"We struggle every month to pay our bills," said J. Michael Nye, the vice president of the company's board of directors. "We have no cushion."
The rescue company's leaders have asked for its annual contribution from the Washington County Commissioners to be increased from about $40,000 to $600,000. The additional money would compensate the company for the money it says it loses serving poor people who cannot pay their bills.
The outcome of CRS' financial crisis could determine what kind of care Hagerstown-area residents get when they dial 911.
A heart attack victim can expect a CRS ambulance to arrive within about five minutes. If the company is forced to cut back service, the next closest ambulance will respond, which will take at least twice as long.
To a person who has stopped breathing, those few minutes could mean the difference between life and death.
CRS, which has a substation in Maugansville, serves about 34,000 homes in Hagerstown, Maugansville, Mount Aetna, Long Meadow, Fountainhead, Cearfoss and Funkstown and Leitersburg.
The company responded to nearly 6,000 calls last year, more than Washington County's other seven ambulance companies combined.
In addition to rising payroll costs, CRS officials point to a number of other challenges. Among them are:
* A lack of support from the city of Hagerstown.
* Hagerstown's high concentration of low-income residents who do not pay their ambulance bills or donate money to support CRS.
* Changes to the company's service territory, which it says have reduced its ability to raise money.
* A declining number of volunteers to help respond to emergency calls.
One of Community Rescue Service's biggest problems is a challenge facing most volunteer fire and ambulance squads - declining volunteerism.
Twenty years ago, CRS medics worked for free. As late as 1992, CRS had only three full-time paid medics. Now, the company pays 25 full-time and 17 part-time medics.
Volunteer companies have been forced to hire trained professionals to pick up the slack for fewer volunteers. One of the major reasons, experts say, is the tremendous training requirements imposed by the state.
Requirements range from 100 hours for the lowest level of emergency medical technician to a 2,000-hour program for paramedics. Few people have the time or desire to complete such rigorous training for a volunteer endeavor.
"We're regulating the volunteers out of business," said Ron Horn, president of the CRS board of directors.
Horn said the company has brought in new volunteers in recent months. But most are in training and have not gained certification.
And history suggests they might not stay long.
Horn said the grueling nature of the work - particularly at CRS, which averages 16 ambulance calls a day - discourages volunteers from staying long.
"The burnout rate is extremely high," he said.
Richard "Dick" Mettetal, the regional administrator of the Maryland Institute for Emergency Medical Services Systems, pointed to societal changes that compound the problem.
More people in Washington and Frederick counties commute to the metro area for work, leaving less time to volunteer as a medic. Both parents often have jobs today, meaning their free time at night must be devoted to their homes and children, he added.
"They just don't have the time to take the training and then volunteer," he said.
'Overboard on payroll'
With fewer volunteers, the rising number of paid medics has caused payroll costs to skyrocket from $379,000 to $991,000 between fiscal years 1994 and 1999. CRS has budgeted $1 million in payroll for this year.
That is one of the major factors that has busted the ambulance company's budget and led its leaders to seek help, said Nye, the board vice president.
"We probably went overboard on payroll," he said.
Nye said the company has compounded its problem by its scheduling format.
Career medics work 24-hour shifts, with 72 hours off. This makes it more difficult to schedule volunteers to fill in gaps.
In contrast, the Williamsport Volunteer Ambulance Service schedules medics in 12-hour blocks, providing more flexibility in scheduling volunteers around paid medics.