey about what people expect.
And what they've experienced.
What have they experienced?
Yeah.
Two, I would think, right?
Yeah.
I mean, it's hard to wait.
I mean, I'm sure that a lot of you know, I know, it's hard to wait.
Yeah.
Is it acceptable?
It's going to be different for different people, I suppose.
Well, as Judy said a few minutes ago, when I had my two heart attacks, she took me to the hospital.
Yeah.
I know.
And you took me to the hospital.
Yeah.
I've been in a situation where I've called my husband to the hospital.
And then we get a bill after I was...
The helicopter.
The helicopter.
Why didn't you get a pre-authorization?
Yeah.
That was a conversation that I just was incredulous.
You need to pre-authorize a helicopter.
Please tell me who at 2 a.m. was at Blue Cross Blue Shield in New Hampshire to authorize that helicopter.
Okay.
And then, just to add on to it, the helicopter was very dunny while she was still in the ICU for payment.
Wow.
17 days in the ICU, and they were dunning me for payment for the helicopter plate.
Yeah.
That's crazy.
I'm thrilled dunning just came up twice in one meeting.
You know that name.
I'm well-spoken.
I'm well-spoken.
You are.
You're well-spoken.
I'm well-spoken for, too, this year.
How-what was the-I know the police department just did a survey not too long ago.
What did they get for percentage of residents responding?
Do you know?
They got about 70, around-above 70, less than 80 people responded.
That's right.
That's not great for our population.
How did people respond?
Did they go online and fill out the survey?
Oh, yeah.
There was paper that was given in many places.
They had online.
They distributed on Facebook and other means.
Maybe they've been on our website here for a while.
And they even did, like, QR codes you can scan that were posted somewhere, too.
I wonder how they could get a higher number.
Were you on the higher interview?
You were the assistant moderator for a while.
14 years.
Is there something that could be done at the primaries in the fall?
Somehow.
Someone that's apolitical.
A table.
It's outside of the polling place.
It could be in the hall.
Could you have a table asking people?
It would be better if you did it outside like they do for the after-voter surveys.
You know, people can't say how to vote for the poll.
That would be totally okay to do a survey that way.
Yeah.
Yeah.
Good idea, everyone.
Because although the...
He's playing on you.
Although the primary, at many times, is not a well-attended election trigger to other...
It's more than 70 people.
Yeah.
Yeah.
Yeah.
But...
Well, I mean, we have more than one way to get that data from people.
Yeah.
But that's a good idea.
Hmm.
I don't think about it.
Yeah.
So our commitment as a committee to you as a community, right?
We're going to transparent process.
Again, that's part of that this evening.
Right?
Data-driven decision-making.
Maintaining current service during an evaluation and focus on the long-term sustainability.
Nicely done.
Did you make that all by yourself?
I did.
It's a terrific slideshow.
Well done.
I like PowerPoints.
Yeah.
It's so much easier for people to guide in the discussion.
Yeah.
Absolutely.
And it's nice to have this capability.
Even though it was fun.
Yes.
Of course.
You see my surprise faces?
I'll say that in the show.
Wow.
We're going to be in multilingual tonight.
Are we going to try to continue to meet every other week?
Yes.
Ideally, right?
Yeah.
Unless something comes up.
Sure.
Yep.
And are we kind of like settled on Tuesdays at 530?
No.
I will do it any time.
We're for you.
Right?
I work for you all.
You tell me when you want to meet and I will be here.
I'm retired.
That's right.
You've been on here.
You're still inviting.
I have to say, this is the first time that I had seen a notice about this meeting.
So, I don't know if I've just been missing them.
But I also didn't do it.
No.
So, this is the first public meeting.
So, I made a big mistake.
Right?
I put out the first one the same night as the police department's meeting.
And I apologize.
That was my fault.
Right?
And I'll own that one.
Rachel and I, we just miscommunicated on that one.
And I wasn't going to compete with another organization in this town for attendance.
Right?
So, we made the decision to step back, to postpone or cancel that meeting, and make it tonight.
So, this is our first public one.
And when we first met, I wanted to get kind of the group together, kind of lay some groundwork.
So, when I came to you, I had this to present you.
Right?
You didn't want to see the first couple meetings, because it was, you know, just trying to get off the ground and see where we're looking at, you know, day one, day two, and moving forward.
Where did you see the post?
I did see it on Life and Ridge.
Yeah.
But I didn't see that it was going to be Zoom.
Yeah, yeah, the link was there, at least in what I was looking at.
And the flyer, I think, wasn't there.
Yeah, so I created the flyer.
We put it on the fire department Facebook page.
Maybe because I haven't thought of it yet.
It's okay.
I will now.
Yeah.
Is there a way to know how many people access the lives?
And Victoria helped me out with the Westlake, which is in the town, Westlake.
She has like a readout of metrics.
Okay, we'll help increasing people that way.
When I messaged you about the conflict last week, you had it immediately changed.
Yeah.
And thank you very much for that.
No, again, we have to work together.
Yeah.
We're all vying for different things in the town, but it's all the same concept, right?
And this was actually a wonderful flyer.
Yeah.
Isn't it?
Not only that, but the police many times are showing up at that same scene or they're working
together.
100%.
Yeah.
Right?
So, can we go back one page?
Do I have to put that?
Yes.
So, I might suggest two things.
You know my question.
I wanted to have a meeting like this.
Yeah.
Okay.
And I think it's important not just for our friends out there, but our friends here.
But some of it is grunt work.
Maybe if we do, you know, committee work, the next meeting is an open meeting like this.
I agree.
We get too redundant every time people stop coming.
And then as we get closer to making full presentations to the board and whatever like that, that might
be different.
Sure.
But if we do a little change up there, we'll still let people know what's going on.
Yeah.
Okay.
Well, we can insert...
If I don't have to do a PowerPoint every week, I would really like you guys a lot.
No, but I mean, we can help edit the PowerPoint and we can get that spreadsheet up there.
That answers a lot of questions out of the gate.
And if we rehash, how many of us Peter Burr have, how many of us, at every single meeting, my people are going to snooze.
Sure.
So if it doesn't say public meeting, then you guys are working.
It'll be a working meeting.
It'll be a working meeting.
Okay.
Okay.
We'll still let people know, and I will say, and you know I've been very happy with what
we've gotten.
Yeah.
Okay.
I'm going to hope that we go back and we bullet point some of the things, okay, that we can put
out there.
Yes, some people are going to watch.
Okay.
Some are.
Some are only going to hear what else is going on.
And you, my only favorite part of control, control the message.
I'd like to at least get five or ten points out there that we talked about tonight.
Because, God bless her, Holly doesn't even live here anymore.
And more people know what's going on in town because of all the work she does.
I'd love for her to have something she gets from our crew here.
True.
With the five or ten things we thought were worth it, okay, so somebody else doesn't have
to go picking through it.
And we're not trying to cherry pick.
We're not trying to shake.
But let's not, I mean, we went a little bit far afield, but I think that we also, again,
no one's looking to eliminate Jarma.
Understood.
Okay.
Yep.
I want to get that out one more time before we close.
Understood.
Because first thing I hear, oh, you were on that.
So, you guys trying to get rid of the ambulance service?
And I'm like, yeah, why don't I just wear the shirt saying that?
Okay.
Well, so you want, you want to have something on social media that would be like a bullet point
thing that would say, number one, Jarma is still our best option.
Sure.
Number two, in the event of needing other hand-on service, we are looking at...
We are looking at, amongst others, we are looking at ABC.
There's a plus and minus to going that route because you can just get a whole bunch of people
that follow on that post and say...
But if it's not done with them, it'll just happen at the next meeting.
Right.
And that gives them the ability to grow their grumbling.
Right.
And then maybe they'll come.
And listen.
Yeah.
No, I think more of it, I think it's more going to frustrate, irritate, and cause discontent.
Right.
What is going to be the response to social media posts?
None?
Well, you know what?
No matter what we do, you're always going to have a naysayer.
Yep.
Right?
You're always going to have the supporters.
And then you're always going to have that group that kind of sits in the middle.
And I think the people in the middle is who this is ideally the ones that we want to capture.
And I think we could, we, that's not I, we, can do that by providing more information and education.
And I'm willing to own the fact that I think the biggest problems we face today is lack of information and education.
If we can control that medium, then I think we have a means of moving part of this.
Well, but nothing says you have to have open comments on the social media either.
Yeah, you can just present the data and start off comments.
Well, yes, that's what I'm asking.
I think that's the worst way to go at the moment.
But I've seen a difference in the community with the use of social media.
Sure.
Holly's page, Life and Range.
That's the naysayers.
Okay?
Things that are posted on there just go sometimes into the toilet.
Sure.
What you've been doing on your Facebook page has been excellent.
I think the same thing for the police department.
I think the same thing for the town of Ringe.
Although I would like to see a little bit more on the town of Ringe.
Sure.
If you have to, you can post, you can shut off the commentary.
Sure.
But I encourage to follow.
Yes.
You encourage people to follow your page for those information.
Sure.
And, you know, that's the way you can come across with a survey.
Yeah.
Through the official fire department page.
Yeah.
Well, for sure.
And that can be shared on other pages.
Right.
Sure.
Right.
And you maintain a little bit more of ownership of it.
Yeah.
The salient point is we need to have a fire department.
We need to have an ambulance service.
We need to have a police department.
Yeah.
Those are all things that the citizens we expect to be part of what we're paying for every year.
Yeah.
I mean, the fire department is critical.
Yeah.
So is an ambulance service.
So is the police department and the DPW and everybody else.
And we can't nickel and dime those services the way we are right now.
The opinion is no new taxes.
Right.
Period.
I've seen three selectmen say that over the course of time.
No new taxes.
Okay.
I'm going to...
May I continue?
Of course.
No.
Well, our town has operated in the past with secrecy.
I mean, this tonight being projected on here was wonderful.
That's where we should be at.
True.
But for the town having tried to get this, it was crazy.
Yeah.
And the same thing with live streaming.
That was a ridiculous fight and venture.
This is all part of transparency.
People can be seated, sitting at home tonight watching this.
Well, if they can hear everybody talking, because I listen to the four-second scenes and I can't.
Sometimes it's not.
You can put on closed captions if you have to.
I can.
Oh, you can?
Yes.
Yes.
Oh, I'm good.
So, the transparency with the school board.
This transparency is important and we see that.
You know, you're talking about that here.
The transparency and the education for the townspeople to know what's going on.
Well, not only transparent, but you have to make the information easily accessible.
Yeah.
So, that's where the live streaming is so important.
Because if you have two little kids and you're both working jobs, you're not coming to this 530 meter.
Right.
The other thing is, come to the fire station.
Right.
Come and ask questions.
Right.
Come walk around the fire station.
Come see what we have.
Come see where we are.
You have to be really skinny, though, if you want to get behind all those trucks.
Yes.
I'm working on that.
I'm trying.
Right.
But, no, seriously.
Come visit us.
Right.
Call the fire station.
Reach out to us.
Send emails.
Right.
We're on social media.
I'm on social media.
Come out and ask questions.
Right.
Again, we're trying to be as transparent as possible, putting this out in front of you tonight.
And we are about moving forward.
We're going to do the same thing.
If you want to come in and watch us talk about and muddle through some of these other things before the next presentation, come see us.
Right.
Well, this was great.
Yeah.
I think you did a wonderful job.
Thank you.
Don't let it go to your head, though.
No.
This is day one.
Another tomorrow is tomorrow.
Right.
So, you are definitely best Dan in the room.
See that, Dan?
I'm proud of everybody.
I'm happy to be the silver medalist.
I was going to say, I think we're going to meet again tentatively in two weeks.
Yeah, let me look at a calendar.
Okay.
And see where we're at.
Memorial Day week.
Oh, go ahead.
Hey, I'm going to turn off this.
Are we okay?