Medical Rescue Team South Authority’s new chief wants to build on established relationships with the public safety community
n November, Medical Rescue Team South Authority (MRTSA), Mt. Lebanon’s emergency medical services provider, appointed longtime supervisor David Terkel to succeed Josh Worth as the authority’s chief. Terkel served as interim chief since Worth’s departure early in 2024.
MRTSA provides ambulance and emergency medical services to six South Hills communities, including Mt. Lebanon.
Terkel, A Duquesne Drive resident, has been with MRTSA since 1995, and has served in a variety of roles with the authority. Among his certifications are swift water rescue technician; bike medic; tactical paramedic and technical rescue, including high angle rescue, structural collapse and confined space rescue. He received MRTSA’s Medal of Valor for his response to the 2018 Tree of Life shootings.
Terkel is eager to maintain and elevate the authority’s standards.
“We are always looking to go with the latest trends and increasing the capabilities that we have,” he said, “Whether that’s by adding new equipment or new protocols with our medical director.”
For example, if a regular patient requires a specific medicine that the ambulances don’t stock, MRTSA’s medical director, Dr. Mohamed Hagahmed, will add a protocol allowing the paramedics to administer medication that belongs to the patient that they might not carry as part of their regular stock.
“Cases like that are few and far between, but we’re always trying to adapt around those types of patients. When we have a very special circumstance, it’s really nice to be able to have a medical director that wants to create these protocols to make sure that they’re taken care of.”
Hagahmed is eager to continue working with Terkel. “I can’t think of a better candidate,” he said. “Chief Terkel is a valuable addition, not just to the station, but to the community. He’s a part of the community and he loves giving back.”
MRTSA is also taking a look at how it handles pain management.
“We have a growing population with prior substance abuse history, and we want to be sensitive to that population. One of the things that we’re looking to do is make sure that we have alternatives beyond morphine and fentanyl. We have added certain medicines into our arsenal, including one called ketorolac. Basically, it’s a very potent NSAID, like a super Advil.”
Another option in pain management is the use of nitrous oxide, mixed in equal parts with oxygen, self-administered by the patient.
“The nice thing about it is it makes them forget that they’re having pain. They just puff on it and when they don’t want to use it, they take the mouthpiece out.”
MRTSA applied for a grant from the state fire marshal’s office to add the nitrous oxide blend to their ambulances since the units they had are no longer usable due to their age.
One of the biggest changes Terkel has seen in the past 30 years is the emergency medical services career path.
“The landscape of EMS has changed as far as who we see coming into the field,” he said. “There’s a lot more turnover now, not as many career EMS professionals.”
Many of the newer EMTs and paramedics are joining to get a few years of emergency medicine experience before moving on to a more prominent position.
“I don’t believe we’re losing people because they don’t like it at MRTSA,” he said. “We’re losing people because this is the way practitioners are being brought into the field now. It’s a trend, not just at MRTSA but in EMS in general in western Pennsylvania.
“There’s a bachelor of science program at Pitt in emergency medicine, which comes with paramedic certification,” he continued. “(Graduates) work here for a couple of years and then apply to medical school. It’s great for them, because it gives them great experience and probably makes them better physicians or PAs.”
Although the turnover can be irksome, Terkel wants to make the best of the situation.
“It’s hard for us as employers; we put them in uniforms, we train them and then they’re off, but if that’s the case, then I would rather have a good two years out of someone than hire a less qualified candidate who might stay.”
One way to ease the turnover crunch is to make a career more profitable. Currently, the top salary for a full-time EMT at MRTSA is $54,000 after five years, and $77,500 for paramedics. Compare that with the top salary of a Mt. Lebanon police officer, $108,472, or
firefighter, $104,390.
“We can’t buck the trend unless EMS becomes a higher paying career,” Terkel said. “There’s really not parity among EMS, fire and police.”
Terkel believes some of that lack of parity may come from the way communities in western Pennsylvania view EMS providers.
“It isn’t rooted into the community structure the way police and fire are. People look at us and say, ‘Well, you bill for what you do, so there’s money.’”
However, often patients receive compensation from their insurance carriers for ambulance and other emergency services costs, but that money may not make it to the providers. Terkel says there is legislation under discussion in Harrisburg that would allow the EMS providers to collect that money directly from the insurance companies.
“Some of (the companies) we don’t get direct pay from, and it hurts our revenue stream.”
Terkel regularly runs into confusion from people about the role of emergency medical service providers.
“Is EMS health care? Is it public safety? In reality, we’re both, but in practicality, there’s still no definitive answer as to what we are. That can leave a lot of grant money on the table, because we don’t fall into certain criteria.”
Terkel’s immediate plans for MRTSA is a back-to-basics approach.
“I want to start us back at our grassroots, making sure that each staff member here has the best fundamentals possible. Most of them do, but with the turnover it’s sometimes difficult. So for me it’s all about making sure we crawl, walk, run. What I don’t want to see us do is get so far out in front that we forget where we came from. MRTSA’s history of excellence is what I was brought up under. I want to make sure we maintain that level of service.”
In addition to staff development, Terkel is looking at rising equipment costs. MRTSA replaced three of its seven ambulances late in 2021, and the remaining four “are in dire need of replacement,” Terkel said. “Right now I’m working on replacing two of them.”
Again, money is a sticking point. The three state-of-the art ambulances came at a price tag of about $298,000 each, three years ago. The cost of something similar today, Terkel says, is around $380,000.
“We’re trying to be diligent about where we spend the money we have available. So we’re probably changing the style of the ambulance — it will still have all the same things in it, but we might go with a smaller body box in order to help defray some of the cost.”
Other expenses on the horizon: The Lifepak monitors in each of the seven ambulances are in need of replacement, at a cost of $55,000 to $65,000 each.
“These are one of the lifelines that we use to help treat critically ill patients,” said Terkel. “These monitors are very high-tech now. They are external pacemakers, they act as defibrillators, they do diagnostic 12-lead EKG’s and we transmit those EKG’s to our partnering hospitals. So there’s a lot of tech now that goes into them, and obviously the cost increases with the technology.”
MRTSA recently replaced its seven stair chairs, wheelchairs with treads that allow them to glide down stairs, instead of medics having to lift them. Total cost of replacement was $49,000.
MRTSA has always had a great working relationship with the Mt. Lebanon Police and Fire departments, but Terkel says some communities are not as fortunate to have those resources.
“Having a career fire department is a benefit for quick response to medical calls if necessary. We feel very fortunate to have such robust police and fire departments as our partners, while at the same time believe we can do a better job working together.
“My goal moving forward is to have more integrated training with our public safety partners,” he said. “We have to function together as a unit when we’re on calls that involve all three services. I would say we do a really good job, seeing that we don’t typically train together, but I would say that if we spend, you know even if it’s one or two training days a year, having all three of us together, I think that we’ll create a more cohesive unit.”
If scheduling training with all six communities is too hard to manage, Terkel believes that even a high-level chiefs’ meeting could help bridge the gap.
“With my longevity and the relationships that I’ve established with the police and fire chiefs here, that will be something that MRTSA will look forward to.”