Saving Lives, Struggling for Funding

Emergency medical services are the invisible backbone of our communities. When the worst happens—a heart attack, a car crash, a stroke—we expect an ambulance to arrive, paramedics to jump out, and care to begin immediately. But we rarely stop to consider the system behind that response, or the people who make it work.

As a volunteer firefighter training to become a volunteer EMT, I recently had the opportunity to work alongside the professionals at Medical Rescue Team South Authority (MRTSA), the EMS provider for several South Hills communities. What I saw reinforced an undeniable truth: these are some of the most skilled, compassionate, and underappreciated professionals in public service.

The People Who Keep Us Alive

The EMTs and paramedics at MRTSA are problem solvers in the purest sense. They enter chaotic, high-stress environments and impose order. They diagnose, stabilize, and transport patients in conditions most of us would struggle to process. And they do it all with a mix of clinical precision and human empathy.

Training to join their ranks means developing not just the technical skills—CPR, airway management, trauma care—but the ability to make fast, high-stakes decisions under pressure. It means learning to read a scene, to anticipate complications, to stay calm when every second matters. It’s a form of professionalism we take for granted until we need it.

But beyond the technical expertise, there is an emotional toll that comes with this work. EMTs are often the first to witness moments of extreme vulnerability—grief-stricken families, patients in severe distress, individuals experiencing the worst day of their lives. They provide not only medical intervention but also human connection in moments of crisis. Their job requires a level of resilience and emotional intelligence that goes far beyond clinical protocols.

The Broken Economics of EMS

For all their skill and dedication, EMS providers in America exist in a state of chronic financial instability. Unlike police and fire departments, which are typically funded as core public services, EMS agencies operate in a gray area—part healthcare provider, part emergency responder. Their funding comes from a mix of municipal support, insurance reimbursements, and individual subscriptions or donations. And too often, that mix doesn’t add up.

Reimbursement rates from Medicare, Medicaid, and private insurers rarely cover the full cost of service. Municipal funding is inconsistent. Subscription models put the burden on residents to voluntarily pay for a service they assume will always be there. The result is a system where EMTs and paramedics are asked to do some of the hardest, most essential work in our communities while fighting for the resources to do it effectively.

The financial strain affects everything—staffing, equipment, training, response times. Many EMS agencies, including MRTSA, must navigate the challenge of balancing high-quality care with limited resources. In some areas, ambulance services have been forced to shut down or consolidate, leaving communities with longer wait times in emergencies. The burden falls on the shoulders of first responders who are already stretched thin.

Compounding the problem is the workforce crisis in EMS. Low wages, long hours, and the emotional toll of the job contribute to high turnover rates. Many EMTs leave the profession after just a few years, seeking better pay and stability elsewhere in healthcare. Without significant funding reform, the cycle will continue—fewer EMTs, longer response times, and greater strain on those who remain.

What Comes Next

If we want a future where high-quality emergency medical care is available to everyone, we need to start treating EMS like the essential service it is. That means stable public funding. It means recognizing EMTs and paramedics as healthcare providers, not just emergency responders. It means valuing their work not just with words, but with policy.

There are potential solutions. Some states have started integrating EMS more fully into healthcare systems, allowing agencies to receive better reimbursements for patient care. Community paramedicine programs—where EMS providers deliver preventative care and chronic disease management—have shown promise in reducing hospital admissions and improving overall health outcomes. Federal and state governments could also step in to provide more direct funding to EMS agencies, ensuring their financial stability regardless of insurance payments.

On a local level, municipalities can prioritize EMS funding in their budgets, recognizing that these services are just as vital as fire and police protection. Public safety leaders can push for consolidations to build scale and develop more capacity in their systems so that EMS doesn't have to stand alone but could be an integral part of fire departments. By combining resources, communities could improve service delivery while reducing administrative overhead and operational inefficiencies.

Residents can also play a role in advocating for EMS. Supporting subscription programs, voting for tax-based funding initiatives, and pressuring elected officials to prioritize EMS funding are all steps that can help ensure emergency medical services remain accessible and effective. EMS professionals shouldn’t have to spend as much time worrying about their agencies’ financial survival as they do saving lives.

At the federal level, the situation could become even more dire. As Congress debates drastic cuts to Medicare and Medicaid, EMS agencies could see their already insufficient reimbursements slashed even further. Many ambulance services, particularly those in rural and underserved communities, rely heavily on these programs to cover the costs of emergency medical care. If funding is reduced, agencies may be forced to cut services, increase response times, or pass more costs onto patients—creating an even greater financial burden on those least able to afford it. These potential cuts make it even more critical for lawmakers to recognize EMS as an essential service and protect its funding at all levels of government.

Spending time with MRTSA made one thing clear: the people in this profession will always show up. They will always do the work. The question is whether we will build a system that makes it possible for them to do it. And that, ultimately, is up to us.

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About Andrew Flynn

Andrew is a Mt. Lebanon commissioner, public finance and policy expert, volunteer firefighter, and community advocate committed to building safer, more resilient, and better-connected neighborhoods. Through public service and hands-on experience, Andrew works every day to make a positive impact in our community.

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