Ari Meisel – Princeton First Aid & Rescue Squad Executive Director

Mark Freda: Ari, thanks for joining us today.

Ari Meisel: Thanks for having me, Mark. It’s always good to see you.

Mark Freda: So let’s talk a little bit about Princeton First Aid and Rescue Squad, or as many of us call it, PFARS. PFARS is made up of both career and volunteer EMTs. Do you want to talk about how that all works?

Ari Meisel: Yeah. So that is a fairly typical model that you’ll often see in different EMS agencies, but what is not typical at PFARS is that the integration between the two is indistinguishable in most cases. Not only is it set up that way in perception, but we really work very hard to maintain that. When we’re on the scene of an accident or an incident, we don’t want police, the public, or anybody else to inherently be able to tell the difference between a volunteer member and a career member.

So we train them to the same standards, and we hold them to the same standards. Another thing that you’ll often see in some squads is that they’ll actually separate it—you have a truck that is all volunteer or a truck that is all career staff. You just rob people of the opportunity to really learn from each other in that case. So we are really adamant about not distinguishing between them.

Mark Freda: Yeah, it’s a great model. So in addition to emergency medical services, PFARS performs a lot of technical rescue services. Maybe you could talk about those.

Ari Meisel: That is something that is extremely unique for us because typically, across the country—and I’ve worked in seven different squads over the years—technical rescue is often performed by the fire department. They have the equipment and the expertise. With the origination of where PFARS came from, rescue was always something that we handled and did, and we have developed a level of skill that seems to be a model for a lot of other people.

We handle rope rescue, motor vehicle extrication, ice rescue, swiftwater rescue, trench rescue, elevators, structural collapse.

Mark Freda: Confined spaces.

Ari Meisel: Confined spaces, thank you. Yeah, if somebody gets stuck in a big air conditioning duct, that’s where we come in. The thing is, it seems simple, but really what it is, is that we need rescue services for when we can’t get to a patient or we can’t get a patient to us. So it makes sense in a lot of ways that we would do that, but it certainly adds an additional interesting element of our training and equipment needs.

Mark Freda: Yeah, good point. Related somewhat to that, Princeton First Aid and Rescue Squad does work hand-in-hand with the Princeton Fire Department in a number of areas, so maybe you could elaborate on how that works.

Ari Meisel: Again, it’s so fascinating over the years to see places where you have a really adversarial relationship between different first responder groups: police, fire, and EMS. I have to say that we have a really incredible working relationship with our fellow first responders here. We basically have police show up on every single scene to be there to help with whatever they can. When there is a fire call, we’re there right beside them.

The other day during that really bad heat wave, we proactively put into action essentially that any fire call the fire department would be responding to, whether it was an actual fire or not, we were going to respond to as well to help support them because of the heat. So we have a great working relationship with them, and we will commonly be able to work cross-equipment. We’re trained on their stuff, and they’re trained on our stuff. The other day we had three days of swift water training at the CP pool that we were doing with them, so it’s a really productive relationship.

Mark Freda: Yeah. You know what’s interesting is that when I first joined the fire department, the people that recruited me to join the fire department several months later recruited me to also join the first aid squad because they belonged to both organizations.

Ari Meisel: Yeah. It’s great. It speaks to how the two are able to work together. What I will say about that too is that a lot of municipal fire departments will also have their ambulances under the fire department, and they’ll have people who are firefighters and EMTs. In a lot of those situations, the firefighters will default to fighting fires, which makes sense. It’s tricky sometimes when you have that under one roof. If you have them in two different organizations that can work really well together, that’s probably the best of both worlds.

Mark Freda: Yeah, because in the scenario you just talked about, if you have to be a firefighter due to a fire, you most likely have nobody left to be on the ambulance. So now you’re hoping that another town’s going to be able to send an ambulance to help you.

Ari Meisel: Correct.

Mark Freda: Another advantage of the model that’s here in town. It has a lot of capabilities that people don’t know about. If you talk about all the different types of vehicles and how many you have.

Ari Meisel: We have quite a few. It’s a very impressive fleet, I have to say, and we get to use all of them. We have five ambulances, one of them is a reserve ambulance. Additionally, we have a beautiful rescue truck, which is essentially a large toolbox on wheels, but it’s got all of our vehicle extrication equipment, ropes, breathing apparatus, and all that kind of stuff.

We also have a UTV, our Gator, which is what we use when we need to get to people who are off in the woods, on Mountain Lakes trails, or on the towpath. We have a boat, which we will commonly use on Carnegie Lake or other places that might need it. We also have two first responder vehicles: one SUV and one pickup truck.

Lastly, we have our rehab truck. We are the only rehab unit in all of Mercer County. Rehab is basically when there’s a large-scale incident or a long-standing fire, and we are there to support the first responders to create a dry, warm, safe environment where we can check them out and get them back into the field as quickly as possible. I think those are all the vehicles. Probably a bicycle in there somewhere.

Mark Freda: And then there’s an Office of Emergency Management vehicle.

Ari Meisel: Right. That’s not our vehicle, but we are certainly one of the groups that are going to operate it. The high-water vehicle is the newest addition to the overall fleet that we have access to, and that thing is quite literally a beast. It is an old Army deuce and a half that can drive through 50 inches of water. What’s really interesting about it is that the back platform comes down so you could drive into a flood area, and then boats could come up to it. We’re going to decrease the time required to get people out of the water onto the boat and onto the vehicle for rescue.

Mark Freda: Yeah, a great addition to the capabilities of rescue operations in the entire town. Here’s one that I think there’s often confusion by the public about: PFARS is not municipally funded, right?

Ari Meisel: That is my biggest PR challenge of all PR challenges as the executive director. We are minimally funded, and I say that with all the gratitude that I can because the town is very supportive of us, but we get about 5% of our budget every year from the town. A lot of that is because of a statutory limit that we have here in the state of New Jersey, which is unfortunate and a little outdated.

So it is not that the town doesn’t want to support us; it is literally that statutory limit. The town gives us about 5% of our budget every year, and everything else that we raise or bill is how we survive. About half of our budget comes from billing, and the other half comes from fundraising, grants, begging, borrowing, and stealing where we can, we don’t steal anything, just to be clear. But it’s an expensive service to provide.

Mark Freda: Isn’t it?

Ari Meisel: Yes, it is, and getting more and more expensive every year. Not only is it more expensive, but it’s less reimbursable. Revenue is harder to come by. Our annual budget’s about $2.25 million, and that enables us to answer the roughly 3,700-plus calls we have every year here in town and some of the neighboring towns as well.

Revenue has been harder to come by because of insurance requirements, the lack of Medicare and Medicaid reimbursement, and the things that insurance companies decide people don’t need an ambulance for anymore. It’s a constant challenge to work through those and try to get those two to meet in the middle.

Mark Freda: Yeah. Here’s a good example of cost: what did an ambulance cost five or six years ago versus today?

Ari Meisel: About five years ago, you’d probably get a brand-new, beautiful ambulance for about $160,000. That was just for the ambulance, because then there’s all the equipment that has to go into it: the AED, a LUCAS device if you have that, and the loader for the stretcher, which is a whole other bunch of money. Nowadays, an ambulance is approaching close to $500,000, and it takes two to three years to get one. The drivers for that—some of that was COVID, steel, and all sorts of things—but also a lot of the ambulance companies have been getting bought up by private equity. So there’s just less of them, less competition, and a greater need for ambulances.

Mark Freda: Kind of a strange thing that private equity is in the emergency vehicle business and looking to profit off it versus just…

Ari Meisel: For-profit is always fine, but yeah.

Mark Freda: Kind of strange. You spoke to this, but again, I just want to make sure people understand that. If I wanted a brand-new ambulance at my front door in, say, January of 2029, when do I need to order that thing?

Ari Meisel: Probably about six months ago.

Mark Freda: See, that’s crazy.

Ari Meisel: It really is. There’s almost next to nothing you can do about that. The only thing you could potentially do is try to get a used ambulance, which some people do, but there’s an element of customization that any ambulance company is going to require. Part of that is because, like I said, we have five ambulances. We don’t want a situation where somebody has to be trained on how to operate and provide care in each one of those five; we need them to be as similar as possible.

Every ambulance company is going to have different needs. Some are going to carry different equipment; some are not. There are ambulances out there that will take two patients, made by Frazier, for example, which is not something that we need, but some people do. So there is basically nothing you can do other than just do your best to plan ahead.

Mark Freda: Yeah.

Ari Meisel: Let’s change things up a little bit. Ari, where did you grow up?

Mark Freda: I grew up in New York City, in Lower Manhattan. My father has had an art gallery there for about 50 years at this point, and that’s where I grew up.

Ari Meisel: Okay. How did you become interested in EMS?

Mark Freda: When I was 23 years old, I was diagnosed with Crohn’s disease, which, for those who don’t know, is a chronic inflammatory condition that affects the digestive tract. It’s considered to be incurable and is very debilitating. There’s a separate story of how I eventually was able to overcome this supposedly incurable illness, which I have been free of for almost two decades now.

Part of that journey was to gain more medical knowledge and learn more about the human body. In addition, I had aging parents, and my wife and I were getting ready to become parents, so I signed up to take an EMT class at John Jay College. That was great. My first volunteer experience was in Upstate New York with the New Paltz Rescue Squad, which is 100% volunteer. My very first call was an 18-year-old college girl who overdosed, and we were able to save her. I was hooked.

Ari Meisel: It is a great occupation, whether you’re a volunteer or career, to know that you can go and help somebody at a time when they might be in very dire circumstances.

Mark Freda: Yeah. I have five children, and my twin 13-year-old boys are very interested in becoming EMTs. I’ve actually started them on the curriculum now. I’ve been teaching them every day, going through some of the curriculum. My plan is that when they sign up to take their NREMT, they’ll just have it down pat.

There is an interesting level of empowerment that this skill set gives people, especially young people. It’s not just the ability, but it instills more of a willingness to help. Furthermore, I recognize that I’m very privileged to be able to do this stuff, and there are a lot of people who really need this kind of help. Being able to do that and see that has been an incredibly humbling experience in my life.

Ari Meisel: Yeah. For a young person, I think there are life lessons and skills that you’re going to learn as an EMT that would take decades to learn just going through standard jobs. It’s very different.

Mark Freda: Yeah. It’s funny because I have five children, and I’ve had other parents say, “I don’t know how you do it. That would be so overwhelming to me.” And I’m like, “I have been in a room where somebody is dying in my hands, the family’s screaming at me, and there are police banging down the door. This is nothing.” It gives you a really interesting perspective.

When somebody feels that level of overwhelm, this equips you with such a level of stress inoculation. What I will say too is now in EMS, there’s such a better focus on mental health. Even when I started 15 years ago, if you saw something bad, it was kind of like “suck it up and move on,” which is not healthy. Now there is a much better focus on mental health resources, debriefing, and supporting that. Even learning that skill is fantastic, to be able to talk to a coworker and say, “Hey, that wasn’t a normal thing that we just saw. Let’s talk about it.”

The only other thing I could put almost at that level is that I also have my private pilot’s license, which I got when I was 15. That was an incredible skill because you’re learning how to manage all these different gauges, communicate on the radio, navigate, and keep a plane in the air. It feels like a very similar thing to me in some ways: having that understanding that if you’re put in a situation, you feel confident that you can handle it.

Ari Meisel: For a young person to learn those types of skills is invaluable.

Mark Freda: We both know that you have a new role at PFARS. Why don’t you tell us a little bit about what that is and how it’s going?

Ari Meisel: After serving as vice president for three years, I was given the opportunity to apply to become the new executive director. The organization has never had an executive director before, which is appropriate that it would because we are an independent nonprofit. I’m the first executive director in the history of the squad, which is an incredible honor. It’s been really great because, at the end of the day, it is a business in many ways. We are serving customers, getting revenue, and dealing with expenses.

My background is in business coaching, productivity, and operations, so I’m able to bring a lot of that to it. Having all the EMS experience that I have informs that even better. I’m really proud of the culture that we have right now and the operational efficiencies that I’ve brought to some of the things that we’re doing. It’s just a great opportunity to be able to help my community.

Mark Freda: Yeah. I think the community’s lucky to have somebody like you, because having the EMS background combined with business knowledge and experience is hard to find. Running that type of organization is very different than just saying, “Oh, I’m going to hop on the ambulance and go help Mark with a sprained ankle.”

Ari Meisel: That’s correct, yes. It’s a very complicated landscape that we’re dealing with. We’ve got regulatory issues, judicial issues, HIPAA, and all these different things. But at the end of the day, we have people who are showing up, doing a job, and working. It’s a lot of fun.

Mark Freda: Yeah, that it is.

Ari Meisel: If somebody out there listening to us says, “Gee, I want to join Princeton First Aid and Rescue Squad,” how do they do that?

Mark Freda: Please do, first of all. Volunteerism is down across the board in this country. Volunteerism in EMS is down even further, and volunteerism in EMS in New Jersey is down even further for all sorts of reasons. We really want people to experience this and give those who want to help their community that opportunity.

As a volunteer, you do not have to be an EMT to join the squad. We will help train you and get you to the point where you can take an EMT class. Under the right circumstances, we can actually help cover the cost of that EMT certification. We’ve also introduced a new volunteer path recently called the Community Responder Program. Previously, we were requiring new members to come in and do 32 hours a month and go through module trainings to get up to our standards. Now, we are asking people to commit 16 hours a month in their first 90 days so they really have an opportunity to experience it. We get to experience them and see how they like EMS.

I’ve had a couple of instances over the years where people went through the whole training, were on their very first shift with me, and never came back again because they realized, “Nope, this is not what I want to be doing.” We want to give people that opportunity. After that 90 days, once they’ve gotten through those first few training modules and duty hours, they can say, “I really like this and want to become an EMT,” and then we can support them on that full track.

We try to provide as much training as we can in-house, including opportunities for rescue training. The very first step is that on the first Tuesday of every month, I do a webinar info session that people can attend without obligation to ask questions and learn about what we do.

Ari Meisel: Yeah, that’s a great system. If somebody wants to support PFARS financially, how can they do that?

Mark Freda: Please do that too. There are a number of opportunities. Besides our annual events and fundraisers, there’s always an opportunity to support PFARS if you want to make a donation because you or someone in your life was touched by what we did.

Most people listening to this will go through their entire lives and never call 911. A lot of people will, and hopefully, if it happened in our town, we were able to respond quickly and help. But even if you don’t call, you want to know that if you, your neighbor, or a loved one needs help, someone will show up when you pick up the phone.

EMS is not considered an essential service in New Jersey. A lot of people are shocked to hear that; there are only 12 states in this country where EMS is an essential service. That means your government is required to provide fire, police, and garbage service, but not an ambulance. It is not a guarantee. I don’t mean to scare people—there will almost always be an ambulance—but it won’t necessarily be an ambulance made up of people who know this community and respond in an average of six minutes or less. It may be another ambulance that takes much longer to get there.

The only way we can keep showing up is through community support and funding. There are opportunities to support the squad, get your name on one of our vehicles, or sponsor equipment that we need. We have our Spring Gala every spring, and this year for the first time ever, we’re having our first golf fundraiser in October. If you’re a golfer and want to support the squad, that’s an opportunity as well. But we’re happy to talk to anybody—if you want to support the squad, we’ll find a way.

Ari Meisel: If you just want to make a quick donation, you can go on the website and do that. But as you said, there’s plenty of other opportunities for more significant donations to help buy needed capital equipment. Equipment is expensive.

Mark Freda: Every dollar counts. A new AED is around $900 at this point, and we need one on every vehicle. We also have an automatic CPR device called a LUCAS device. Anyone who has done CPR knows how tiring it is after a few minutes, and outcomes are so much better with consistent, quality CPR. They cost about $17,000 each. If someone is in cardiac arrest and being transported for 15 or 20 minutes, we want to ensure they’re getting the best CPR possible. We need tools to cut open vehicles, as well as long, strong, reliable ropes. All of those things cost money, so every dollar really counts.

Ari Meisel: What I think might be interesting too is that we’ve talked about emergency medical technicians, but you have to have more training than just the EMT class or certification to really ride the ambulance. Maybe you could talk a little bit about some of the other classes that PFARS puts in place.

Mark Freda: Absolutely. For the majority of those additional trainings, we offer them in-house or provide the resource to take them. One class that is more and more relevant is TECC—Tactical Emergency Casualty Care—which is essentially active shooter training. I’m certified in that, and all of our career staff are certified in it. You learn how to operate in active shooter environments, reach patients, identify people, and manage chaotic environments.

There’s also PEPP for pediatric care, as well as specialized trauma classes like ITLS and PHTLS. These specialized certifications prepare us for situations we could come across at any given time.

Ari Meisel: It’s good to hear there’s a lot of training. The level of training required by PFARS exceeds that of a number of other EMS agencies operating elsewhere. The level of training required by different squads can vary quite a bit.

Mark Freda: Absolutely. This is the seventh squad I’ve been a part of over the years, and I’ve never been part of a squad that required this level of upkeep and enrichment. If a certification exists, we want our people to have it, which keeps everyone sharp.

Princeton doesn’t necessarily see the same level of acuity every day as some other municipalities, but that makes training even more important. We don’t see gunshots every day, but we need to know how to handle them. The training to stop a bleed for a gunshot is the same training you would use if someone got impaled on a construction site here. We keep refreshing and enriching, and that’s deeply ingrained in how we operate.

Ari Meisel: In June, the squad does an open house every summer, which is a free way for people to come look at the building and meet people.

Mark Freda: Exactly. We really are a community EMS provider. The open house in June is an opportunity for the public to come in, see the vehicles, touch the sirens, and meet the people who keep this community safe. You don’t have to wait for the open house, though—if anybody ever wants a tour, we are very happy to show you around our facility.

As squads in other areas struggle or shut down, municipalities often replace their homegrown volunteer/career mix with a private provider based out of a hospital. The level of care might be fine, but that crew is usually covering two or three towns. They don’t know your school or area, and they’re going to take longer to get there. It’s not the same level of care that a true community EMS provider offers.

Ari Meisel: Many towns that take over EMS provide one ambulance. PFARS has four active ambulances and a reserve ambulance, with two crews on duty during the day. The capabilities are very different.

Mark Freda: That’s right. We often have situations where we have two or three calls at the same time, so our ability to cover that ourselves is essential to maintain our standard of care. We don’t want a situation where a third call doesn’t get the proper care because we couldn’t get there.

This has been great. PFARS is an independent nonprofit, a great place to volunteer, and a great place to support financially. Ari, thanks for being here today.

Ari Meisel: Thanks for having me, Mark.