A middle-aged woman sits on the curb at the corner of Roberts and County Line roads, her legs splayed into the street. Glass shards lay scattered around the flip-flops on her feet, catching the late-afternoon sunlight and reflecting the purple polish on her toenails.
Her passenger side window shattered on impact when another car plowed into her vehicle, moving it clear across the intersection. The man driving the other car looks to be about her age. He approaches her, only to be stopped in his tracks by Christopher Flanagan and four other police officers from Radnor and Lower Merion townships. Flanagan steps toward the driver, separating the two. The driver’s affect is a bit odd, his arm movements exaggerated and his voice loud. In a calm but stern voice, Flanagan instructs him to return to his car.
Superintendent of Radnor’s police department, Flanagan is also the chief of Narberth Ambulance, an elected position he’s held for 24 years. He’s been with the company for 35 years, joining as a 15-year-old volunteer. The woman is oblivious to Flanagan—and everyone else, for that matter. She stares at her feet, which are trembling in time with her hands. Feeling a hand on her shoulder, she turns her head. Kneeling there is Narberth Ambulance’s Olivia DeLorenzo. “We’re going to take care of you,” she says.
The woman begins to cry.
A 22-year-old senior year at the University of the Sciences in Philadelphia, DeLorenzo has volunteered with Narberth Ambulance for almost two years. She wants to become a doctor, a career choice confirmed by the time she’s spent with the company, whose jurisdiction extends through Lower Merion and Haverford townships, Conshohocken, and West Conshohocken.
All three women are clad in similar blue shirts and black pants. They don’t wear badges, patches or anything else that signifies their rank and experience, but their training has been quite different. For six to eight months, EMTs attend a class held two nights a week and on Saturdays. They’re trained in first aid, giving oxygen, immobilization and other skills. Paramedics learn how to intubate patients, start IVs, administer medications and use EKGs and defibrillators. The training window is 18 months to two years. Narberth also has eight PHRNs, pre-hospital nurses with special training for ambulance work. A six-member physician response team of ER doctors is on call for medically complicated crises like cardiac incidents that can’t be stabilized on-site and accidents involving multiple vehicles.
An EMS team typically arrives at the scene with little information from dispatch, which comes in the form of brief descriptions like “walking wounded” or “respiratory incident.” “It’s like being a medical detective,” says Christine Luczka, a full-time EMT with Plymouth Community Ambulance Association, one of the 22 ambulance companies serving Montgomery County. “I hand them my chart and give a 20-second report that sums up the 20 minutes of work we did before we got to the hospital.”
That “hand-off” transfer is critical. “They need to know what the patient needs right away and what can wait, especially if the ER is busy with critical patients,” Luczka says.
An 18-year-old freshman at Bryn Mawr College, Elizabeth Sharp is part of that school’s volunteer EMS team. She rides with Narberth Ambulance on Thursday evenings and spends Friday nights with EMS at Bryn Mawr. Raised in New York City, Sharp spent her high school years in the NYPD’s law enforcement explorer program. After passing a variety of tests, she was accepted to an FBI post, where she participated in security operations at John F. Kennedy Airport and elsewhere. “Part of the reason I chose Bryn Mawr is because of its EMS team and because of the reputation of Narberth Ambulance,” she says. “At Bryn Mawr, we’re treating mostly inebriated students. It’s with Narberth that I get to go on real calls.”
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Luczka also volunteers with Narberth Ambulance, where she serves as chair of its membership committee. She notes that 48 percent of Narberth’s 73 active volunteer members are female. The numbers are similar at Good Fellowship Ambulance Club, which covers nine Chester County municipalities and the borough of West Chester. Forty percent of its paid EMS staffers are women, and executive director Kimberly Holman is one of only three female ambulance EDs in the state.
Holman was 15 when she joined GFAC as an EMT, eventually earning her nursing degree, then becoming a PHRN. Named executive director in 2016, Holman now oversees 45 paid staffers and more than 100 active volunteers. GFAC has the highest call volume in Chester County, largely thanks to its proximity to West Chester and its recent service deal with Chester County Hospital.
In Delaware County, ambulance companies are owned by the health systems, namely Crozer-Keystone. Divided into north and south divisions, the squads are based at Crozer Medical Center and Delaware County Memorial Hospital. Together, they serve 19 municipalities from East Lansdowne to Ridley Park.
Ambulance companies’ varying business structures make for interesting, often difficult economics. Good Fellowship and Narberth are nonprofits. But unlike police and fire departments, they don’t get substantial funding from the townships they serve. In 2017, GFAC received just $23,000 from its service area of nine municipalities and the West Chester borough. In 2018, five of those regions agreed to a funding formula based on call volume and population. Now, GFAC gets up to $130,000 from the municipalities and West Chester. The borough’s contributions actually went from nothing to $90,000 a year, says Holman. “No one ever explained to them how much of our services West Chester uses,” she says.
According to Narberth Ambulance executive director Albert Davey, less than 1 percent of the company’s annual revenue comes from the five townships it serves. Membership fund drives provide roughly 10 percent of the annual budget, with nearly 6,000 residents donating anywhere from $35 to $100 each. An annual bike race raises funds from corporate and private sponsors, bringing in $170,000 in 2018. “We’re incredibly blessed to have so much community support,” says Davey. “But a new ambulance costs $250,000, and we have to buy one every year to rotate our fleet.”
In Chester County, GFAC holds a membership drive that brings in about $100,000 a year. The squad has other sources of revenue, including its own investment account and funds from a trust. The Lasko Family Foundation donated a $190,000 ambulance in 2018. “The only stable revenue streams we have are municipal funding and insurance reimbursements,” Holman says.
Those reimbursements vary, but most insurance plans don’t cover all the fees for an ambulance trip. Patients are billed for the rest. “Our expenses are $2.5 million annually, and we receive only $1.8 to $1.9 million from insurance reimbursements,” says Holman. “That leaves a huge gap that we have to cover,partially through patient billing.”
Lt. Marie Eckman (left) and Amanda Sanday.
Davey knows that an ambulance bill can be an unwelcome surprise. “If you buy a gallon of gas, you know what that costs, but you don’t know what an IV bag costs,” he says. “Our trucks are in a state of readiness 24/7, and providing that care costs a lot of money. When you call 911, we don’t ask if you have insurance or the ability to pay. We don’t refuse anyone—but we do have to bill.”
Back at Roberts and County Line roads, the woman involved in the car accident is now on a stretcher in the back of the ambulance. Although she’s sitting upright and appears unhurt, she’s taken the right advice and is heading to the hospital to get checked.
Bryn Mawr and Riddle are Level 3 community hospitals; Lankenau and Paoli offer Level 2 trauma centers; and Jefferson University Hospital and the Hospital of the University of Pennsylvania are Level 1 trauma centers. “If you’re having a stroke, go to Bryn Mawr,” says Davey. “It has a comprehensive stroke center where a certain procedure can be done.”
Maternity also goes to Bryn Mawr, while crush injuries go to Lankenau. For spinal injuries, it’s Jefferson, and pediatric patients head to Bryn Mawr, based on its affiliation with Nemours Children’s Health. “The level of Bryn Mawr’s pediatric skills are fantastic,” Davey says. “But if it’s pediatric trauma—or parents insist—they go to CHOP.”
As it turns out, Bryn Mawr is the closest and most appropriate hospital for the woman in the car accident—and it also happens to be her personal choice. Most of us, after all, would prefer to make choices based on what’s familiar. The woman’s tears have stopped, but her hands and feet continue to shake. She tells Narberth Ambulance’s Olivia DeLorenzo about her generalized anxiety and panic disorders. Almost as an afterthought, she adds that her breast cancer is now in remission.
Then a uniformed police officer appears, tucks himself inside the ambulance and puts the woman’s Louis Vuitton handbag on her lap. “We found several unmarked prescription bottles in your bag,” he says. “Why do you have so much medication in bottles with no labels?”
According to the woman, they were prescribed for her anxiety disorder.
“But why are you carrying around so many pills?” the officer asks.
Later, after blood tests at Bryn Mawr Hospital, the woman was arrested and charged with possession of a controlled substance and driving under the influence of a controlled substance. The other driver, whose behavior raised suspicions, was cited only for the accident.
After 35 years of service, Narberth Ambulance’s Flanagan has learned not to make rash judgments, as first impressions are sometimes wrong. “We don’t make an opinion about patients,” he says. “Our job is to preserve life.”
As for the anonymity of their work, it’s a big part of what makes first responders the heroic stuff of movies and TV shows. “A lot of what they depict is realistic—except we don’t generally have earthquakes and skyscrapers engulfed in flames,” says Davey with a chuckle.