(Fremont County, WY) – EMS ambulance services in Wyoming was the topic of discussion in a webinar hosted by AARP on Monday, with the panel, presenters, and participants hoping to gain a better understanding of the critical needs, issues, and problems that the areas and counties of Wyoming face when it comes to emergency services.
AARP host Tom Lacock introduced the panelists at the table, which included Senator and Kemmerer Fire Chief Fred Baldwin, who is also a co-chair of the Labor Health Committee.
Giving a presentation with information and statistics was Jennifer Davis, the healthcare policy advisor to Governor Mark Gordon. The webinar walked participants through the EMS services issue, as well as possible solutions to the problem.
Lacock also introduced Fremont County Commissioner Larry Allen as one who “has seen its services struggle with budgets and qualified personnel,” Lacock said. Commissioner Allen said that he hoped to raise some awareness as to how the EMS services are struggling and “how we can provide a more secure base for them to operate on.”
“A lot of hospitals operate their ambulance services, and those ambulance services are fortunate because the reimbursement level is a lot higher than what we have as a private provider that we have in Fremont County,” Allen continued. “But I hope that we can come to some kind of an agreement on how we can get this funding to make it more stable. …How to recruit more individuals to go to work there and make it more attractive for maybe outlying areas or providers to come in and offer their services at maybe an affordable rate.”
EMS: “Not required to exist”
Jennifer Davis’ presentation gave an overview of Wyoming demographics in regard to size, geography, topography, populations, highway, interstate traffic and closures, tourism and visitors, accident data, as well as the currently mapped EMS systems and 30-minute response times all over the state.
EMS is not designated as an essential service in Wyoming, and in June 2023, the Legislative Committee rejected the essential service designation.
“I think the main thing that stands out with emergency medical services in the state of Wyoming is that they are currently not required to exist,” Davis said. “What I hope people will learn (today) is the status of our current EMS system, and some ways that we can hope to make that sustainable over time…and sharing with all of you the reality of what our system is now, some things we need to improve it…and then hopefully, for all of you to share with your friends and neighbors about the situation that we’re in so that we can really have a better understanding around the state where we’re at, and then encourage us as the government, both the executive branch and the legislative branch to act on this.”
The lack of help and support for ambulance services is not just a problem in Wyoming, but nationwide, especially in rural areas. Ambulance services have run out of both money and volunteers.
“What we see in Wyoming of our own system is that there is a large percentage of our EMS services that are run by volunteers,” Davis added. “What that means is that what it’s currently costing Wyoming to operate these services….we know that we don’t have the sustainable funding to even support what we currently have. Volunteerism is drying up in our country in this case as well as others. So it’s really hard for these entities to recruit volunteers because people need to have a paying job…and so what we are seeing is that some of the volunteers who are older are opting to leave the space, just due to aging (and this is a demanding profession) and we don’t have young people coming in behind them because the younger generation is needing to work…or work a couple of jobs and either doesn’t have the time to volunteer or it’s just not something that they’re wanting to do at this point in time.”
Besides the lack of sustainable funding, reimbursement system, and an aging workforce, other problems include a lack of consistent operational structure, EMS responding to regular mental health calls as first responders, and a decline in EMS program enrollment.
Davis also mentioned Wyoming’s number two revenue source: Tourism.
“In 2022, we had 7.5 million people visit our state,” she said. “They’re spending about $4.5 billion on goods and services, and we’re getting about $257 million in tax revenue from that. What that also means is that 7.5 million visits to our state is putting additional stress on our emergency services…accidents on the interstates, hiking injuries in our parks…all of those things are from individuals coming from outside of Wyoming who are also utilizing our EMS services that we’re having a difficult time sustaining.”
Wide Open Spaces: Accessibility
“Wyoming has 97,000 square miles, with 6 people per square mile. “We’re very large and very spread out, which means that taxes our resources even more because we need to be able to reach those rural areas,” Davis said.
“Another consideration is that 99% of Wyoming’s geography is land, and 0.7% water. “We have at least 250 named mountain passes in Wyoming…which means we have medical services needing to also access individuals in remote areas, across mountain passes…which makes it difficult in the winter months to access people.
“Commercial traffic also moves through the state on I-90, I-25 and I-80. “We also need to have EMS available along those busy areas. The other thing to take into account is… unfortunately, our roads are closed a lot in the winter months…so again, that makes things really difficult.
“What we know is that citizens really lack knowledge of the current system,” Davis said. “I think we take advantage of it within our state and in our communities. And I will even admit it, I didn’t know this for many years as well, but I just assumed when you pick up the phone and call 911, someone will eventually show up. That could be a non-reality in Wyoming if we don’t figure out how to fund it.”
Commissioner Allen gave a brief history of EMS services in Fremont County…starting with the services being county-owned and operated with volunteers and ambulances…to privatization, with the county now currently under contract with Frontier Ambulance, a part of Priority Ambulance whose corporate offices are based in Tennessee.
“The first year, it started out at $900,000 subsidy, and we’re in our third year, and it’s now $2.2 million,” Allen said. “They had some struggles along with their operations, their employees formed a union, and we recently approved a $380,000 increase in subsidy, just so they could pay for their union demands.”
Fremont County’s EMS service answers to about 6,500 calls per year, covering 10,000 square miles.
“We have a very limited workforce because they cannot pay their employees what I feel is what they deserve,” Allen noted. “You trust somebody with your life, they out to be paid more than serving a hamburger at McDonald’s or Burger King…they’re underpaid just because their reimbursement levels are not adequate.
Allen added that they’re actively trying to recruit new trainees and new training opportunities and had asked the municipalities and the tribes for help with the funding.
“It’s not happening fast enough for us; it’s getting worse…uneconomical for a private provider,” he said.
Allen also said that the county has taken the opportunity to form a task force for a special district, coinciding with the bill that was passed last year.
“We have to have a board and we can ask for mill levies…and rightly so, we’re getting a lot of resistance when we even mention that. So it’s looking like our only choice is to ask for a one-cent sales tax…that way, everybody pays for the operation of the ambulance. I’m not one to advocate a tax, but we’ve got to figure out something to pay for this.”
Solutions at a local and regional level
Senator Baldwin acknowledged the resistance towards any new taxes or an increase in taxes and spoke to restructuring through the EMS districts. Many rural counties across the state don’t have those full-time or part-time employees…“and we’ve lost some of our volunteer EMS services because the money’s just not there.” he said. “For EMTs and firefighters, it’s very difficult to get people to take time away from family lives, away from their normal work days. It’s a difficult situation, and it’s not just in Wyoming; it’s across the nation. It’s happening everywhere. I believe regionalization is an answer that may work. It may not, but at least it’s an effort moving forward. So that’s what’s being done in the legislature right now, but there’s a lot more to do.”
Davis said that the Governor is proposing a $5 million general fund appropriation that would allow groups and communities to come together in their own region to work on the EMS issues to understand who is covering a specific area, how they’re covering it (volunteer or paid employees), the true cost of operations ” …and then important, where is the funding gap?”
The EMS special districts bill had some challenges with areas not wanting to do a tax. “The other challenge that we had, was that…the reason the special district was created is that many counties per the constitution are allowed 12 mills. Twenty-one of twenty-three counties are already tapped at their 12 mills. So they needed another avenue to be able to potentially tax, which was the EMS special district.”
Commissioner Allen is the fire chief of Lysite, and also a first responder. “The satisfaction and the relief the people show when you show up popping over the hill with your lights and sirens going, that you’re coming to their aid…the people don’t realize what they have until they don’t have it.”
“The public needs to know that this is an issue,” Davis added. “The public needs to know that this service may not exist at its current capacity if we don’t do something. And the question is, are they okay with that? And if they’re not, then we’ve got to figure out how to fund this.”