05/30/2025
You can believe what you want from this post (and what was also read aloud at the SMT Board of Supervisors meeting). We caution you to remember that there are two sides to every story and this is only one side of the story. Once our team has had the time to debrief from this decision, we will be putting out an official statement about last night's decision.
* South Middleton Township Announces New Emergency Medical Coverage Changes *
On May 29, 2025, the Township Board of Supervisors approved changes to emergency medical services (EMS) coverage in the Township. This statement provides an overview of EMS coverage in South Middleton, why this change is being made, and what to expect moving forward.
Currently, South Middleton Township is covered by Cumberland Goodwill EMS (CGEMS) which provides both basic life support (BLS) and advanced life support (ALS) coverage to the entire Township. It also has first-due coverage of the northern third of South Middleton – moving east-west, roughly everything north of Lindsay Road and Heisers Lane to the Carlisle boundary. BLS is medical first aid during the initial moments of a health emergency. In non-life-threatening situations, BLS can often be sufficient. However, in much more serious medical events, BLS is incapable of providing the advanced level of care needed. In such scenarios, when BLS is first on the scene, they essentially apply stabilizing measures until an ALS provider can arrive. Yellow Breeches EMS (YBEMS) has first-due coverage over the remaining two-thirds of the Township, but only provides BLS coverage. This has long left the southern zone of the Township at a lesser degree of care than the northern part.
Due to YBEMS’s limited capacity, often times CGEMS units are dispatched into the southern zone from their Carlisle station, or wherever the unit was when it received the call, to assist YBEMS until it is determined an ALS response is unnecessary. Depending on the circumstances, YBEMS can cancel the CGEMS MICU, like if it is determined that it is not an ALS call after all. It is estimated that 40% of such 911 calls in the southern zone see CGEMS being cancelled out after already being dispatched. This means that there could be two ambulances and a total of four EMS personnel (two per ambulance) out-of-service on a call that may never have needed to be tied up on such a response. This needless redundancy is not only highly ineffective and inefficient, it is expensive and potentially dangerous.
Because of these issues, and driven by ongoing concerns over YBEMS’s financial stability, in 2016, the Township commissioned a study to review EMS coverage in the Township. That report outlined what was already well known, that YBEMS’s organizational structure is significantly lacking in key areas, most notably in administrative oversight, organizational structuring, personnel management, and long-term financial planning. CGEMS, by contrast, was and continues to be recognized nationally for its excellence, holding CAAS accreditation. This is the industry gold standard in which an EMS organization must demonstrate it meets or exceeds, as well as continuously maintains, numerous industry excellence standards. Putting this into perspective, of the more than 23,000 EMS organizations in the United States, only 185 (six in Pennsylvania) have been accredited in such a way.
In addition to the reasons listed above, due to overall trends in EMS and medical billing, and complicated by YBEMS’s precarious financial situation, it was inevitable that, despite the heroic efforts of its members, YBEMS would eventually fail. For this reason, the Township encouraged YBEMS to merge with CGEMS, with the new entity to be in place by summer 2017. This did not occur, reportedly due to YBEMS’s lack of motivation to see it happen. South Middleton seriously considered severing our contract with YBEMS then, but we were encouraged not to do so at the time by neighboring municipalities.
Over the course of the next eight years, South Middleton Township continued to provide the lion’s share of municipal financial support, to keep YBEMS open and operational. This included increasing our overall EMS spending by 41% between 2019 and 2025. The vast majority of South Middleton taxpayer funding for EMS went to YBEMS, as CGEMS is generally, operationally self-sufficient.
In 2023, YBEMS lost its liability insurance coverage. YBEMS never informed of us this until they were literally weeks away from closing their doors. Township staff scrambled and worked with an insurance broker to find YBEMS new coverage. It has since been revealed that YBEMS was likely dropped from its prior coverage due to the criminal investigation into their former chief, Doug Shields, for inappropriate sexual contact with a minor, a 15-year-old girl who was volunteering at YBEMS in 2021. This sexual abuse reportedly occurred throughout much of that year, weekly, and in multiple locations at YBEMS’s Mill Street headquarters. It has been alleged that Shields, who may have had victims going as far back as the 1990s, made inappropriate comments while at work, publicly in the presence of others, which should have alerted those to the risk he posed. In an ongoing civil lawsuit, brought about the victim, it has been suggested that YBEMS violated its own internal policies and lacked necessary oversight to prevent this abuse from happening. This includes a policy, we understand, that prohibited those under 16-years-of-age from staying overnight at YBEMS’s station.
Shields was convicted on multiple counts and sentenced in April of this year to 6.5 to 17 years in prison. Around the same time, the aforementioned lawsuit was filed against YBEMS, alleging gross negligence, among other claims. The lack of transparency from YBEMS on this matter, including actions YBEMS took (or is taking) to address any internal shortcomings they have discovered since, should give anyone pause from providing YBEMS with more money. At the very least, YBEMS should have provided South Middleton with assurances, which they have not, that taxpayer funds were not going to fund their legal defense.
In preparing our EMS budget allocations for 2025, as opposed to the other three emergency services organizations (fire and EMS), which offered timely and full budgetary information to the Township, YBEMS provided incomplete data and were slow to offer details when asked (often repeatedly) to provide much needed information. At times our questions, even when coming directly from the Board of Supervisors, were met with hostile resistance. This came on the heels of the prior year’s budget difficulties, in which YBEMS blindsided the Township with a requested 316% budget increase over the prior year.
YBEMS recently announced their intention to pursue intermediate-ALS (iALS) coverage. This is a step between BLS and ALS that would allow YBEMS to provide a degree of service on par with ALS. Again, South Middleton, despite being the largest municipal funder of YBEMS, and its biggest coverage area, was not made aware of YBEMS’s intentions to do this until the service was set to be launched. This iALS initiative was not mentioned in any five- or ten-year plans provided to us, which means YBEMS either kept us in the dark or just decided to do it, recently. Ensuring the health, safety, and welfare of the public does not fall to any other entity other than the Board of Supervisors. With no plan outlining the proposed iALS rollout, its coverage, quality, safety protocols, scheduling, or even how YBEMS intended to pay for it, was a major violation of trust.
YBEMS is in a highly precarious financial and legal position. This, along with unclear leadership (the chair of YBEMS’s board of trustees just resigned), and complicated by ongoing questions regarding their internal organization changes, were just too much for the Board of Supervisors to allow to continue. That is why we are terminating our contract with YBEMS.
This action was not taken lightly by the Board of Supervisors. The vast majority of YBEMS personnel are good people and selfless public servants with whom Township personnel have worked with for many years and greatly respect. These good people, and the honored name of “Yellow Breeches EMS,” unfortunately have been failed by the reckless actions of a few rash and irresponsible people over the years. It is they who are to blame, not South Middleton Township who did our utmost best, time-and-again, to keep YBEMS’s doors open against the inevitable.
Moving forward, CGEMS will station at least two ALS-capable ambulances, fulltime-staffed, 24/7, in the southern zone. This is something that does not exist now. The units will be housed at Township facilities on Park Drive until a more permanent location in the southern zone can be identified and secured for CGEMS’s usage. It is our belief that EMS coverage in the Township will be improved and expanded with now fulltime, dedicated-ALS units, overseen by a single, unified provider. There will be no reduction in service or increase in response time; and with little long-term cost increases. In fact, costs of the switch will likely decrease over time, both in public appropriations and in private medical billings.
