In case you haven't noticed, the future of local ambulance associations is in peril.

                Back in 2011, the Lower Milford Fire Company discontinued its ambulance service, which covered that rural community in Lehigh County for decades.  The emergency medical service was replaced with an agreement with six neighboring ambulance providers including Coopersburg and Upper Perkiomen Valley Ambulance.

                Then, in 2012, the borough of Coopersburg discontinued their longtime relationship with Coopersburg Ambulance Corps, opting to contract with Upper Saucon Ambulance Corps to provide services for its residents.

                In 2013 Green Lane's Community Ambulance Association entered into an agreement with the Harleysville Area Emergency Medical Service, Inc. to provide advanced life support services.

                Earlier in 2014 we learned of the financial woes of the Upper Perkiomen Valley Ambulance Association and their ongoing efforts to keep that service afloat.

                Now comes news that the Lower Frederick Regional Ambulance will merge with Plymouth Community Ambulance of Plymouth Township.

                The reasons are many and not as simple as one might think.  Yes, in the economic reality of the recent, and not so recent, years, donations and memberships are down while expenses continue to rise.  The days of the volunteer emergency service provider are gone.  Insurance companies and legislators provide ever-increasing minimum standards for ambulance associations, and their staffs, when providing basic or advanced life support services.  Training and certification of personnel has been improved significantly and so has the quality of care to patients.

                The demands of the intense and extended training created a dwindling pool of volunteers, as most groups opted for professional paramedics and emergency medical technicians to staff their ambulances.

                Groups of small-town volunteers needed to quickly become businesses that were paid to provide a service, and absorb all of the costs and complexities that come with running that business.  

                Another contributing factor to the demise of the local ambulance associations is that the same insurance companies that recommended the improvements in service slowly began to decrease the amount they would pay for that improved emergency care.  That left the ambulance associations scrambling to get payment from the individual that the service was provided to.  It became another expense and a task that affected the organization's cash flow.  In many cases, insurance companies themselves were slow to reimburse ambulance associations for services, forcing them to come up with the money to cover everyday expenses while acting as a collection agency for unpaid bills.

                There is no "one-size fits all" solution when it comes to solving the problems that arise when providing the best emergency care available to area residents.  Mergers work for some, long-term contracts to provide advanced emergency care work for others.

                The Upper Perkiomen Valley Ambulance Association has taken a big step in the right direction by naming municipal officials to their governing board along with local professional business people who all volunteer their time to the group.

                While local professionals can provide the know-how to operate the business of providing emergency care, local officials can learn the intricacies of providing this vital service the public.  While not physically providing the emergency care, they are the administrators who keep their finger on the pulse of the community and the health of their emergency medical services.

                And, hopefully they can keep it local.