The challenge of rural EMS

In recent years, some emergency medical services in Wyoming have struggled to stay in business.

According to Dirk J. Dijkstal, Health Readiness and Response Section Chief for Wyoming Department of Health, at least 11 agencies have been replaced by another, consolidated or closed their doors since 2015.

The State of Wyoming does not mandate county government to provide emergency medical services. As a result, these operations have to find other ways to fund their businesses. Emergency medical service is a high-cost industry and healthcare insurance does not cover all the costs.

In the fall of 2022, the State published a Report to the Governor’s Healthcare Task Force which explained why the state does not designate Emergency Medical Services an essential service, which would mandate local government to fund it.

“Wyoming’s statutes regarding municipal and county powers do not designate any “essential service” municipalities and counties are required to perform,” the report read. “Instead, municipalities and counties are given authority to provide services, such as fire protection, but these are not required. Mandating EMS as an essential service may therefore unintentionally prioritize EMS above other public functions.”

The report went on to read that “21 of 23 counties are currently at their maximum mill levy. Unless taxing authority is increased, requiring counties to provide and fund EMS services would result in the overwhelming majority of counties needing to discontinue other services.”

The report did discuss a possible way to fund EMS in Wyoming.

“Should the Legislature move forward with an essential service designation, [Wyoming Department of Health] recognizes the importance of including a sustainable revenue stream in order to fund such a mandate,” the report states. “Potential solution: New statute to authorize County Commissioners to create an EMS District, similar to a Solid Waste District, to be voted on and approved by the constituents of a specified area.”

Emergency medical services in the rural areas rely on some volunteers to staff their operations, Dijkstal said.

“There has been a general decrease in volunteerism across the nation,” he said. “A lot of the volunteers have been aging out and there has been a decrease in who is willing to volunteer.”

The following bills proposed for the upcoming legislative session offer a partial solution to the funding issue.

Senate file No. SF0003, sponsored by the by the Joint Labor, Health & Social Services Interim Committee, reads, “Every state officer and employee shall receive up to twenty-four (24) hours of leave with pay during each calendar year to use when the state officer or employee is absent from work due to service as a volunteer firefighter or volunteer emergency medical technician in the state of Wyoming.”

Senate file No. SF0008, sponsored by the same committee, reads, “Volunteer firefighters, emergency medical technicians and volunteer search and rescue persons may elect to participate in the state employees’ and officials’ group insurance plan...These volunteers are eligible to enroll in the group insurance plan …after initially volunteering for ninety (90) days. After the ninety (90) day period is over, the volunteer shall have thirty-one (31) days to enroll in the group insurance plan.”

In Wyoming, operating EMS statewide has been challenging, Dijkstal said.

“Since 2015, we’ve seen 11 agencies at least replaced by another,” consolidate or close their doors, he said. Eleven others have had contractual differences, so another provider has taken over the area.

One of Carbon County’s EMS provides an example of how to successfully operate an ambulance/emergency medical service, but even it has challenges to face. Stayton Mosbey, director of South Central Wyoming Emergency Medical Services, said they operate under a joint powers board.

The towns of Riverside, Medicine Bow, Saratoga, Elk Mountain, Hanna, Encampment and Carbon County signed a joint powers agreement in 2009, as stated on carboncountywy.gov.

Mosbey said they formed SCWEMS as a way to provide service “the most economical way we can.”

Irene Archibald, chairman of the SCWEMS joint powers board, said most of the revenue to fund the EMS comes from the services it provides, but each of the entities contributes money. About one quarter of the budget comes from the contributions the municipalities and the county pay, Archibald said. It works well because it “gives us all a say.” Each entity contributes $34 per resident, based on the 2020 U.S. Census, she said. In 2009 when they formed the board, the cost was $30 per resident.

The board raised the contribution amount for the first time last year because of inflation, she said. Each entity appoints one member to the board, she said. The governing body makes the appointment. The EMS also gets some money from the state Industrial Impact fee paid by big projects such as the wind turbines, she said.

Mosbey said some emergency medical services in Wyoming are struggling to remain operational.

“There are several ambulance companies that have went under - Sweetwater Medics went out of business; Sheridan just consolidated with Campbell County Health,” he said. “That’s just a few of them in recent years.”

People are leaving the EMS and fire services, in part, because of “the low pay and benefits” and “poor work-life balance,” he said. Some EMS only pay minimum wage. The average starting pay in the U.S. for an emergency medical technician is $37,000 annually.

He said the night shifts can be “brutal. Some do 24-48 hour shifts, which means they have to be away from their families during that time.” Another challenge is the high cost of equipment, he said. Low call volume areas covering large geographical spaces is another drain on funding.

He said healthcare reimbursements are low. Medicare pays about 30 percent of what is billed. Some patients are uninsured and don’t pay and Medicaid pays even less than Medicare.

“The reimbursements don’t keep up with the costs [of operating the EMS],” he said.

Dijkstal said, on average, it costs $525,000 a year to operate one ambulance. Seventy-five thousand dollars of that is the cost of the equipment. This is the cost of “continuing operations” and does not include the cost to initially set up an EMS operation.

“It is a high-cost industry and the usage rate is what funds it,” he said. Low call volume is a challenge in rural areas.

Housing affordability is another factor, Mosbey said.

“The dynamics of families have changed,” he said. It now takes two peoples’ wages to support a family, leaving less time for volunteering.

“We are a combination department with paid volunteers and full-time staff,” he said.

Another challenge is communities like Encampment do not have an emergency medical technician living in town to respond to the scene before the ambulance arrives, he said.