Commission focuses on EMS sustainability

Calling 911 doesn’t guarantee that an ambulance will be sent to your aid.

At least, it’s not a guarantee in Wyoming, because emergency medical services are not considered essential.

This is something that could change in the near future, however, and the Crook County Commissioners are keen to start looking for ways to support local ambulance services now, rather than wait for the state to make its own changes.

At the request of Commissioner Jeanne Whalen, representatives from each of the county’s ambulance services were in attendance at last week’s meeting. Discussions centered on a listening session hosted by Governor Mark Gordon, at which Whalen heard in detail the problems with funding and sustainability that are becoming an increasing issue statewide.

“One of the things they talked about was…EMS as an essential service,” she said, noting that this would require a funding source.

It’s early days for this conversation at the state level, Whalen said, so is there anything that can be done at the local level to make the county’s ambulance services more sustainable?

Status Quo

Because each of the four Crook County ambulance services works differently, and so their organization and funding sources are “all over the place,” Whalen asked the representatives to describe in detail how each operates.

Speaking for Moorcroft, Dorothy Baron said the EMS is owned by the city and operates with a small group of volunteers, relying on assistance from members of the fire department to drive the ambulance. The bills are paid through the revenue collected; however, she said, this doesn’t really meet the costs.

“The city eats it,” contributed Commissioner Fred Devish, who has previously served on the Moorcroft Town Council and is a member of the town’s fire department.

Pine Haven works in a similar manner, said Dusty Downey. That town’s service is also under the auspices of the town and relies on the fire department for ambulance drivers; currently the Pine Haven service has around four volunteers, though all of them work so are not always available in the day.

Anthony Vopat spoke on behalf of Sundance, where the ambulance is a paid service through Crook County Medical Services District and employs four full-time paramedics, with members of staff available to drive.

In Hulett, said Jason Perry, the ambulance service is an independent 501c3 that includes three paramedics, four EMTs and one advanced EMT, with the driving taken care of in-house. It doesn’t make enough to sustain itself, he told the commission, and depends on donations to continue.

As the conversation moved to the kind of service each offers, Downey explained that there’s a reason Pine Haven has opted for a basic EMT service, rather than one at an advanced level. The more sophisticated the service, the more equipment is needed to sustain it – and that can be prohibitively expensive.

However, a paramedic intercept can be requested if a patient would benefit from more advanced care, such as an IV, before reaching hospital. Said Baron, EMTs are able to tell when this is the case, rather than when the priority is to simply get that patient to a medical facility.

Whalen commented that it’s impressive to see four departments that operate so differently but all work together, covering one another during times when one town has a shortage of EMTs.

“We’re in a position where nobody else has our back [financially speaking], so we have to have each other’s,” agreed Perry. “That’s not sustainable, though.”

Representatives also spoke to the shortage of volunteers, which Perry noted is something all services struggle with. “It’s nationwide,” he said, pointing out that becoming an EMT requires more than 170 hours of certification training.

Whalen also asked why it is that Crook County’s EMS services offer so many classes, but still have low numbers of volunteers. Perry explained that, while some do stick around, the classes attract younger attendees for whom it can be a career stepping stone.

“It’s an issue that’s been building,” said Vopat, telling the commission that there was a spike in volunteerism across the nation after 9/11 but there has since been a 27% decrease.

Looking Ahead

We all acknowledge there’s a problem with financing and sustaining ambulance departments, said Devish. Is there a solution everyone can come together on?

With that in mind, the commission questioned whether the individual county services would benefit from being defined as essential and having access to a guaranteed source of income.

Absolutely, said Perry, although he clarified that the departments would not be expecting to receive a large amount of money. Rather, he explained, it would open funding doorways such as the ones currently available to fire and law enforcement.

Becoming an essential service would also get “more eyes on the problem”, he added, and those eyes would likely be in a better position to do something about it.

Vopat agreed, saying that the funding opportunities would likely take a couple of years to materialize, and that it’s impossible to know what it would look like. However, he said, it’s great that the issue is being talked about and that conversations like this one are occurring.

In terms of future funding, the idea of a rural healthcare district that collects a mill levy was considered by all to be unlikely to pass a public vote. As Whalen put it, citizens will wonder why it’s necessary when they already fund a medical district, while Commissioner Kelly Dennis commented that property tax increases make it more likely than ever for people to resist.

Another alternative on the table would be a “stupid tax” that would, for example, increase the fines levied for DUI convictions and direct those additional funds to EMS. There are a “ton of ways” it could be funded as an essential service that don’t involve a mill levy, said Perry.

The commissioners stressed that their goal is to offer support however it’s needed. The county will do whatever it can to push it, said Devish, while Whalen stated that she would prefer to be proactive than wait for the state to find an answer.

Whatever the future holds, all four EMS representatives were adamant that giving up is out of the question. There are always good people to volunteer and ways to raise money, Downey said.

“We’ll find a way, but it could be a lot easier than it is,” he said. “We’ll survive. We will survive.”