In February, Oak Bluffs is a small town on a quiet island. By the second week of July, it is something else entirely. The year-round population swells with tourists, seasonal workers, second-home owners, and day-trippers off the ferry, and the number of people who might need an ambulance on any given afternoon climbs with it. The number of ambulances does not.
John Rose, Fire and EMS Chief in Oak Bluffs, has run that summer for years. He describes it as the clearest illustration he knows of a problem that resort towns across the country share and rarely talk about. The system is funded for the people who live there and used by the people who visit.
“We budget for the town on the tax rolls. We run calls for the town that shows up in July. Those are not the same town, and the gap is where people get hurt.”
A department sized for the off-season
Municipal EMS budgets are built on a year-round population. That is the number that sets the tax base, the staffing, the apparatus count, and the mutual aid agreements. It is a reasonable way to fund a fire and EMS department in a town where the population holds steady throughout the year. It works badly in a town where the population does not.
Rose says the summer load does not arrive gradually. It arrives on a ferry schedule. A single busy weekend can stack beach incidents, traffic collisions, alcohol-related calls, and the ordinary cardiac and stroke emergencies that happen at any population on top of one another, all competing for the same two or three rigs.
The visitor who does not know where they are
There is a second layer to the summer problem that has nothing to do with volume. The patient is often a visitor who does not know the island, cannot say which beach they are on, and assumes the medical infrastructure matches the place they came from.
Rose says the assumption is the dangerous part. A family from a city with three trauma centers does not understand that the island hospital cannot do what their hometown hospital does, and that a serious case means a transfer off the island by ferry or, when the patient cannot wait, by a Coast Guard helicopter his department coordinates. The expectation and the reality are far apart, and the gap usually becomes clear at the worst possible moment.
“They think they’re fifteen minutes from a trauma center. They’re not. They’re on an island, and the next step is a long way from here.”
The seasonal staffing trap
The obvious fix is to staff up for the summer. Rose says it is harder than it sounds. The people qualified to run these calls are not sitting idle in May waiting for a summer contract. Trained paramedics have year-round jobs somewhere, and the island’s cost of housing makes a seasonal hire close to impossible. A medic cannot rent a room for three months in a market priced for vacation homes.
So the department leans on the same year-round crew, asks them to absorb a tripled call volume for ten weeks, and watches the fatigue compound. The burnout that thins out small departments does not build evenly across the year. It builds in the summer.
What a fair model would look like
Rose argues that towns whose population swings with tourism need a funding structure that recognizes the swing. He points to a few directions worth pursuing.
Seasonal occupancy and tourism revenue, already collected in most resort towns, could be tied directly to emergency services capacity rather than flowing into general funds. The people generating the summer load would help fund the response to it.
Regional surge agreements, planned before the season rather than improvised during it, could move trained personnel and apparatus toward the coast for the months that need them. The model exists for wildfire and hurricane response. It does not yet exist for the predictable, calendar-driven surge that hits resort communities every year.
And housing, Rose says, sits underneath all of it. A department cannot hire seasonal help, it cannot house, and it cannot retain year-round staff who are priced out of the town they protect. Any serious conversation about summer staffing is also a conversation about where the responders are supposed to live.
The call that does not wait for September
The summer ends. The ferries thin out. The population drains back to its winter number, and the department goes back to running the town on the tax rolls. The crews who carried the surge are still there, a little more tired than they were in June.
“The ocean doesn’t check the calendar. Neither does a heart attack. We just have to be ready for both versions of this town, and we’re only funded for one.”
On Martha’s Vineyard, the booking calendars for next summer are already filling. The call volume that comes with them is already coming. Rose says planning for it now is the difference between a hard season and a dangerous one.