Tammy Van Dam is worried about her granddaughter growing up without access to prompt EMS. Tammy and her family live in Jones County, South Dakota’s least populated county, where she is a leader and primary responder for the county’s only ambulance service. Murdo, the county seat where Tammy lives, sits along I-90, a major cross-country route used by hundreds of thousands of visitors to the Black Hills and the annual Sturgis motorcycle rally. In recent years, the number of volunteers has dwindled to the point where survival of the ambulance service is in question. Concerned, Tammy contacted our consulting group.
With a grant from the John T. Vucurevich Foundation, we put together a project that used Jones County as a case study to explore the future of rural ambulance services in South Dakota. The study revealed some important findings:
- When local people were educated about EMS and the full real costs of providing these services (including the value of volunteer labor), many became interested and engaged. Few had realized the dire nature of the situation or that rural EMS is a local creation and responsibility. We invited people into a discussion about the future of EMS in their community through planned conversations, facilitated community meetings and a simple survey of all households in the county.
- Despite a tendency to be fiscally conservative and opposed to expansions of government, the residents of Jones County overwhelmingly expressed a desire to preserve the local ambulance service and demonstrated a growing understanding of EMS as a basic and vital community service. A majority indicated they were willing to pay more taxes and/or donate more money to ensure that the service survived. They also demonstrated a fierce independence in wanting choices about their future.
- We found that the club-like organizational structure of the local ambulance service (a not-for-profit corporation) inhibits community involvement as well as internal change. Like most rural ambulance services, the Jones County Ambulance Service developed locally and organically during the 1970s. The organic development led its bylaws and governance to be more like a club than a business. Members serve as board members, leadership is elected and decision-making, including the discipline of members, is largely done as a group.
- The club structure worked well when there were enough volunteers and the provision of EMS was uncomplicated. But now that the service must replace the volunteer subsidy and address the challenges of operating a service that is more complicated, demanding, liable and in need of clear lines of responsibility and accountability, the club structure no longer works well. The service needs a board, made up of key community stakeholders who are not providers, that can help it obtain the attention, support and funding it needs. It also needs leadership that is not elected and is prepared and accountable for performance and structure. But moving from a club to a business demands a vote of the provider/members, who are reluctant to let go of what traditionally has worked.
- This project highlighted the unanswered question of who should fund rural EMS. While local residents expressed a willingness to pay more for EMS, they also felt it unfair that they subsidize services for the thousands who travel through their county. More than half of their transports are for people who live outside the county and pay no taxes.
The project was a significant eye-opener for the residents of Jones County. In recognizing that the future of their EMS will be determined by local action or inaction, Tammy and the other residents are pulling together a group of key community stakeholders to develop a survival plan. Whether they will survive or make needed changes remains to be seen, but they are hoping their openness will bring attention to the need for true EMS system planning and funding that is beyond the local community.
If you would like a copy of the report, e-mail me at john@safetechsolutions.us.
John Becknell is the founding publisher of Best Practices and a consultant and partner at SafeTech Solutions.
