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A Quarterly Newsletter Brought to By Your Township

Ambulance Companies
Facing Crisis of Their Own

  Volunteer fire companies are on the verge of extinction, and now Pennsylvania is facing another public safety crisis.
  This one involves emergency medical service agencies, whose numbers have shrunk dramatically from 2,000 in the late ’80s and early ’90s to between 900 and 1,000 today.

  As volunteers dwindle, paid personnel become harder to come by, and insurance reimbursements only partially cover expenses, the EMS crisis has reached a tipping point in many communities.
   “The reality is that ambulance services are experiencing a severe financial crisis,” says Stephen Bobella Jr., the executive director of both the Northern Berks EMS and the Elverson-Honey Brook Area EMS, which serve municipalities in
Berks, Chester, and Lancaster counties.


A manpower shortage

  Circumstances, however, have not always been so dire.

  For decades, ambulance services thrived. Buoyed by low operating expenses and more than equitable reimbursements from patients’ insurance companies, many organizations had built a nest egg of savings.

  “We had in the ballpark of a million dollars socked away at one time,” David Braucht, president of the Penns Valley EMS Board of Directors in Centre County, says.

  He calls it the “golden age of reimbursement,” when insurance checks covered expenses.

  “When EMS started, it was about neighbors helping neighbors,” Scott Rhoat, chief of Bellefonte EMS and the president of the Centre County Ambulance Association, says. “It’s almost impossible today for volunteers only to run an EMS system."

  Following passage of Pennsylvania’s first EMS law in 1985, emergency services became more regulated, and many agencies started the shift from volunteer to paid personnel who could better provide round-the-clock EMS coverage. Around this time, agencies also began to separate from their volunteer fire companies to become independent organizations.

  “Many years ago, we were viewed as strictly a transport service,” Bobella says. “Today, we are a health care provider.”

  With well-equipped ambulances and highly trained staff, today’s EMS providers take the emergency room out to the community and into living rooms. However, better care brings higher expenses, and the consequences of this shift in services — from volunteer to paid staff, from transport only to advanced health care — have taken a financial toll on EMS operations.

  For starters, the equipment needed to deliver basic and advanced life support is expensive. Paying for a career staff also greatly increases EMS budgets. Salaries, however, for first responders remain low, making it difficult to attract candidates to the job.

  The increased level of training requirements can be a deterrent, too. To become an EMT takes 200 hours and costs upwards of $1,000. The training for a paramedic is even more intense, requiring a multi-year and multi-thousand-dollar investment in time and money.

  “When an EMT starts at $9.50 an hour and is making maybe $18,000 a year, it’s hard to convince people to go into this career,” Rhoat says.

  In rural areas, where the population pool is smaller, paramedics and EMTs are even harder to find, yet these units’ life-saving services are especially essential in a region where trauma and critical-care centers are hours away.


Not keeping pace

  Saving lives is the goal of EMS providers so when a 9-1-1 call comes in, they respond first and deal with money issues later.        “EMS is the best example of socialized medicine, where we are required to respond and transport and can’t refuse service,” Rhoat says, “and those who can pay make up for those who can’t.”
  While the scope of emergency medical services has evolved over time, the system that finances it has been slow to change. In recent victory, however, the state increased the reimbursement of ambulance transportation for Medicaid patients for the first time in 14 years.

  In January, the Medicaid reimbursement rose from $120 to $180 per loaded trip for basic life support transport and from $200 to $300 per loaded trip for advanced life support. The act also allows for a $2 charge per mile for loaded
trips in excess of 20 miles.

  A 2018 law made another important change by requiring health insurance plans to pay all reasonably necessary costs associated with ambulance services, even if the victim is not transported. Previously, insurance carriers could
refuse to reimburse an ambulance company that provided medical service to a patient but didn't transport the person to the hospital.

  Private insurance has also become problematic for ambulance companies since the Affordable Care Act, which ushered in high deductible, high-copay insurance plans. These make it more challenging for EMS companies to collect from patients, particularly if the EMS is an out-of-network provider.

  In these cases, the insurance company will send the reimbursement check to the insured individual, who should then turn it over to the ambulance company. Unfortunately, some
individuals simply cash these checks and rebuff ambulance companies attempts to recoup reimbursement, which only exacerbates the problem.


Seeking solutions

  With reimbursements below cost for all payers, agencies must raise the remaining funds through municipal contributions, membership programs, donations, fundraisers, and grants.

  And there’s another challenge: EMS has been self-sufficient for so long that communities simply take their emergency services for granted. “For 30 years, EMS had been delivered to the valley for nothing,” Braucht of Penns Valley says.

  Those days are over, EMS officials say, and solutions must come soon through community involvement, local government support, and legislative action.

  Chuck Cressley of Jefferson County EMS understands how the challenges facing EMS right now can feel overwhelming.

  “We’re not giving up,” he says. “If we don’t work through this, then essentially, we would have to go back to a time when the local funeral director provided emergency transport in a community, and that is untenable.”


A Quarterly Newsletter Brought to By Your Township

Recycling Reversal
Overseas Ban on Waste Changes
What Most Pennsylvanians
Can Put in Their Bin

    If you’re like most Americans, you probably have not given much thought to what happens to that plastic bottle, glass jar, or newspaper you put in your recycling container. You figure it is being recycled somehow, and by keeping it out of the landfill, you are doing your part to make planet  Earth a better place.
    This “out-of-sight, out-of-mind” mentality came to a screeching halt earlier this year when the recycling industry was rocked by action out of China. What most people did not realize until then was that the items they had been recycling, week in and week out, were likely being shipped to China, the world’s largest  consumer of recyclables.
    On January 1, in an anti-pollution crackdown, China implemented a ban on certain recyclables from other countries, most notably mixed paper (such as junk mail) and mixed plastic (those labeled three through seven), and enacted stricter rules about the level of contamination it would accept on other materials. Recycling Reversal Overseas Ban on Waste Changes What Most Pennsylvanians Can Put in Their Bin.

    As a result of a decision made halfway across the globe, what can now go in your recycling bin has likely changed, and if it hasn’t yet, it will soon. Without China as a major market, recyclers are being forced to find other outlets, and until new markets pick up the slack, what was once considered a recyclable has become trash.

    Communities and consumers are scrambling to adapt to the new realities of recycling.

    For some, China’s ban has forced local recycling programs back to the basics and shifted their focus to materials with traditionally strong markets, such as corrugated cardboard, plastic bottles and jugs with necks, metal food and beverage cans, and glass bottles and jars. Others are exploring whether it makes sense to halt recycling altogether until the marketplace rebounds.

    Meanwhile, amid these changes, Pennsylvania’s recycling law is celebrating its 30th birthday. The trouble is, the future of recycling has never looked murkier.


A shift in recycling

    Thirty years ago, Pennsylvania developed the most sweeping recycling program enacted by any state at that time.

    Today, recycling has become a way of life for most Pennsylvanians. More than 11.6 million residents — about 94 percent of the state’s population — have access to recycling, including about 79 percent who have the convenience of curbside pickup.

    Over the years, recycling initiatives have faced challenges as markets ebbed and flowed, and despite current conditions, the commonwealth’s program will rebound again, state Secretary of Environmental Protection Patrick McDonnell predicts.

    Still, the latest news out of China has sent a large shock wave through the recycling industry and caused a major disruption to the recycling loop, which consists of the user or sorter, the processor, and the buyer.

    “Suddenly, the buyer went away, and there was nowhere for the material to go,” Kathryn Sandoe, chief communications officer at the Lancaster County Solid Waste Management Authority, says.

    With limited markets, communities mandated to recycle are re-evaluating what items are valuable enough to still collect and sell. Earlier this year, Lancaster County, one of the first areas in Pennsylvania to react to the market collapse, cutout some long-time recycling staples and trimmed its curbside recycling to four items that it believes have had traditionally strong domestic markets.
    “We looked at marketability and wanted to ensure that the materials could still be sold six
months, a year, two years from now,” Sandoe says.
     With such a major change to its program, the authority has focused its efforts on re-educating people on what can be recycled and how to prepare it (flatten cardboard, empty and rinse containers, remove lids).
    “We know we are challenging many long-held beliefs of recycling, and the initial reaction has been surprise and shock,” she says, noting that she’s hopeful that curiosity, understanding, and finally adaptation will follow.
     And while it may seem that the changes took place overnight, they were in the making for a while.

Reducing contaminants

    For many years, China’s insatiable appetite for recyclables masked the problems of contamination in the nation’s recycling stream.

    Part of the problem can be traced back to how easy recycling had become, especially once many programs implemented single-stream collection, allowing all recyclables to be placed together for pickup and sorting later at a processing facility. Too many people made assumptions that just about everything could be recycled — tin foil, drinking glasses, plastic toys, even garden hoses — when in reality, they couldn’t.
    And now that China has lowered its boom, communities that still want to recycle — whether because of a state mandate or because they believe it’s the right thing to do — must find ways to provide a clean, quality product.
    According to, a website dedicated to encouraging less waste, the answer to U.S. recycling woes starts with clear recycling guidance for consumers, who sort recyclables from the rest of their waste. An effective education program could help to put an end to what the industry calls
“wishful recycling,” trying to recycle things that aren’t recyclable.
    Many solid waste handlers have begun asking customers to be more diligent about their recycling
habits, and “when in doubt, throw it out” has become the mantra of the new post-China recycling guidelines.
    While it remains to be seen how recycling rebounds from this latest market setback, in the short term at least, costs for local programs will almost certainly rise as recyclers pass on increased costs to customers.
    Some in the industry, however, see this latest crisis as just another blip in the inevitable rise and fall of markets.
    Only time, of course, will tell.

State Warns Public to Be on

Look Out for Spotted Lanternfly

The spotted lanternfly, Lycorma delicatula, is an

invasive plant hopper native to China, India, and


The insect was first detected in Pennsylvania

in Berks County

Here we go again. First, it was the emerald ash borer that marched relentlessly from west to east across the commonwealth, leaving a trail of decimated ash trees in its wake. Now, the spotted lanternfly is threatening to spread from southeastern Pennsylvania and could wreak even more havoc than the ash borer. According to the state Department of Agriculture, the pest poses a significant threat to the grape, apple, and stone fruit industries, worth

nearly $175 million, as well as the state’s $12 billion hardwood industry. Consequently, the U.S. Department of Agriculture awarded the state nearly $3 million last summer to fund control efforts and public outreach. With

13 southeastern counties under quarantine, state legislators have requested an additional $20 to $40 million in federal funding to combat the insect. Municipalities in the quarantined counties (see the map) have been asked to alert residents and post signs and information about how to recognize the spotted lanternfly. The goal is to minimize the risk of the insect leaving the quarantined area. Given that insects don’t recognize quarantines,

it is a good idea to get educated about this invasive species and watch for its arrival in your community.

How to identify the pest

The spotted lanternfly, Lycorma delicatula, is an invasive plant hopper native to China, India, and

Vietnam. The insect was first detected in Pennsylvania in Berks County in the fall of 2014 and spread to Bucks, Chester, Lehigh, Montgomery, and Northampton counties. To try to control its spread, the state extended the quarantine area to include Carbon, Delaware, Lancaster, Lebanon, Monroe,Philadelphia, and Schuylkill counties. The bug has also been seen in Delaware, New York, and Virginia. The state Department of Agriculture says that adult lanternflies are about an inch long and a halfinch wide at rest. The lanternfly’s forewing is gray

with black spots, and the wingtips have a net-like appearance in black and gray. The hind wings have contrasting

patches of red and black with a white band between them. The legs and head are black, and the abdomen is yellow with broad black bands. Immature stages, called nymphs, are first black with white spots and then develop red patches as they grow. Lanternflies prefer the plant called Tree of Heaven, Ailanthus altissima — another invasive species in Pennsylvania — as their primary food source and mating and egg-laying location. (To learn how to identify Tree of Heaven, go to www.agriculture., click on the “Program Information” box, and choose “Ailanthus Identification” in the list of publications on the right.) However, any smooth surface, from trees to vehicles, campers, yard furniture, farm equipment, and other items stored outside can act as sites for

egg laying. Adult lanternflies begin laying eggs in late September and continue through late November

or early December.

The warning signs

Beginning in late April to mid-May, nymphs may be found on smaller plants and vines and any new growth on trees and shrubs. As the year progresses, older nymphs and adults will migrate to the Tree of Heaven, if available, and may be observed feeding on the trunk and branches. Trees may have weeping wounds of sap on the trunks, and heavy lanternfly populations will cause honey-like secretions to build up at the base of the tree, blackening it and the surrounding soil with sooty mold. Wasps, hornets, bees, and ants may be attracted to the secretions and tree wounds.

In areas with large populations of lanternflies, adults may also feed on other trees, including willows, maples, poplars, tulip poplars, birch, and ash. The Department of Agriculture says that egg masses can be scraped off the trees, double bagged, and disposed of. You can also drop the egg masses into alcohol or hand sanitizer to kill them.

The department is asking anyone who sees spotted lanternflies, especially outside the quarantined

counties, to do the following:

• Collect a specimen and submit it to the department’s entomology lab for verification, using the entomology program sample submission form at

• Take a picture of any life stage of the spotted lanternfly, including egg masses, and email it to

• If you can’t collect a specimen or take a photo, report a sighting by calling the automated invasive species report line toll-free at (866) 253-7189. Leave a message, making sure to include details about where you saw it and your contact information.

What to do

Anyone who observes spotted lanternflies beyond the quarantined counties should try to destroy them. Because insecticides may kill beneficial insects, including pollinators, on infected trees, property owners should consider using the integrated pest management strategy that the state is using. It involves locating Tree of Heaven plants,

killing all but a few to act as “trap trees” to attract the lanternflies, and then treating those with a systemic insecticide to eradicate the pests. As an added step, Gov. Tom Wolf has created the Pennsylvania Invasive Species Council. This advisory panel of 17 state and non-governmental agencies will identify invasive species that currently or could threaten the state’s natural and agricultural resources and the industries they support. To learn more about these pests, go to the Department of Agriculture’s website, www., and check

out information available from the Penn State Extension at


Thirteen southeastern Pennsylvania counties are under quarantine for the spotted

lanternfly. The public in affected areas is asked to dispose of egg masses; check

vehicles for insects and egg masses before leaving a quarantined area; buy firewood

locally and not move it out of the area; and not transport brush, yard waste, or construction

waste outside quarantined areas.

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