Emergency medical services are a critical part of the public safety system. When someone calls 911 for a medical emergency, the expectation is simple: trained personnel and an ambulance will be available to respond. Maintaining that level of readiness, however, has become increasingly difficult for EMS agencies across Pennsylvania. Rising operating costs, workforce shortages, changing reimbursement practices, and declining traditional revenue sources have placed growing pressure on a system that must remain ready 24 hours a day, 365 days a year.
The Alle-Kiski Emergency Services Authority (AKESA) was created to address those challenges locally through a regional, long-term approach.
One of the biggest challenges facing EMS is that the cost of providing the service begins long before an ambulance responds to a call. EMS agencies must maintain trained personnel, ambulances, medical equipment, medications, communications systems, facilities, insurance, training, and administrative support at all times.
Those costs exist whether an ambulance responds to ten calls in a day or none. This is known as the cost of readiness.
The traditional EMS funding model does not adequately account for that cost. Instead, agencies have historically relied on a combination of insurance reimbursement, municipal support, subscriptions, donations, grants, and other revenue sources. That model has become increasingly difficult to sustain.
Insurance remains an important source of EMS revenue, but reimbursement is generally connected to individual patient encounters and transports. It does not directly fund the entire system that must exist before a call occurs.
An ambulance must already be staffed. Personnel must already be trained. Equipment must already be purchased and maintained. Vehicles must already be operational. Those expenses exist regardless of whether a reimbursable transport occurs. Even when a patient is transported and insurance is billed, reimbursement may not cover the full cost of providing the service. That creates a continuing gap between the cost of maintaining EMS readiness and the revenue generated through individual calls.
Not every 911 EMS response results in transportation to a hospital.
EMS personnel may evaluate a patient, provide treatment, assist someone at the scene, respond to a call where transportation is ultimately refused, or provide other medically necessary assistance. Those responses still require personnel, vehicles, equipment, fuel, medical supplies, and time.
Historically, however, many non-transport responses have generated little or no reimbursement. From an operational standpoint, the ambulance and crew still performed the service. From a financial standpoint, the agency may receive little revenue to offset the cost. This is another reason a system funded primarily through individual transports is difficult to sustain.
EMS is also experiencing significant workforce pressures. Communities increasingly depend on paid professionals to provide around-the-clock coverage, while EMS agencies compete with hospitals, health systems, public safety agencies, and other employers for qualified personnel.
Recruiting and retaining EMTs and paramedics requires competitive wages, benefits, training, equipment, and reasonable working conditions. At the same time, the need for emergency medical care does not decrease simply because fewer people are available to provide it. A sustainable EMS system therefore requires enough predictable revenue to maintain both its workforce and its equipment over the long term.
Pennsylvania places responsibility on local governments to ensure that emergency medical services are available within their communities. That means municipalities cannot simply assume that the existing EMS structure will continue indefinitely if the financial and workforce conditions supporting it are no longer sustainable. For Brackenridge, Harrison, and Tarentum, the question became:
How do we ensure that reliable EMS remains available to our communities not only today, but five, ten, and twenty years from now?
That question ultimately led to the development of AKESA.
Emergency medical services do not operate neatly within municipal boundaries. Ambulances respond across communities, personnel and equipment may support neighboring areas, and emergencies occur regardless of jurisdiction.
A regional authority allows participating communities to approach EMS as a shared public safety system rather than as several separate municipal problems. Through AKESA, Brackenridge, Harrison, and Tarentum can coordinate governance, personnel, equipment, planning, training, financial management, and service delivery under one regional organization.
The goal is not simply to combine organizations. The goal is to create a structure capable of providing dependable EMS for the long term.
The AKESA funding model recognizes that EMS has two basic costs:
Insurance billing remains an important part of paying for the response component. A readiness fee provides a stable funding source for the system that must be maintained before an emergency occurs. Rather than depending almost entirely upon the number of reimbursable ambulance transports, subscriptions, donations, or varying municipal contributions, the Authority can establish a predictable financial foundation for regional EMS service.
A regional funding structure also allows communities served by the same EMS system to support it through a consistent methodology. Historically, municipal contributions, tax bases, subscriptions, donations, and other funding sources have varied from community to community.
AKESA creates one regional organization responsible for determining the resources necessary to provide service and establishing a transparent method for supporting those costs throughout the service area. The objective is a system that is understandable, predictable, and financially sustainable.
The creation of AKESA did not happen overnight. More than a year and a half before the Authority was formed, local EMS providers and municipal leaders began discussing the long-term sustainability of emergency medical services in the region.
Representatives from participating municipalities and the local EMS agencies formed a working group that met regularly to review financial information, staffing conditions, service needs, and potential solutions. The group considered different approaches before determining that a regional emergency services authority offered the strongest framework for addressing the issue over the long term.
The group then engaged professional consultants experienced with Pennsylvania EMS authorities to help evaluate the concept, develop the governance structure, prepare organizational documents, and establish a path toward implementation. As part of that process, a community presentation and public meeting was held on December 4, 2025, at Highlands High School to explain the proposal, answer questions, and receive public feedback.
On March 25, 2026, Brackenridge Borough, Harrison Township, and Tarentum Borough each approved the creation of the Alle-Kiski Emergency Services Authority and authorized the filing of its Articles of Incorporation. Following incorporation, representatives were appointed to the Authority Board and AKESA began operating as an independent public authority.
The Board is now responsible for developing the policies, finances, staffing structure, service model, and other components necessary to transition from the existing system to the regional Authority.
AKESA is now in the implementation phase.
The work ahead includes developing the detailed service and operational plan, establishing staffing and administrative structures, coordinating the transition of existing EMS operations, preparing budgets, evaluating equipment and facility needs, and establishing the revenue necessary to support the system.
A major part of that process is the development of the proposed EMS readiness fee. Before implementation, the Authority will conduct the required public process regarding the proposed service and fee structure. Property owners will receive the required notice, residents and other interested parties will have an opportunity to review the proposal and provide public comment, and the Authority Board will consider that input before taking final action.
After adopting the service and funding plan, AKESA will continue the work needed to transition to full regional operations.
AKESA is not being created because the communities want another layer of government. It is being created because the system responsible for answering medical emergencies must have a dependable structure behind it.
The traditional EMS funding model increasingly asks agencies to maintain 24/7 readiness while relying heavily on revenue generated only after certain types of calls occur. That mismatch has contributed to financial and workforce instability throughout Pennsylvania. AKESA is designed to address that problem locally.
By combining regional cooperation, professional governance, insurance billing, and dedicated readiness funding, the Authority can build a more predictable foundation for emergency medical services. The objective remains straightforward:
When someone in Brackenridge, Harrison, or Tarentum needs emergency medical care, a professional EMS system should be ready to respond.