By Shawne Wickham
The New Hampshire Union Leade
EXETER, N.H. 鈥� Seacoast-area fire departments have been sounding the alarm after Exeter Hospital notified them it was abruptly ending a program that sends paramedics to medical emergencies when advanced critical care is needed.
Now the Attorney General鈥檚 Office has stepped in.
For more than three decades, Exeter Hospital鈥檚 Advanced Life Support (ALS) Program has served surrounding communities by dispatching paramedics in an 鈥渋ntercept鈥� vehicle to critical medical emergencies such as car crashes and cardiac arrests.
Paramedics are the highest level of first responders licensed by the state Bureau of Emergency Medical Services. While larger communities typically have their own paramedics, the intercept program has provided that level of care for smaller communities.
But towns that contract with Exeter Hospital were notified on Sept. 10 that the ALS intercept program would end on Sept 20. Hospital officials said they made the decision to end the program and lay off its paramedics as a cost-cutting measure.
The short notice of the termination, along with concerns expressed by local communities, prompted the AG鈥檚 office to get involved.
Representatives from that agency held an emergency meeting Thursday night with management from Exeter Hospital and Beth Israel Lahey Health, the hospital鈥檚 parent company. And on Friday, Attorney General John Formella announced: 鈥淭oday, our office received assurances from Exeter Hospital that it will continue its ALS Program through at least December 20, 2024 .鈥�
鈥淎s a healthcare charitable trust, Exeter Hospital must operate in a manner that protects the public,鈥� Formella said in a statement. " Exeter Hospital鈥檚 announcement that it would be discontinuing the ALS Program within 10 days provided wholly insufficient notice to the communities that rely upon it.鈥�
Formella said hospital officials 鈥渨ill engage in a collaborative effort with state and local officials to discuss the concerns raised this week.鈥�
In 2023, the Attorney General鈥檚 Office approved the merger of Exeter Health Resources, which includes Exeter Hospital, with Beth Israel Lahey Health. The AG鈥檚 office originally opposed the merger, alleging that it would reduce competition in the healthcare market, but the state reached a negotiated settlement that included certain conditions to protect consumers.
On Friday, hospital spokesperson Sonya Vartabedian said in a statement: 鈥淎fter working with the Attorney General鈥檚 Office, we have reached an agreement to extend the closure date of the Paramedic Intercept Program. This program has served as a resource for many communities, and we will work with the impacted departments, state and local officials during the transition period.鈥�
Top-level emergency care
Paramedics are licensed to perform certain medical procedures that emergency medical responders (EMRs) and emergency medical technicians (EMTs) are not, such as intubation and administering IV medications, according to Justin Romanello, chief of the Bureau of Emergency Medical Services.
鈥淲ith paramedics, you have the most tools in your toolbox,鈥� he said.
Romanello鈥檚 agency licenses just under 6,000 emergency responders statewide, including about 1,400 paramedics, 1,500 advanced EMTs, 2,700 EMTs and 250 EMRs, Romenello said.
Every level has a role in stabilizing a patient and getting them to a hospital as quickly as possible, he said. 鈥淎nd that鈥檚 important because there are very few things that we can do pre-hospital to fix a problem, and ultimately ... a patient needs to get to the hospital to truly be fixed,鈥� he said.
Smaller towns typically don鈥檛 have the call volume to have paramedics on staff, Romanello said. But ideally, every community should have access to that level of care through its mutual aid agreements with other towns or contracts with ALS providers, he said.
鈥淚 am confident that anywhere in this state could activate and get that resource coming,鈥� he said. 鈥淗ow long they wait certainly depends on the limitations of where they are in the state.鈥�
And that鈥檚 where a parademic intercept team can make a difference, going directly to a patient鈥檚 home or crash scene, or meeting the ambulance en route to a hospital.
Cheshire Medical Center in Keene, Frisbie Memorial Hospital in Rochester and Huggins Hospital in Wolfeboro operate intercept programs for communities in their service areas.
鈥楥omplete devastation鈥�
Kourtney Wiegand, a night charge nurse at Exeter Hospital, said the decision to end the ALS program 鈥� and lay off 14 paramedics and their manager 鈥� puts patients鈥� lives at risk.
In her eight years at Exeter Hospital, she said, 鈥淚鈥檝e had so many different patients that would not have been alive if it weren鈥檛 for them.鈥�
Wiegand said news of the program鈥檚 termination shocked hospital staff. 鈥淓verybody was crying,鈥� she said. 鈥淚t was complete devastation.鈥�
鈥淥ur paramedics are so incredible, and so talented and skilled,鈥� she said. 鈥淭hey go out in the community and they start the critical care out there. These patients are so much more stabilized by the time they get to us, and it makes a huge difference.鈥�
Her biggest fear? 鈥淭hat people are going to die,鈥� she said.
Some local fire department officials have voiced concern on social media since they learned of the program鈥檚 termination.
鈥淭o say our department is devastated by the news is an understatement,鈥� Kingston Fire Department posted. 鈥淭hrough the years they have saved so many lives and now to think of medical calls without this next level of care is just unfathomable,鈥� the department wrote, calling on area residents to join its Save Exeter ALS Campaign online.
Stratham鈥檚 selectboard issued a statement calling the hospital鈥檚 action 鈥渁n abrupt and shocking decision that concerns a critical service to the community.鈥�
Some officials have sought to temper the anxiety exploding on social media.
鈥楢m I freaking out? No.鈥�
Closure of the Exeter ALS program is 鈥渃ertainly a loss of a resource,鈥� EMS Chief Romanello said, but he stressed, 鈥淎ll the communities are still covered by an ambulance, a transport mechanism, and by outstanding, qualified EMS providers.鈥�
Exeter Fire Department issued a statement calling the hospital鈥檚 ALS program 鈥渁 valuable life-saving service,鈥� though it noted that Exeter鈥檚 use of the service was 鈥渧ery limited鈥� because the fire department has its own paramedics.
Hampton Falls Fire Chief Jay Lord also wanted to reassure his community. 鈥淲e鈥檝e got great partners that can help out, and it鈥檚 horrible that this service went away, but the community doesn鈥檛 need to have any change in expectation of what鈥檚 going to happen to them,鈥� he said.
Lord said Hampton Falls is within 10 to 20 minutes of emergency departments in Seabrook, Exeter and Portsmouth. 鈥淲e鈥檙e also very fortunate in that we鈥檝e got mutual aid partners in Seabrook, Hampton and Exeter that staff at that (paramedic) level,鈥� he said.
The fire chief plans to meet with his counterparts in those three towns on Tuesday to discuss options. And he expects to present a plan to his town select board the next morning.
鈥淎m I concerned? Yes,鈥� Lord said. 鈥淎m I freaking out? No. But I鈥檓 paying attention and we鈥檙e coming up with a plan.鈥�
Kensington Fire Department called the termination of the ALS intercept program 鈥渁 major blow鈥� to the town and the other communities that rely on it for mutual aid. More than 40% of Kensington鈥檚 medical calls typically rely on Exeter ALS, officials said in a social media post.
鈥淲e want to reassure the community that we will continue to provide our community with professional EMS and ambulance transport services,鈥� they said. 鈥淲hile we wait to learn more, we are working with our mutual aid partners to make contingency plans.鈥�
But they warned, 鈥淲hile our crews can request paramedics from surrounding towns like Exeter, Amesbury, (Mass.) and Seabrook, we expect that those towns are going to face an overwhelming level of demand in the aftermath of this change, and average response time for paramedic arrival will increase.鈥�
The Kensington department also expressed sympathy for the paramedics being laid off as a result of the hospital鈥檚 decision. 鈥淭hey have saved countless lives and served our community, often to little recognition or thanks,鈥� they wrote. 鈥淭hank you, Exeter ALS.鈥�
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