Views and to-dos from your Pittsburgh neighbors.

Across Pennsylvania and much of the country, EMS is not just under strain. It is failing quietly, in ways most people will not notice until the ambulance does not come.

Pennsylvania lost nearly 400 agencies between 2013 and 2017. More agencies have since shuttered, leaving around 1,200 operating in the state today. At the same time, more than half of EMS agencies report operating deficits, according to statewide EMS studies and supporting reporting. 

Response times are increasing. The model that has supported EMS for decades is unraveling, but public expectations have not changed. When you call 911, someone shows up. What most people do not see is how fragile that guarantee has become.

The problem is structural. EMS is treated as an essential service, but it is not funded like one.

Most systems rely on a mix of billing revenue, municipal contributions and occasional grants. That model may have worked years ago. It does not hold up today. Over 50% of EMS agencies reported budget deficits in recent years. Reimbursement rates often fall short of actual costs. Staffing is harder and more expensive. Call volumes are rising. And many municipalities, especially smaller ones, do not have the tax base to keep filling the gap.

Relying on billing and patchwork support is no longer sustainable. If EMS is essential, it needs to be funded like essential infrastructure. A different approach is required if we want to stabilize EMS for the long haul. 

Here in Allegheny County, the communities of Tarentum, Brackenridge and Harrison recently came together to create a new Alle-Kiski Emergency Service Authority. The model borrows from something people already understand: water systems. Most residents do not think twice about how their water system is funded. There is a base charge that supports readiness. The system is maintained and available when you turn on the tap. You are paying for the system to be there.

EMS works the same way. The value is not just the transport. It is the ambulance that is staffed and ready at 2 a.m. when nothing else is moving.

An EMS authority allows municipalities to work together under a single structure and to establish a stable funding mechanism to support a ready service. This way funding isn’t solely dependent on whether a call is billable or whether insurance pays. It recognizes what the current model refuses to: that availability itself has a cost.

This does not replace billing. It gives billing a foundation to stand on. It also allows for regional coordination and long-term planning that’s out of reach for a municipality that is trying to solve the problem alone. That cooperation cools the competition for the same pool of paramedics and puts to bed the quiet hope that a neighboring borough’s service will cover the gap.

That is the part people do not say out loud. Communities have been covering for each other informally for years. An authority just makes it official and sustainable. Most importantly, it brings EMS in line with how we already fund other critical systems.

Communities across the state are going to have to make a decision. Either build a sustainable model proactively or react when service is no longer available.

The authority model is not theoretical. It is being implemented now. And it starts from a simple premise.

EMS is not optional. Funding it should not be either.

Dwight Boddorf is the borough manager of Tarentum, Pennsylvania, and led the successful creation of the Alle-Kiski EMS Authority and a regional police merger. He can be reached at manager@tarentumboro.com.

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Will the ambulance show up? An authority can keep the medics coming.

by Guest commentary by Dwight Boddorf, Pittsburgh's Public Source
April 15, 2026

<h1>Will the ambulance show up? An authority can keep the medics coming.</h1> <p class="byline">by Guest commentary by Dwight Boddorf, Pittsburgh's Public Source <br />April 15, 2026</p> <p>Across Pennsylvania and much of the country, EMS is not just under strain. It is failing quietly, in ways most people will not notice until the ambulance does not come.</p> <p>Pennsylvania lost nearly 400 agencies between 2013 and 2017. More agencies have since shuttered, leaving around 1,200 operating in the state today. At the same time, more than half of EMS agencies report operating deficits, according to statewide EMS studies and supporting reporting. </p> <p>Response times are increasing. The model that has supported EMS for decades is unraveling, but public expectations have not changed. When you call 911, someone shows up. What most people do not see is how fragile that guarantee has become.</p> <p>The problem is structural. EMS is treated as an essential service, but it is not funded like one.</p> <p>Most systems rely on a mix of billing revenue, municipal contributions and occasional grants. That model may have worked years ago. It does not hold up today. Over 50% of EMS agencies reported budget deficits in recent years. Reimbursement rates often fall short of actual costs. Staffing is harder and more expensive. Call volumes are rising. And many municipalities, especially smaller ones, do not have the tax base to keep filling the gap.</p> <p>Relying on billing and patchwork support is no longer sustainable. If EMS is essential, it needs to be funded like essential infrastructure. A different approach is required if we want to stabilize EMS for the long haul.&nbsp;</p> <p>Here in Allegheny County, the communities of Tarentum, Brackenridge and Harrison recently came together to create a new Alle-Kiski Emergency Service Authority. The model borrows from something people already understand: water systems. Most residents do not think twice about how their water system is funded. There is a base charge that supports readiness. The system is maintained and available when you turn on the tap. You are paying for the system to be there.</p> <p>EMS works the same way. The value is not just the transport. It is the ambulance that is staffed and ready at 2 a.m. when nothing else is moving.</p> <p>An EMS authority allows municipalities to work together under a single structure and to establish a stable funding mechanism to support a ready service. This way funding isn’t solely dependent on whether a call is billable or whether insurance pays. It recognizes what the current model refuses to: that availability itself has a cost.</p> <p>This does not replace billing. It gives billing a foundation to stand on. It also allows for regional coordination and long-term planning that’s out of reach for a municipality that is trying to solve the problem alone. That cooperation cools the competition for the same pool of paramedics and puts to bed the quiet hope that a neighboring borough's service will cover the gap.</p> <p>That is the part people do not say out loud. Communities have been covering for each other informally for years. An authority just makes it official and sustainable. Most importantly, it brings EMS in line with how we already fund other critical systems.</p> <p>Communities across the state are going to have to make a decision. Either build a sustainable model proactively or react when service is no longer available.</p> <p>The authority model is not theoretical. It is being implemented now. And it starts from a simple premise.</p> <p>EMS is not optional. Funding it should not be either.</p> <p><em>Dwight Boddorf is the borough manager of Tarentum, Pennsylvania, and led the successful creation of the Alle-Kiski EMS Authority and a regional police merger. He can be reached at </em><a href="mailto:manager@tarentumboro.com"><em>manager@tarentumboro.com</em></a><em>.</em></p> <p>This &lt;a target=&quot;_blank&quot; href=&quot;https://www.publicsource.org/pennsylvania-ems-funding-problems-authorities/&quot;&gt;article&lt;/a&gt; first appeared on &lt;a target=&quot;_blank&quot; href=&quot;https://www.publicsource.org&quot;&gt;Pittsburgh&#039;s Public Source&lt;/a&gt; and is republished here under a &lt;a target=&quot;_blank&quot; href=&quot;https://creativecommons.org/licenses/by-nd/4.0/&quot;&gt;Creative Commons Attribution-NoDerivatives 4.0 International License&lt;/a&gt;.&lt;img src=&quot;https://i0.wp.com/www.publicsource.org/wp-content/uploads/2025/07/cropped-ps_circle_favicon_blue.png?resize=150%2C150&amp;amp;ssl=1&quot; style=&quot;width:1em;height:1em;margin-left:10px;&quot;&gt;</p> &lt;img id=&quot;republication-tracker-tool-source&quot; src=&quot;https://www.publicsource.org/?republication-pixel=true&amp;post=1331545&amp;amp;ga4=G-CCLXQK5C14&quot; style=&quot;width:1px;height:1px;&quot;&gt;&lt;script&gt; PARSELY = { autotrack: false, onload: function() { PARSELY.beacon.trackPageView({ url: &quot;https://www.publicsource.org/pennsylvania-ems-funding-problems-authorities/&quot;, urlref: window.location.href }); } } &lt;/script&gt; &lt;script id=&quot;parsely-cfg&quot; src=&quot;//cdn.parsely.com/keys/publicsource.org/p.js&quot;&gt;&lt;/script&gt;

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