It’s something that keeps emergency responders in rural Utah up at night — what if someone in need of an ambulance calls for help and no one arrives?
The scenario isn’t unrealistic.
“There’s times when help is an hour or more away in these small communities,” said Darin Bushman, Piute County commissioner. With decreasing volunteerism, and more demand, it’s getting harder to provide ambulance service, Bushman said.
Compounding the problem is the fact that EMS is not considered an essential service.
“All our towns and counties are required to provide law enforcement and fire protection,” Bushman said. “But they don’t have to provide EMS.”
Bushman is working with state legislators to develop a series of bills to address the importance and sustainability of EMS services in the state.
Not every town has it’s own police department. Most small towns have agreements with their county sheriff’s office to provide law enforcement, Bushman said. He said a similar arrangement could be reached with EMS.
In some parts of the state, Bushman said cities that do pay to provide ambulance service are being relied upon to provide it to outlying communities.
“There is no buy-in from the municipalities,” Bushman said.
In Piute County, there are seven emergency medical technicians to cover an area of some 766 square miles. At least two of them work full-time jobs outside of the county, and another is a bus driver who is often out of town, meaning that there are times when residents of Piute County are dependent on Sevier and Garfield counties for EMS.
Another challenge is the state’s bureau of EMS is funded through fines and forfeitures. Since the state Legislature passed a justice reinvestment initiative in 2015, which modified the state’s sentencing matrix for many crimes, those funds have been depleted. Piute County went from between $5,000 to $6,000 each year from those funds to $800.
Complicating the issue further is the strain of tourism and travel on EMS. Bushman said Piute may have 100 EMS calls a year, and that 75 of them are during peak tourist season.
“All of our organizations are funded through billing,” said Mike Willits, Sevier County’s EMS director and president of the Rural EMS Directors Association of Utah. He said oftentimes people from out of state who are helped by area EMTs never pay the bill. The result is that in order to offset the losses, the price goes up and local people wind up paying more for ambulance services.
• Why is it hard to get EMTs to volunteer? EMS systems in rural Utah are generally a paid volunteer basis. This means EMTs volunteer their time for training and meetings, and while they may be on call, are only paid when they go on a run.
“We’re up about 200 calls from last year,” Willits said. He said many times EMTs are dispatched in support of firefighters or law enforcement, but the calls wind up being scenarios for which there is no bill.
Other times calls can burn up an entire day. Sevier County has four full-time EMTs and two part-timers. The rest of the roster is made up of paid volunteers. Willits said a class has to be hosted each year just to keep the same number of EMTs.
“Everyone has a lot of things going on,” Willits said. “People have jobs, they have kids and events they have to go to.”
The irregularity of the schedule creates a strain on EMTs, which inherently can be a difficult situation. Some calls can even result in mental trauma, which also plays into retention of EMTs, Willits said.
Another issue is training. Qualifications have been ratcheted up since EMS service began. In the early days, EMS in the region was often people being transported in a hearse owned by one of the local funeral homes to the hospital.
While the equipment and training standards have improved, it also comes at a cost.
“A basic EMT is really close to what a paramedic may have been 20 years ago,” Willits said. He said EMTs are trained to do more, faster, which while good for patients means more time in the classroom. He said what may become inevitable is the addition of more full-time EMTs.
• What can be done?
“There is no one silver bullet,” Bushman said.
The effort in the Legislature focused on addressing several issues, Bushman said.
First, is to make EMS an essential service, similar to fire protection and law enforcement, Bushman said. If cities, towns and counties are required to provide the service by law, that is a good first step, Bushman said.
Next, is to help find ways for municipalities to fund it. Many small towns don’t have large enough budgets to absorb extra costs for EMS, so finding a funding mechanism is also an important step to helping solve the problem, Bushman said. One solution could be to allow counties to add a local option onto transient room tax.
“It will move it from the local constituency base to those who are actually using the services,” Bushman said. He said a rural hospital tax could also be expanded.
Also, making EMS billing a certified debt is also a step toward solving some of the challenges. By making it a debt that can be pursued across state lines, the hope is to improve collection rates.