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Lower Cape Ambulance Association

AMBULANCE RUN

Lower Cape Ambulance Will Dissolve at End of Summer

Truro and Provincetown will speed up transition to in-house EMS teams

By Amelia Roth-Dishy Aug 9, 2023

PROVINCETOWN — Lower Cape Ambulance Association (LCAA) Chief Operating Officer Steven Roderick announced this week that the nonprofit service will shut down on Sept. 1. The reason, he said, was an insurmountable loss of staff.

Truro and Provincetown have been adding emergency medical personnel as they prepare to transition from the longtime collaborative arrangements they have had with LCAA.

In January, it seemed LCAA might cease operations by July 1, forcing the towns to build their in-house fire and rescue capacities rapidly. But following successful negotiations in March and April, the parties agreed to complete the transition gradually over the next three years.

At the end of June, Provincetown brought on eight new full-time firefighter-medics, six of whom were former LCAA employees. According to Roderick, this represented an unanticipated blow to the nonprofit’s operations. It has proved impossible to rebuild swiftly enough, he said, despite efforts to recruit additional per-diem medics.

“LCAA was led to believe that Provincetown might hire two of our current employees in its first round of recruiting,” he wrote in an Aug. 7 press release. “This sudden shift in the hiring plan for Provincetown significantly impacted LCAA’s ability to fully staff all shifts going forward.”

Provincetown Town Manager Alex Morse said LCAA should not have been blindsided by the town’s hiring move. “Before extending job offers to any LCAA employees, we spoke with LCAA management about specific names and the number of staff to ensure it would not impact their operations,” Morse wrote in an email to the Independent.

The LCAA board met last Thursday, Roderick said, and voted unanimously to dissolve the organization. Provincetown and Truro town officials were notified on Friday afternoon.

“We’ve had shortages since July 1st,” Roderick said in an interview. “We don’t want to exist if we can’t deliver a service. You can’t be hanging on when it’s about patient care.”

Morse wrote that he was “disappointed” by LCAA’s imminent disbandment. “We were hopeful that we would continue our partnership with them for at least a few more years, and were a bit taken aback by the news since the possibility of LCAA ceasing operations so soon was never communicated to us,” he wrote.

Morse said he is confident that Provincetown will be able to make the additional new hires required to compensate for LCAA’s closure.

Provincetown received 54 applications — including 12 from LCAA employees — for the eight new full-time positions that town meeting voters approved in April, according to Assistant Town Manager Dan Riviello.

Morse said that the town will now use the fiscal 2024 funding appropriated for the LCAA contract, which was supposed to be renegotiated in the coming weeks, to hire additional fire and EMS personnel. “There were several other qualified candidates who applied and were interviewed in our last round of hiring, and we’re confident we can move expeditiously to bring more staff on board,” he wrote.

“At this time, we do not anticipate needing an additional ask of town meeting voters at this fall’s special town meeting,” Morse added.

The ambulance line item in this year’s budget came to $1,120,000 after a debt override boost of $101,876.

Provincetown may have been surprised by the news from LCAA, but Truro was anticipating it, said Truro Town Manager Darrin Tangeman in an interview on Monday.

The town meeting warrant appropriated $706,000 from free cash to the fire and rescue budget for “one-time and short-term EMS provision” during the transition from LCAA. The town has already contracted with Montana-based Best Practice Medicine to hire two traveling paramedics on six-month terms and is seeking additional paramedics from the company.

Tangeman also said the town was making offers to three additional candidates on Monday to fill remaining firefighter-medic roles after hiring three new employees since March. As the Independent reported last week, 11 candidates were interviewed this month, just one of whom was from LCAA.

A press release distributed by Tangeman’s office on Tuesday described increasing mutual aid requests from Provincetown as a strain on the region’s EMS capacity. “Truro officials strongly encourage Provincetown to engage supplemental service provisions, such as Traveling Paramedics or another ambulance service, to alleviate the burden on the Outer Cape’s advanced life support system while Provincetown strives to meet full staffing,” the press release read.

But according to Morse, “Provincetown has been able to provide the needed coverage throughout the entire summer when Lower Cape was unable to provide the agreed upon staffing for their shifts.” The town is “exploring options with other ambulance providers” for supplemental coverage through Halloween, although that’s “unlikely to be necessary,” Morse wrote.

Tangeman told the Independent on Aug. 8 that he and Morse are in communication about how best to cope with the LCAA decision.

Roderick said his organization will work with its remaining employees to help them get jobs before Sept. 1. Several of them already have full-time jobs elsewhere, he noted.

“Clearly, Provincetown will need more people, so maybe some will jump to Provincetown,” said Roderick. “Truro is looking. Other departments are looking. Coastal Medical is looking. These people are in demand.”

Like so many social-service and health-care fields, emergency services nationwide are facing worsening workforce shortages, according to a 2022 survey from the American Ambulance Association. Numerous news reports indicate that Cape Cod is no exception.

The Lower Cape Ambulance Association has been the Cape tip towns’ regional ambulance service for 86 years. The idea behind the model was to keep fire department costs down and reduce strain on volunteer EMS personnel. But Lower Cape’s dissolution has been brewing since at least 2022, when Truro commissioned a report from Capital Strategic Solutions that pointed out that the service was not meeting its full contractual obligation to provide three ambulances and six medics for Truro and Provincetown.

Increased communication between LCAA and the towns this spring seemed to have restored the three-way relationship.

“It’s a very sad day for me,” Roderick said.

PARAMEDICS

2 Fire Departments Staffing Up Ahead of Schedule

With LCAA phasing out over three years, Provincetown and Truro are going in-house

By Amelia Roth-Dishy Aug 2, 2023

Staffing up is the focus as the complex transition from the 86-year-old Lower Cape Ambulance Association to in-house emergency medical services in Provincetown and Truro gets underway.

Provincetown’s new EMS coordinator, Othaine Rance, far left, stands next to Fire Chief Mike Trovato and Town Manager Alex Morse with the rest of the department’s new hires: Lisa Potter, Molly Costa, Dan Notaro, Patrick O’Neil, Zak Goldstein, Michael Anderson, Robert Runci, and Joseph Nystrom. (Photo courtesy Town of Provincetown)

At the end of June, Provincetown announced, with some fanfare, that it had hired all eight of the emergency responder positions that town meeting voters had approved in April. Three of those employees are firefighter-EMTs and five are firefighter-paramedics, the more advanced qualification; their start date with the town was July 1.

Truro, too, has been quietly staffing up in the past few months after more than a year of slow-going. Three of eight open positions have been filled since March, with two or three more candidates from a pool of four finalists likely receiving offers in the coming week, according to Town Manager Darrin Tangeman.

Truro approved four new firefighter-paramedic positions at the April 2022 town meeting but could not hire anyone until the new year. Another four positions were approved at the last town meeting.

The personnel across the two towns are arriving with dramatically different levels of EMS experience on this sandbar. In Provincetown, six of the eight new hires were former LCAA employees, Fire Chief Mike Trovato said.

In Truro, none of the three new hires came from LCAA. Truro officials have interviewed 11 new applicants over the past few weeks, and only one was from LCAA, Tangeman said.

The town is also contracting with a traveling paramedic company based in Bozeman, Mont. to bring in two new medics on six-month contracts, according to Truro Fire Chief Tim Collins. “What this allows us to do is have advanced life support coverage while gearing up our existing staff,” he said.

At an office hours chat open to town residents on Monday, Tangeman said that Truro is “ahead of schedule in terms of recruitment and hiring.” Still, he said, they’re “competing for the same people that Provincetown is” to fill these paramedic roles.

Provincetown received 54 applications in five months for the eight positions; 12 of those applicants were LCAA employees when they applied, according to Assistant Town Manager Dan Riviello.

In January, former LCAA medic and new Provincetown employee Patrick O’Neil told the Independent he thought that no LCAA staff had applied for the first four Truro jobs because “the department does not have a good reputation.” In response, Truro Fire Chief Tim Collins said, “Everyone is entitled to their own opinion.”

“We had to go through a more deliberate process for compensation analysis, and we were going through extended collective bargaining negotiations that didn’t conclude until after Provincetown had already started their recruitment,” Tangeman told the Independent. The negotiations wrapped up in June, he said.

“Once that agreement was reached, we moved forward aggressively to advertise and hire,” Collins said.

“We are now very competitive,” Tangeman added.

The latest postings in Truro advertised a union position with benefits, an hourly salary range of $35.31 to $46.08, and a $3,000 signing bonus.

This hiring spree was precipitated by a flurry of winter negotiations between Provincetown, Truro, and Lower Cape Ambulance. Historically, Lower Cape ran transports to Cape Cod Hospital in Hyannis and collected ambulance payments from insurance, relieving the town’s volunteer emergency responders of making the trip.

But the towns have wanted to move away from the LCAA contract for a few years; in 2022, Truro commissioned a report that outlined Lower Cape’s failure to meet its staffing obligations of having four medics in Provincetown and two in Truro.

At one point, it looked like Lower Cape would have to cease operations by July 1, forcing the towns to staff up in a serious crunch. But renewed communication efforts as well as concerns expressed by Lower Cape’s own employees, who were not certified as firefighters, halted the plan.

The transition is now expected to take up to three years, and the towns and Lower Cape are renewing an 18-month contract sometime in August with the possibility of a one-year extension in 2025.

After six of its 16 full-time employees took jobs in Provincetown, LCAA is now facing a staffing shortage. Six departures “was a little more than we expected,” Lower Cape COO Steven Roderick said. Lower Cape is actively hiring to meet its ongoing staffing obligations, which are two ambulance crews in Provincetown and one in Truro, through the transition.

“The idea is they ramp up, we ramp down,” Roderick said. “But we have to agree when those numbers change, and I don’t think we’ve mapped that out between the two towns.”

In addition to the eight new full-time employees, Provincetown has also brought on an EMS coordinator, Othaine Rance. But according to Trovato, these hires haven’t moved the needle on the actual number of emergency responders in town, since LCAA employees have constituted the seasonal rescue squad in the past. “We’ll basically have summer standby year-round,” he said.

Part of the problem is that Provincetown, Truro, and Lower Cape have all been working with one limited pool of qualified medics and EMTs. “We’ve been pulling the same people to do all these tasks,” said Trovato. “We were lucky to grab two people that weren’t affiliated with any other department, and hopefully we can keep them here.” One is commuting from Centerville and the other from the Barnstable area, Trovato said.

Although Truro has yet to hire any former LCAA employees, it will have pulled at least seven new firefighter-EMTs and firefighter-paramedics into that pool.

The two chiefs have differing visions of how the firefighting side of the equation should be handled going forward.

Trovato is more disappointed with how the transition played out; he wanted two in-house divisions, Provincetown Fire and Provincetown EMS, the latter essentially taking over Lower Cape’s role. The town’s call firefighter network is “incredible” and functional, Trovato said. At the recent Coffey Men store fire at 173 Commercial St., “within 10 minutes, I probably had 40 call guys there,” he said, and despite a sprinkler system malfunction, they were able to contain the fire to the “store of origin.”

Collins, on the other hand, said that call firefighters can’t be a “silver bullet” for Truro. In fact, most of them have died or moved away. “Doubling the size of your fire department is a good thing,” he said. Though people more readily focus on the ambulance services, he said.

“I understand that,” Collins said. “But we have a very robust mutual aid situation on Cape Cod. Our geographic location makes it more of a challenge.

“At the end of the day,” he said, when people call, “we’re coming.”

CRISIS AVERTED

Lower Cape Ambulance Gets Reprieve

Provincetown and Truro will build full-time EMS depts. — but more slowly

By K.C. Myers Apr 5, 2023

PROVINCETOWN — The twisting saga of the Lower Cape Ambulance Association (LCAA) and the fire departments of Provincetown and Truro took yet another turn this spring. Both towns are still moving to bring all fire and EMS services into their fire depts. — but the transition from the private ambulance crews of the 87-year-old nonprofit LCAA will now take three years instead of mere months.

On Monday, town meeting voters in Provincetown ratified the change by unanimously approving a $1,058,476 override as part of the town’s general budget. The money will both extend LCAA’s contract for three years and fund the hiring of eight new full-time firefighter-paramedics and firefighter-EMTs.

The extension of LCAA’s working life eases the pressure on both towns’ fire depts. to hire a large number of staff before this summer. At one point, Provincetown was contemplating 16 new hires by July, and Truro eight.

Many of those positions would have been filled by hiring current LCAA staff, but the transition plan had some speed bumps, with questions about the terms of employment for LCAA’s members who are EMTs or paramedics but not firefighters.

Provincetown had received 20 job applications as of the Feb. 27 select board meeting, according to Town Manager Alex Morse. Three of those were from paramedics, and the rest were from firefighter-EMTs.

LCAA was revived, in part, because the organizations began speaking to each other — something that apparently hadn’t been happening regularly. When LCAA’s leaders appeared at a Provincetown Select Board meeting on Feb. 27, member Bobby Anthony alluded to the lack of communication.

“It is a sight to behold — all of us in the same room,” said Anthony.

Later that night, LCAA’s Chief Operating Officer Steven Roderick said, “We did have this meeting with Truro, and it was one of the first meetings we’ve had with Provincetown, Truro, and LCAA in the room at the same time in probably four years. It was a very productive meeting, and I think we will be able to discuss the issues.”

Truro Fire Chief Tim Collins and Town Manager Darrin Tangeman did not return calls for comment.

“I can’t thank you enough — it makes everyone feel more comfortable,” said select board member Louise Venden.

Anthony, who previously served as Provincetown’s police chief, told a story from the summer of 1987 when there was not enough ambulance coverage in town and the police department responded to an attempted suicide. His officer initially did not understand the gravity of the situation, and Anthony insisted the officer drive the person to Cape Cod Hospital — a trip that normally might have taken place by ambulance.

The woman’s mother called Anthony later to thank the department, and he recounted her words with great emotion. “It is so important that we do the right thing,” Anthony said.

RESCUE

LCAA Medics Say They Can Help the Fire Dept.

Trovato agrees to hire as many as 16, even if they don’t want to fight fires

By K.C. Myers Jan 25, 2023

PROVINCETOWN — As word spread that the Lower Cape Ambulance Association (LCAA) would close in a few months, requiring Truro and Provincetown to hire two dozen medics, so did worry — and not just among residents of the outermost towns who face an hour’s drive to the nearest hospital.

Truro paramedics Jeff Souza and Christy Avila were photographed in November. Truro has been trying to add four staff members to the EMT-fire dept. and plans to add four more in the next year, but Lower Cape Ambulance members make the case — and Provincetown Fire Chief Mike Trovato agrees — that there is a serious shortage of paramedics and EMTs Cape-wide. (Photo by Nancy Bloom)

Seventeen of the 21 paramedics and EMTs who work for LCAA signed and sent a letter dated Jan. 18 to the Provincetown Select Board. It outlined their concerns about the recently announced plan to shutter LCAA and replace the service with eight new paramedics in Truro and eight firefighter-medics in Provincetown, plus eight returning summer rescue squad medics by July 1.

The transition plan, according to the letter’s author, LCAA paramedic Patrick O’Neil, will leave Provincetown badly understaffed in 2023, with only two ambulance crews per shift in the height of summer.

“We usually have four ambulances, and we are busy,” he said.

O’Neil wondered how Provincetown would be able to hire eight paramedics with firefighting certifications in such a short time. He also asked how Provincetown could expect former LCAA medics — who lack firefighting certification — to work the summer and shoulder seasons without benefits.

As it stands now, Provincetown’s seasonal rescue squad is made up of LCAA employees who pull 80-hour weeks working for Provincetown seasonally in addition to doing their year-round jobs for LCAA. Those leaving LCAA could be hired into full-time positions in a minute elsewhere since there is a shortage of paramedics across the Cape, he said.

O’Neil said that if Provincetown’s consultant, Norman Sylvester, who came up with the transition plan, “is counting on former LCAA personnel working the summer standby positions without the guarantee of full-time employment and benefits, then this town may find itself in the same position every single fire department on this peninsula finds itself in right now: grossly understaffed.”

In life-or-death situations, experience matters, O’Neil told the Independent. Without LCAA paramedics, he said, the Outer Cape will lose valuable experience.

Truro has been trying to hire four medics for months, with no success. The town wants to hire an additional four in the next year. None of the LCAA staff have applied for those jobs, said Truro Town Manager Darrin Tangeman.

O’Neil said Truro is not as desirable a place to work as Provincetown. “All I will say about that on the record is that the department does not have a good reputation,” O’Neil said of Truro.

Truro Fire Chief Tim Collins said, “Everyone is entitled to their opinion — that is all I am going to say on that.”

On Jan. 23, Provincetown Fire Chief Mike Trovato and Town Manager Alex Morse presented an updated plan to the select board. It honors the requests of the LCAA staff.

“We need them,” Trovato said. “There’s a shortage of paramedics and EMTs. So, we sat down and we realized that this is going to be a three-to-five-year process. The people that we have, we need to keep them.”

Trovato said he now wants to hire 16 people in 2023, including as many as he can from LCAA. He says he is prepared to provide year-round benefits — even for those who do not want to be firefighters, as is the case with O’Neil. Trovato said he would be able to build the firefighting side of the department slowly, as long as the medical side is fully covered.

“I want a one-word answer,” select board member John Golden said to Trovato on Jan. 23. “Are you confident that we’re going to be okay this summer with that plan?”

“I am confident,” Trovato said.

On Jan. 24, O’Neil said he was heartened by Trovato’s and Morse’s new plan. “It is much better than what I heard just a few days ago,” he said. “I am pleased.”

Stan Sikorski told the select board he hopes the transition from LCAA to town EMS departments will be seamless. In 2020, he said, “My heart stopped, and six minutes later the rescue squad showed up and took over CPR from my wife and daughter. This is very critical.”

EMERGENCY MEDICINE

Lower Cape Ambulance Will Take Its Last Ride on July 1

Provincetown needs to hire 16 medics; Truro needs 8

By K.C. Myers Jan 18, 2023

TRURO — The symbiotic relationship between Provincetown, Truro, and the Lower Cape Ambulance Association (LCAA) will come to an end on July 1. Though the demise of the 86-year-old nonprofit had been planned for 2024, it will now happen a year earlier, following a Jan. 4 vote of the LCAA board, said Steven Roderick, its treasurer and operating officer.

The earlier closure is due to a breakdown in communication between LCAA, the Provincetown town manager, and Sylvester Consultants, Roderick said. Provincetown is paying $48,000 for the consultant to come up with a transition plan to safely merge the ambulance service with the town’s fire dept. Roderick said he intended to keep the nonprofit open through fiscal year 2024 to help Truro and Provincetown transition to their own professional departments. But Roderick said Provincetown’s administration stopped communicating in October.

Lower Cape Ambulance staffers Jordanka MacNeely and Chad Foakes. (Photo by Nancy Bloom)

“This lack of communication made it unworkable for LCAA to go forward with its good faith,” Roderick said.

Provincetown Town Manager Alex Morse disputed Roderick’s version of events. Morse said he had asked LCAA to reduce its cost for partial use of the service in 2024, that Roderick asked his board, and the response was to end the service early.

“For me, this is sad,” Roderick said. “Our service is great. We are able to provide a high level of care. The select boards talk the talk, but they have not done the work. When was the last time they created a regional plan?”

Since 1947, LCAA has functioned primarily as a transport service to Cape Cod Hospital for both Truro’s and Provincetown’s fire depts. The arrangement allowed “call” or volunteer firefighter-EMTs with other full-time jobs to leave their usual work and respond to medical emergencies in their towns. Afterward they could return to work rather than make the more-than-two-hour round trip to Cape Cod Hospital, because LCAA would make those rides for them. LCAA keeps the ambulance payments from insurance companies and private payers and receives annual payments from each town.

This system functioned well for years, and Roderick said it still offers the best bang for the buck. But the fire chiefs in Truro and Provincetown have wanted to sever ties with LCAA for the last few years.

The chiefs have been complaining that LCAA has not had the staff to meet its contractual obligation to the towns, according to a 2022 report by Tom Impey of Capital Strategic Solutions that Truro commissioned.

The towns pay LCAA to have three ambulances and crews available to both towns, but LCAA has not had the resources for a third ambulance for a few years, Impey wrote in his report. The LCAA has had trouble keeping its staff at full capacity: four medics in Provincetown and two in Truro.

Provincetown Fire Chief Mike Trovato said there is a Cape-wide paramedic shortage and that getting rid of LCAA won’t solve it. But at least with all the scheduling under his control, he said, he will know ahead of time and be able to call on his own staff.

“The way it is working now, no fault to anyone, but when LCAA was short-staffed I would not know about it until there was a call,” Trovato said.

Provincetown pays LCAA $1.02 million a year, and LCAA earned $620,000 in ambulance receipts from Provincetown runs. Yet when LCAA is short-staffed, Provincetown’s crew or “mutual aid” from other departments have to take up the slack.

The towns’ fire depts. have been slowly staffing up. Provincetown now hires a full-time rescue squad of eight people for nine months of the year and relies solely on LCAA only in the deep winter. Truro’s staff is now up to eight full-time paramedics and EMTs year-round. And both towns have on-call personnel and their own ambulances. With LCAA down one ambulance, LCAA personnel end up using the town ambulances but keeping the revenue, according to Impey’s report.

Morse said the news that LCAA is closing a year early is not unexpected, and the town is not completely unprepared.

“I want to make clear we are confident in our ability to make this transition and the expectation is our public safety will only improve with the proposal we will bring to town meeting,” Morse told the Independent.

Staffing Up

Of the two towns, Truro is in a slightly better position to make the transition in a few months. After rejecting the expenditure at the 2020 town election, voters in Truro last year approved $355,763 per year to hire four full-time firefighter-paramedics.

Those positions have been advertised, but they still have not been able find anyone, said Town Manager Darrin Tangeman.

Without LCAA, Truro will need to hire four more rescue workers. Salaries for these next four will be funded by the $430,000 the town previously paid to LCAA. Ambulance receipts brought in another $230,000 from Truro runs, Impey’s report stated. When those receipts begin going to town-staffed ambulance runs, that money can be diverted to the new fire dept.

Truro Fire Chief Tim Collins will still be asking town meeting for another $150,000 for “increased capital costs as well as additional salaries for increased staffing,” he wrote in the January edition of Truro Talks, the town manager’s newsletter. (Collins did not return a call seeking comment.)

Provincetown’s situation is more dire. The town must hire eight firefighter-EMTs by July 1. Those will be on top of the eight medics that usually begin work in Provincetown in April as the regular seasonal rescue squad.

This will be tricky, because Provincetown generally hires LCAA staff as seasonal rescue squad members, Roderick said. Trovato said he plans to hire as many LCAA paramedics to be full-time Provincetown employees as he can.

LCAA has 16 full-time employees and five part-time, Roderick said. But not all want to be firefighters along with their medical duties. There is a good chance that overtime costs will be an issue, at least for a while, Trovato said.

At the same time, Trovato wants to cultivate a new stable of firefighters who are available on call, since Provincetown’s densely packed downtown and isolated location at the tip of the Cape make a fast response by lots of firefighters essential.

“Yes, there will be bumps in the road, but there will always be an ambulance to go out the door; I know from the last 40 years, there is mutual aid,” Trovato said.

Morse said Truro and Provincetown are talking about a regional EMS service without LCAA.

As for the costs to Provincetown, Morse said he is now working with the consultant and Trovato to come up with an amount he will request at town meeting in April to hire eight new people. Morse estimated that with overtime, a billing service, a deputy chief at the fire department, and full benefits, the eight new people will cost $1.3 million. Provincetown would then hire another eight full-time people next year. All 16 together will cost $2 million, Morse said.

LCAA’s ambulance receipts from Provincetown runs and the fees the town pays to LCAA total about $1.5 million per year, though, so actually the new cost to taxpayers is just $500,000, said Morse.

Of course, LCAA is hardly alone when it comes to staffing problems, Roderick said. Truro has been unable to hire the four new paramedics that were approved last year — so finding 24 new medics in two years on the Outer Cape will be daunting.

Trovato, however, said paramedics prefer town jobs to private ambulance companies because the county retirement benefits are attractive. Trovato said he will definitely hire any LCAA employee as either a year-round staffer, an on-call per diem staffer, or a summer rescue squad staffer.

“I don’t want to see anyone lose their job,” Trovato said.

SCALING UP

Provincetown Prepares to Build Its EMS Capacity

Report recommends adding 16 emergency medical staff

By K.C. Myers May 11, 2022

PROVINCETOWN — The select board and other town officials are now backing Fire Chief Michael Trovato’s call to create a full-time emergency medical services department with 16 new staffers.

This means the end of the 85-year partnership among Provincetown, Truro, and the nonprofit Lower Cape Ambulance Association (LCAA). Trovato has been seeking this change since 2018, but it took a report from consultant Tom Impey of Capital Strategic Solutions to tip the balance.

“It is not rocket science,” Trovato told the Independent. “I have been telling them this for years, but if they hear it from someone they hired from over the bridge, then they will listen.”

Provincetown pays LCAA nearly $1 million a year for backup ambulance services. In addition, LCAA collects the fees for every ride to Cape Cod Hospital. Leaving the LCAA would thus bring $1.2 million a year into the Provincetown Fire Dept. accounts, Deputy Fire Chief Jimmy Roderick told the select board on April 25.

That is nearly enough to pay 16 new emergency medical technicians (EMTs) and paramedics, which would cost $1.4 million, Roderick said.

Those16 EMTs and paramedics would mean there could be a crew of four in the station 24 hours a day. That is the theoretical staffing level now during the summer, when “summer standby” crews and the LCAA are fully staffed. But the part-time and per-diem jobs offered by Provincetown and LCAA are not attracting enough employees, Trovato said, to keep staffing where it needs to be.

And that is hurting emergency services. The town’s service zone plan, filed with the Mass. Office of Emergency Medical Services, calls for response times in Provincetown and Truro of nine minutes 90 percent of the time, according to Trovato.

“We rarely meet those standards,” Trovato wrote in his report to the select board.

For decades, Truro and Provincetown found it efficient to pay LCAA to provide a stable of medics who have other jobs but could fill shifts that provide backup coverage. But the labor pool has shifted, and on-call medics are few and far between. Now, even the smallest towns must hire full-time rescue crews because there are so few on-call backups living nearby. Paramedics are in high demand Cape-wide; this has hurt LCAA’s ability to keep a full roster, Trovato said.

The LCAA medics have other jobs they must go to. The department cannot make them stay if someone calls in sick.

In recent years, Truro, Provincetown, and LCAA have all been understaffed. Wellfleet and Eastham have been taking up the slack through mutual aid, Trovato said.

The LCAA crews often use town-owned ambulances. So, while the nonprofit keeps the fees paid by insurance, the town must maintain the ambulances, the study noted.

During budgeting discussions early in 2022, Trovato asked Town Manager Alex Morse to increase his budget so he could hire four new medics, but the request was turned down pending the results of consultant Impey’s work.

“The board is motivated to support the fire dept.,” said the select board’s John Golden on April 25.

“There is nothing I would not do to make this fire dept. whole and happy,” added board member Bobby Anthony, “because if it’s whole and happy that means the town of Provincetown is well protected.”

The study recommended phasing out LCAA in two years. In the meantime, the fire dept. has applied for a federal Staffing for Adequate Fire and Emergency Response grant. If the town gets it — awards are announced in the fall — the feds would pay for all 16 new staffers for three years, totaling $4 million, Roderick said.

After that, though, the town would have to pay the medics — that is, if they can be found. Trovato said he has eight people working part-time as “summer standby,” or who are just on call. If he can offer them full-time work, that would stop them from taking a job at another department.

Trovato would like to keep an on-call crew of firefighters even as he scales up to a salaried medical service. This is because isolated and densely packed Provincetown needs bodies fast in a fire. The current number of call firefighters is 45, he said.

Another study presented on April 25 recommended that Provincetown construct a fire substation for $18.9 million. While Trovato liked the idea, the select board did not comment. Morse said staffing and a new substation would be considered together in future planning.

AMBULANCE CALL

EMS Study: It’s Time to Phase Out Lower Cape Ambulance

Consultants recommend municipal EMS systems instead of shared services

By Jasmine Lu Apr 20, 2022

TRURO — A regional study of emergency medical services in Truro, Wellfleet, and Provincetown, presented to the select board and finance committee on April 12, points to a phasing out of the Lower Cape Ambulance Association (LCAA).

The report recommends that Truro and Provincetown each establish their own municipal fire-EMS systems similar to Wellfleet’s current model.

For years, Provincetown’s fire dept. has been poised to end its contract with LCAA and build its own self-sufficient ambulance service — a move that would land Truro in a tough spot.

The two towns currently share the expenses of contracting the service, but if Provincetown pulls out, Truro would be hard-pressed to absorb the entire cost and would be forced to part ways with Lower Cape as well. While this may make fiscal sense, Truro has been wary of what losing the additional ambulance staffing might mean for its own personnel, given that the town’s fire dept. is already short-staffed.

Truro Fire Chief Tim Collins at the firehouse. (Photos by Jasmine Lu)

Last fall, Truro Fire Chief Tim Collins told the Independent that “in an ideal world, Lower Cape would still be here — and we’d have additional firefighters.”

But since then, the town has warmed to the idea of letting go of LCAA. In bracing for Provincetown’s possible withdrawal from the contract, Truro solicited the regional study by Capital Strategic Solutions, a Marlborough-based consulting firm that specializes in municipal project management and oversight.

LCAA has been a “godsend to you for the last 80 years,” acknowledged Tom Impey, a consultant from Capital Strategic Solutions. But he questioned whether it could be a “viable entity without a significant increase in the cost to the town of Truro.

“This is certainly not an indictment of LCAA for doing a poor job,” Impey continued. “But your towns are growing. And they’re growing at such a rate that LCAA is not going to keep up unless they see a huge influx of cash from both the communities to buy more ambulances and hire more people.”

Currently, LCAA has been relying on equipment and personnel supplied by Provincetown’s and Truro’s municipal fire departments, much to the frustration of fire chiefs from both towns.

“There have been numerous times where your ambulance has been out of service for months at a time, and you’ve taken ours,” Collins said at the select board meeting, addressing his comments to the LCAA representatives. “You have experienced staffing issues where you’re not running at full staff, and it’s expected that Truro will supplement that.”

“Nothing against Lower Cape Ambulance,” Provincetown Chief Mike Trovato told the Independent, “but we’re paying them a million bucks a year, and they’re collecting all the ambulance revenues, while they’re using our trucks.”

Neither town is compensated when LCAA uses municipal ambulances, but Truro and Provincetown are on the hook to cover repairs and maintenance.

Dan King and Lt. Jeff Souza are a two-person crew in Truro on April 15.

Impey had one disclaimer about LCAA’s finances, however. “This isn’t a money-making thing,” he pointed out. “Lower Cape Ambulance, remember, is a nonprofit. Everything they make goes back into the business, so it’s not like, ‘Oh, my goodness — this is a cash grab.’ No, Lower Cape, at the end of the day, operates on zero revenue.”

Already equipped with two town-owned ambulances, Truro is well positioned to switch over to a municipal EMS system, said Impey. The final stretch would involve hiring eight additional firefighter-paramedics, which would cost the town $800,000. But if Truro severs its contract with LCAA, which costs $430,000 annually, and then scoops up the $253,000 in revenue that LCAA has been collecting, what’s left is a net additional annual cost of $117,000, the study estimates.

Switching to crews of firefighter-paramedics could be a “force-multiplier,” Collins told the Independent. While LCAA crews are limited to EMS-only calls, the eight new firefighter-paramedics would be dual-trained in both fire suppression and EMS.

“You also have more control over that operation because they report directly to the board, the town manager, and the fire chief,” Collins added. “And you’ll not only increase your fire suppression capability in Truro but also to our neighboring towns, if we need to send people over for mutual aid.”

At the select board meeting, Impey added that this model could improve the town’s fire protection classification, which in turn could help lower residents’ insurance rates. “While there’s an increase in cost,” he said, “there’s an increase in benefit as well.”

Chief Collins drives a municipal ambulance in town.

For Provincetown, the regional study recommended hiring 16 full-time firefighter-paramedics, using the $1 million spent annually on the LCAA contract and the $600,000 in revenue that has been going to LCAA.

Trovato, however, is opposed to jumping quickly into this change. As long as he’s around, he said, he intends to keep the Provincetown Fire Dept. operating with 50-odd volunteers.

As for the EMS side, Trovato plans to hire LCAA employees after Provincetown ends its contract with the organization. “That way, no one would be out of a job,” he told the Independent. “They would be getting a better job with benefits. There’s a lot of people who work with Lower Cape who are fantastic. You don’t want to let them get away.”

Then, with a new “Provincetown EMS” in place, Trovato plans on hiring firefighter-paramedics, slowly building up a force of dual-trained personnel to take over “after we’ve gotten too old,” he said.

CURRENTS

This Week in Provincetown

Meetings Ahead

By The Independent Oct 1, 2020

Meetings are held remotely. Go to provincetown-ma.gov and click on the meeting you want to watch.

Thursday, Oct. 1

Recycling & Renewable Energy Committee, 10 a.m.
Public Pier Corp., 1 p.m.
Select Board, 3 p.m.
Licensing Board, 5 p.m.
Zoning Board of Appeals, 5 p.m.
School Committee, 6 p.m.

Tuesday, Oct. 6

Council on Aging Board, 1:30 p.m.
Historic District Commission, 4 p.m.

Wednesday, Oct. 7

Conservation Commission, 6 p.m.

Thursday, Oct. 8

Scholarship & Trust Administration Committee, 3 p.m.

Conversation Starters

Covid-19 Update

As of Sept. 29, there were zero new cases of Covid-19, 32 cases considered recovered, and one death as a result of the virus in Provincetown.

Lower Cape Ambulance Food Drive

The Lower Cape Ambulance Association, town agencies, and local organizations have partnered to hold a 17-day food drive beginning Thursday, Oct. 1.

Drop-off boxes will be available at the following locations in Provincetown and Truro: Helping Our Women in Provincetown, Seamen’s Bank’s two branches in Provincetown and Seamen’s Bank in Truro, and Salty Market in Truro, according to an announcement from Leslie Sandberg, spokesperson for Provincetown’s Covid-19 response effort.

Another opportunity for donations can be found at the Provincetown Crop Swap, located at Provincetown Public Library, which operates similarly to the swap shop at the town transfer station, except with food. People can drop off fresh, uncut fruits and vegetables or take some home.

The organizations collaborating on the drive include the Provincetown Food Pantry (Lower Cape Outreach Council), Provincetown Crop Swap (a joint effort of the Provincetown Health Dept., Provincetown Public Library, and SKIP), AIDS Support Group of Cape Cod, Helping Our Women, the Soup Kitchen in Provincetown, Provincetown Council on Aging, and Truro Council on Aging. The food and funds donated will help the people of the Outer and Lower Cape through each of these organizations.

Alex Juchniewich, Provincetown’s community support liaison and a case manager for the Homeless Prevention Council, said the council has seen a dramatic increase in the number of families in need of services during the pandemic.

“Our Back-to-School Backpack Program served 200 families this year, versus the usual 130 to150,” Juchniewich said. “I’ve received multiple calls reporting housing, financial, and food insecurities. Families are diverting funds to meet expenses, and access to healthy food is definitely a concern for many.”

Donation checks can be mailed to Lower Cape Ambulance, P.O. Box 1721, Provincetown, MA 02657. Please note that it’s for LCAA Food Drive. Or donations can be made online at the Lower Cape Ambulance Facebook page, or on the Lower Cape Ambulance Association website, lowercapeambulance.org.

The ‘Swim’ Happened

No, you didn’t see the orange-swim-capped masses plunging through the harbor from Long Point to the Boatslip. But even in the year when festivals were squashed by the fear of a deadly virus, the Swim for Life still attracted 220 swimmers, kayakers, and volunteers, who raised $110,000 for nonprofits, according to founder and director Jay Critchley.

From oceans, pools, and ponds all over the U.S., swimmers pulled together to support the AIDS Support Group of Cape Cod, Helping Our Women, Outer Cape Health Services, and other local charities and nonprofits. On Sept. 12, a virtual Swim festival bestowed Marianne Clements with the David Asher Volunteer Award and recognized Joe Stewart of Baltimore, Md., for completing his 30th swim.

Top fundraisers include Jim Youngerman, who raised over $16,000 and swam in Lenox and on Cape Cod; Hilary McHugh of Provincetown, who swam a mile daily from July 31 to Sept. 12 and raised over $8,000; organizer Jay Critchley, who swam for the first time since 1988, raising over $7,000; Barbara Jo Ravelle, who swam a mile daily from Aug. 15 to Sept. 15 in Duck Pond in Wellfleet and raised over $4,500; Maura Twomey, an open water swimmer who swam the English Channel in 2015 and raised over $4,500. Also, Reenie Desabrais of Provincetown, Jon Drew MacClaren of Sheffield, and Kathryn Rafter and Francie Beal of Dallas, Texas, all raised over or near $3,000. Jason Greene of Provincetown and Chris Nagle of Truro raised over $2,000. Other $1,000 Club participants include Christine Croteau of Worcester, Laurie M Shields of Sterling, Susan Goldberg of Provincetown, Jane Barber of Provincetown and Breckenridge, Colo., Joe Stewart of Baltimore, Md., George Stamides of Burlington, Bill Silvestri of Quincy, and Erik Koper of West Newton. —K.C. Myers

TOWN MEETING PREVIEW

Truro Pulls Firefighter Override off Warrant

Provincetown fire chief says he’ll stick with Lower Cape Ambulance

By K.C. Myers Sep 10, 2020

TRURO — Town meeting may feel more like recess this year, as voters gather outdoors at the Truro Central School ballfield at noon on Saturday, Sept. 26.

Even the warrant has been child-sized, now that the planning board has withdrawn 11 articles that would have gone before voters in April had the coronavirus not delayed spring town meetings and pushed them outdoors. The planning board held back on articles it had worked hard on in order “to minimize the amount of time we’re exposed to each other and the elements,” said Town Manager Rae Ann Palmer.

The select board also agreed on Tuesday to withdraw from the warrant an article on the hiring of four new firefighter-paramedics, which would have increased the size of the fire dept. by 50 percent, from 8 to 12 members. This would have cost taxpayers $351,904, adding $75.89 to the first-year tax bill on a home valued at $500,000, said Fire Chief Timothy Collins.

The same request, which involved a Proposition 2½ override, failed to get a majority at the town election in the spring by a vote of 209 to 257. But officials wanted it to go before voters again. If the proposal had been approved at town meeting, they would have scheduled yet another town election for the next hurdle.

Palmer said more paramedics are important, due to the domino effect that will result if Provincetown Fire Chief Mike Trovato is successful in parting ways with the Lower Cape Ambulance Association (LCA). That nonprofit provides ambulance services to both Provincetown and Truro, and the combined support of both towns is necessary to keep LCA afloat. If Provincetown withdraws, Truro would need to take on much more of the cost of the ambulance service.

Trovato, who has refused for months to talk about his reasons for wishing to break away from LCA after 83 years, on Monday told the Independent he has “given up on trying to create a Provincetown emergency medical service” and will stick with LCA. Trovato said he still thinks his idea is the right move, but he realizes he does not have support from town hall.

After hearing this news, the Truro Select Board Tuesday agreed to remove the firefighter article from the warrant.

“I think it would be best to not put it on the override and wait until the dust settles in Provincetown,” said board member Jan Worthington. “We just need to be clear with the public, because it’s been such a screwed-up process.”

Chair Robert Weinstein agreed.

“I think it’s important for people to understand why we are removing this and the difficulties we have in dealing with — hopefully, it’s not impolite to say — erratic behavior coming from Provincetown,” Weinstein said.

Articles that will likely still generate interest include a petition to make the planning board an appointed rather than elected body.

Only six of 15 Cape Cod towns have elected planning boards, said Robert Panessiti, chair of the Truro Charter Review Committee. Many argue that planning board positions are rarely contested, so whoever signs up, even as a write-in, gets on the board without any real oversight, which the select board would have if it appointed the members. But the charter committee, which was reviewing this change, did not make a recommendation on this article. And the select board voted 2 to 3 against it, with Weinstein and Kristen Reed in favor.

NCO club — The Payomet Performing Arts Center wants to renovate “T-5,” known as the “NCO Club,” the old clubhouse at the North Truro Air Force Base. (Photo Kevin Rice)

Among the community preservation articles is a proposed $168,000 grant to the Payomet Performing Arts Center to help the nonprofit enter into a lease with the Cape Cod National Seashore to renovate the old clubhouse at the abandoned North Truro Air Force Base and use it as a performance space.

If successful, it would be the first time since the Air Force abandoned the base that anyone had been able to renovate and lease one of the existing buildings, said Kevin Rice, artistic director of Payomet.

Payomet has a tent there, and the Truro Center for the Arts at Castle Hill built a kiln on the base. But there are dozens of abandoned buildings that are slowly falling apart.

The clubhouse is a 3,000-square-foot building used from 1951 to 1984 by enlisted officers and the community as a bar and gathering spot.

“It was really the hub of a lot of socializing, and a lot of marriages resulted from it,” Rice said. “We are working on an agreement with the park service — a philanthropic partnership.”