ELIZABETHTOWN, Pa. (WHTM) — Imagine living in a community without emergency services. Many EMS departments are hanging on by a thread financially. That’s why some are considering requiring annual payments.

Northwest EMS in Elizabethtown, like a lot of EMS services, runs on a subscription model. But only 44% of the community are paying in, and it’s not enough.

“If we don’t fix it, who will?” asked West Donegal Township Manager John Yoder.

It’s the reality of a looming EMS crisis.

“As insurance reimbursements go down, and as costs go up, and as the baseline of subscribers doesn’t change, pretty soon you’ve reached a point where there’s nothing left,” Yoder said.

Northwest EMS, which serves West Donegal and several other municipalities has been operating at a deficit for the past six years. The expected budget shortfall for 2022 is over $500,000.

“If you do the pro forma and work it out three to five years, there’s the potential for insolvency of EMS service,” Yoder said.

The solution is a regional authority formed by multiple municipalities coming together to administer and fund EMS services currently served by Northwest.

“Municipalities are tasked to do this. We can either do it by charging people a fee, or by raising people’s taxes,” Yoder said. “If we raise people’s taxes, we miss all the not-for-profits. If we charge a fee, the not-for-profits have to play in the same.”

The proposal would have people paying somewhere around $75 a year per household. Businesses would pay a fee, too.

“You may spend the $75 and think, ‘I’m never going to need this service.’ But God forbid someday you do need that service, you want to know that that ambulance is there and ready to come assist you,” Yoder said. “You want to make sure that organization is financially stable for the long term.”

The goal is to have the authority up and running by next year, but there are still regulatory processes that have to be completed, as well as public hearings.