Cincinnati’s first-ring suburbs face unique challenges. Changing demographics, economic stability, and issues regarding resources and security are common threads among these jurisdictions.
The ways the 49 Hamilton County cities, villages, townships, and municipal corporations not only adjust but thrive is the focus of this series, First Suburbs—Beyond Borders. The series explores the diversity and ingenuity of these longstanding suburban communities, highlighting issues that demand collective thought and action to galvanize their revitalization.
The demand for emergency medical service has increased dramatically in recent years in the small towns, villages and townships around Hamilton County, far outstripping any growth in their population.
Calls for medical care have increased 40-50% in some communities over the last 10 years while the population has remained stagnant. Going back 20 years, calls to 911 have doubled or more in some cases. Aggravating the demand, many of the incidents are more severe, requiring intensive levels of care and time.
The long-term trend has stressed the budgets of these small towns, many of which are already operating on thin margins. Some have turned to creative ways to stretch their resources, refurbishing old ambulances, adopting new shift schedules, and following up with residents to prevent repeat calls. It’s also meant local government leaders asking their residents for more tax dollars to fund emergency services.
“We’re struggling to keep up with the demand,” says Sam Keller, mayor of Cheviot.
In that west side city of 8,500 people, the number of emergency medical runs has more than doubled over the last 20 years, increasing by 144%, says Fire Chief Bob Klein. The city’s population actually decreased during that time.
In Miami Township, in the county’s far west quadrant, calls for service have increased 40.5% since 2010, township officials say. The township’s population has grown only incrementally, 1.3%, during that time.
In Colerain Township, population 60,000, emergency medical runs have increased 35% over 10 years, according to
township records. The population grew just more than 1% over that period.
In Green Township, the most populous township in the county with more than 60,000 people, calls for service have increased by 15% just since 2021, says Administrator Frank Birkenhauer.
Aggravating the trend, the incidents have become more severe, says Jeff Weckbach, Colerain Township’s administrator. “Those runs that require more care is where we've seen the growth,” he says. These so-called advanced life support runs can include providing cardiac care, breathing tubes, and intravenous medications.
What's behind the trend
First responders and government officials say they see several reasons behind the trend. One is the overall aging of the population, as the oldest of the Baby Boom generation is now approaching 80, with the youngest in their 60s. “A lot of it has to do with the aging demographic of our population,” Weckbach says.
“As folks get older, the type of care that they need tends to be a little more intensive.”
With an over-65 population, “You see an increased prevalence of falls; you see an increased prevalence of cardiac-related emergencies, and diseases like chronic obstructive pulmonary disease, congestive heart failure, and diabetes,” says Will Mueller, assistant fire chief in Colerain.
Falls are the number-one reason for emergency runs there, accounting for about 15% of emergency runs. “It's not overdoses; it's not heart attacks, or car crashes. It's falls,” Mueller says.
Mueller and others see another trend contributing to the outsized demand for emergency care. People appear more ready to dial 911 when they have a problem than they did years ago. For many, 911 has become, in effect, the first call when care is needed, not the family doctor.
“They almost rely on 911, the local paramedic services, as their doctors,” says Rick Bley, director of safety services in Springfield Township. “Every time something happens, they rely on you as their health care.” Calls for emergency service in the township increased by 25% over the last 10 years even as the population declined slightly.
After decades of public awareness campaigns around 911, its widespread recognition as the universal emergency number, and the awareness that tax dollars support the service and the people who respond, there appears to be a shift in the public’s overall willingness to call for emergency help.
“It seems like there is a psychological difference now in how to use the 911 system,” says David Miller, captain of Cheviot’s emergency medical service. “We've always been here to help, and we always will be here to help, but there does seem to be a difference in how people view the purpose of an emergency ambulance in their community.”
While an aging population and a readiness to call for emergency help are contributing to driving the demand, there’s another, darker, reason. There’s been a significant increase in episodes of mental health breakdowns, several emergency responders say.
In Green Township, for example, in just one year, from 2023-2024, there was a 75% increase in mental health-related calls, says Chris Godfrey, the township’s fire chief. Many of those calls were for suicide attempts, he says.
Following the pandemic of 2020-2021, first responders in Colerain Township saw a 16% increase in psychiatric crisis emergencies, Assistant Chief Mueller says.
It’s unclear whether there’s been more awareness of mental health issues, less stigma around seeking help, a reaction to the pressure of social and environmental conditions, bullying, the pervasiveness of a social media-driven culture, or all of the above, but first responders say they see the results.
“There has been a drastic increase in psychiatric emergencies across all age ranges, across all ethnicities, and both genders,” says EMS Captain Miller. “It is a widespread issue.”
Based on his experience, Miller says among children he often sees a defiance, chronic disobedience, or anger at home or school. With adults, it’s often threats or thoughts of harming themselves, he says, sometimes because they have stopped taking prescribed psychiatric medications.
In Springfield Township, population 36,000, first responders are paying more attention to training in mental health response and in preventing repeat calls for such issues, Bley says. “A lot of people in the community are suffering from mental health issues that prevent them from being able to really care for themselves, or they're relying on the resources of the local government to help them,” he says. Training responders to refer people to the kind of ongoing behavioral care they may need, can result in better mental health care and cut down on psychiatric emergencies.
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Joe SimonThe cost of a new fire truck now approaches $2 million.
Costs of equipment, vehicles increasing
While demand for emergency care has skyrocketed, so has the cost of providing it. The cost of emergency vehicles has escalated in recent years, forcing governments to hang on to fire trucks and ambulances longer.
The cost of a ladder truck has doubled over 10 years. In 2014, such a vehicle, which carries extended ladders to reach upper floors, and is outfitted with other specialized equipment, cost about $900,000. Today, the cost is close to $2 million, says Green Township’s Birkenhauer. The cost of a new ambulance has risen nearly 50%, going from $250,000 to $350,000.
To save money, the township has purchased used trucks from Anderson Township and from a fire company in Pennsylvania. That purchase meant a red fire truck has now joined Green Township’s once all-white fleet.
Cheviot’s fire department is working with a 27-year-old pumper truck. Its newest fire truck is more than 11 years old. Cheviot has saved money by buying ambulances that were built as demonstrator models. “You’ve got to have connections,” Chief Klein says. “That's what you get when you've been around for 36 years.”
In Colerain, rather than completely replacing an aging ambulance, mechanics lift off the chassis and mount it on a new engine and mechanical system. “We call that a remount,” Weckbach says. “We can essentially remount the same box three or four times and save significant dollars in the process.”
Wait times to receive new vehicles that have been ordered are extraordinary. It takes three years after the order for a new ambulance to arrive, Springfield Township’s Bley says. Miami Township recently took possession of a new fire truck that was ordered nearly three years ago. It cost $850,000, but had to be insured at today’s value -- $1.3 million, Administrator Brett says.
Taxes for emergency services rising
Steadily rising demand, surging costs, and the need to stay competitive in salary and benefits has resulted in ballooning costs for public safety. And that has towns and townships going back to the voters seeking more money to pay for it.
On the May 6 ballot, Miami Township is trying for a second time to pass a tax levy for fire and emergency medical service expenses. In the November 2024 election, the township had asked its residents to approve a 6.5 mill levy for fire and EMS. That included the renewal of an expiring 3.5 mill levy, plus three additional mills to fund growing costs. It failed, resulting in the loss of more than $900,000 in the township’s 2025 budget. The township has reduced its request to 4.5 mills on the May ballot.
If the levy fails, “We’ll have to look at closing a station,” Brett says. “We certainly don’t want to do that.” Layoffs of fire and EMS personnel would also be likely, he said.
Miami Township provides fire and emergency services to the village of Addyston, whose voters in November renewed a five-year tax to pay for those services.
It also provides service to the neighboring villages of North Bend and Cleves. Voters in North Bend passed a renewal of a fire and EMS levy in November, but a request to add another 2 mills to property tax bills, which would have raised another $101,000 a year, failed. The 2-mill increase is back on the May ballot in North Bend.
Officials in Cleves did not vote to put tax proposals on the ballot this year or last. Despite that, Miami Township signed five-year extensions of its agreements to provide services in Cleves, as well as in Addyston and North Bend. However, the township can opt out of the agreements if its May 6 levy does not pass, Brett says.
In November, paying for fire protection and emergency medical services was on the ballot seven times in six different communities. Springfield Township’s trustees had warned that if its levy did not pass, “reserve funds will be depleted and the need to reduce services, as well as continue to use outdated and old equipment, would be necessary.” The tax was approved.
In Greenhills, which once relied on all-volunteer force, voters last fall passed a new tax to begin paying its fire and emergency medical workers.
New solutions
But tax levies depend on the moods of voters, and with costs rising so much, local governments have turned to creative methods to save money, such as remounting old ambulance chassis and buying pre-owned or demo models trucks and ambulances.
Colerain, using a grant from AARP, will also install grab bars in homes for free, as another way to prevent falls. So far, the program has resulted in a 90% reduction in repeat falls.
The township also recently began a motor-vehicle crash billing system. When a non-township resident is involved in a car accident in the township, their insurance company can be billed for the cost of EMS and police personnel responding. Other cities have adopted similar programs. In Cheviot, EMS billing brings in nearly $400,000 a year.
In Colerain, to try and control the number of emergency calls, officials are employing a method called community paramedicine. The township has hired a full-time professional whose job is to follow up with people who have been released from a hospital. They check in with them, ask about their medications, encourage them to take them properly and analyze the home to see if it’s safe for recovery.
That’s especially important in the case of people injured from falls, as an analysis can suggest ways to prevent another fall. “Their sole job is to provide these sort of wraparound services to hopefully prevent EMS runs,” Weckbach says. Springfield Township is also experimenting with the community paramedicine model, Bley says.
Preventing emergencies pays off for residents and for their local governments. As demands for emergency services continue to rise, it will be just one way that communities respond.
The First Suburbs—Beyond Borders series is made possible with support from a coalition of stakeholders including the Murray & Agnes Seasongood Good Government Foundation - The Seasongood Foundation is devoted to the cause of good local government; Hamilton County Planning Partnership; plus First Suburbs Consortium of Southwest Ohio, an association of elected and appointed officials representing older suburban communities in Hamilton County, Ohio.