Opinion
Update, October 23: Cataldo, Chelsea’s ambulance company, is being sold to Coastal Medical Transportation Systems, which would combine two of the state’s largest ambulance companies. Our story has the details.
Chelsea sends a private company to its residents’ worst emergencies, and that company bills for every ride. It is time for the city to study whether Chelsea should run its own ambulance service instead.
This is not a radical idea. Many Massachusetts cities and towns already do it through their fire departments. The question for Chelsea is whether the money, the jobs and the control that come with it are worth the cost and the risk. The city should find out.
The ambulance business is consolidating
Emergency ambulance service in Massachusetts is increasingly run by a few large private companies. Coastal Medical Transportation Systems bought Fallon Ambulance and LifeLine Ambulance in 2022 and Alert Ambulance in May of this year. Cataldo, which serves Chelsea, has grown by buying Atlantic, Northshore and Lyons ambulance companies, and its website now lists 16 communities for 911 service. When fewer companies compete for municipal contracts, cities have less leverage. A city that can run its own service, or credibly threaten to, negotiates from strength.
The money
Ambulance transports are billed to insurers, Medicare, MassHealth and patients. When a private company holds the contract, it keeps that revenue. When a city runs the service, the city collects it.
The numbers can be real. Gloucester’s fire department runs two ambulances. In 2018 its EMS coordinator told the city’s Budget and Finance Committee that the service brought in about $1.3 million a year, according to the committee’s minutes.
The same minutes show the catch. Gloucester wrote off $510,355.27 in unpaid ambulance bills from 321 accounts that year. Insurers and public programs pay less than the billed rate, and some patients cannot pay at all. What Chelsea would collect depends on how many of its patients have MassHealth, Medicare, private insurance or nothing at all. Any study has to start from Chelsea’s real mix of patients, not from the billed rate.
The jobs
A city ambulance service means full-time EMT and paramedic jobs with city pay, benefits and pensions, based in Chelsea. Those are good jobs that do not require a four-year degree. Chelsea could build a pipeline from Chelsea High School and Bunker Hill Community College’s Chelsea campus into EMT training, and recruit people who know the streets and speak the languages of the patients they serve. Dennis Cataldo has said EMT work is often treated as a stepping stone with high turnover. A city job with a pension is a reason to stay.
The costs, honestly
Running ambulances is expensive, and some cities have tried and pulled back. In 2023 Revere’s fire chief told that city’s council a city-run service would be “prohibitively expensive,” putting the cost of outfitting a single ambulance at about $1 million. “We’d have to hire a whole other department to staff the ambulances around the clock,” he said. Melrose gave up its own ambulance service in 2025 and signed with Armstrong, saying it could not fill shifts without heavy overtime.
Chelsea would face the same staffing market every other provider faces. It would need vehicles, a station, billing, medical oversight and backup for busy nights. It would probably still need a private company for overflow and non-emergency transfers. Those are reasons to plan carefully, not reasons to never ask.
What Chelsea should do
The City Council should order a feasibility study of a city-run ambulance service, whether run by the fire department or as a separate city service. The study should answer plain questions:
- How many ambulance calls and transports Chelsea has each year, and what they would bring in at real collection rates.
- What it would cost to staff, equip and house the service, including pensions and overtime.
- How response times would compare with what residents get now. That starts with the city publishing the response times it has today.
- How many jobs it would create, and how Chelsea residents could be first in line for them.
If the answer is that the city would lose money or service would suffer, Chelsea will have learned that cheaply and can negotiate its next contract with real numbers in hand. If the answer is that a city service would pay for itself and put Chelsea residents to work answering Chelsea’s emergencies, the city should do it.