By Dolly A. Butz
Sioux City Journal
SIOUX CITY, Iowa — A growing and aging population contributed to a 21% increase in emergency medical services calls Sioux City Fire Rescue responded to over the past five years, according to city officials.
The city tallied 9,042 EMS calls in the 2024 fiscal year, up from 7,432 in FY 2019.
Sioux City Fire Rescue started the new EMS division on Jan. 1, 2018, to fill the void left by Siouxland Paramedics, the nonprofit agency that stopped providing emergency services due to financial difficulties.
“Some of it’s just based on population growth, population movement. An aging population contributes to that as well, because as people age, they have more tendency to need emergent health care,” EMS Director Jim Haden said of some of the reasons behind the increase. “There’s all sorts of different factors that go into it. Sioux City’s actually an older population than some municipal areas, so that contributes probably as much as anything else to it.”
Fire Chief Ryan Collins told The Journal the trend isn’t just a local one. He said EMS calls are on the rise across the state of Iowa and the nation.
“Here in Sioux City, our call volumes are typically increasing between 200 and 500 calls per year. Most of that is attributed to the EMS side. As far as root causes, we’re all struggling to determine what that root cause is. I think there’s lots of different contributing factors to it,” Collins said. “It could be age of the population. More and more folks are relying upon that 911 system as they age. But also it could be the cost of health care insurance and using the 911 system as their primary care physicians.”
Since there are more fire resources around the city than ambulances, which tend to be busier, Haden said both a fire truck and an ambulance respond to a medical emergency.
“That gets the advanced life support, first response to the scene, in theory, quite a bit quicker,” he said. “An ambulance generally staffs two people, minimum. A fire apparatus can be anywhere from two to four people. Generally, it’s three people staffing a fire apparatus at any given time.”
At an Aug. 5 Sioux City Rotary Club meeting, then-outgoing Fire Chief Tom Everett said the city doesn’t meet the national standard for the “number of people to put on the scene for a medical call.” Everett officially handed the reins of the department to Collins Monday, during a pinning ceremony at City Hall.
“For a heart attack, we’re supposed to have nine people on scene. It takes that many hands to do all of the different things going on when somebody has a heart attack. So, if you have less than that, somebody is doing more than one job,” Everett said. “So, if we send one apparatus — that’s three people — that’s just simply not enough to do what we need to do. So, typically, we send two, and now we’re looking at actually sending three to confirm cardiac events and strokes.”
Haden said there are financial challenges that come along with an uptick in EMS calls. He said adding more crews and equipment need to be considered, which can “cost quite a bit of money.”
In FY 2026, $160,000 is programmed in the city’s Capital Improvement Program for mechanical CPR devices, heads-up CPR technology, portable ambulance equipment and training storage needs. Then, in FY 2029, $440,000 is programmed for Lifepak defibrillator replacement for frontline fire apparatuses, including seven engines, two aerial trucks and two squads with training aids and storage.
“For every ambulance, you have the ambulance expense, plus you have probably well over $100,000 for each ambulance for just the equipment that goes in it,” Haden said. “There’s all sorts of considerations between ambulances and the personnel. The biggest cost, of course, for any agency is going to be the personnel cost.”
The City Council approved a total EMS operating budget of $5,385,503 for FY 2025, which began July 1. The budget increased 2.7% ($142,530) from the previous fiscal year ($5,242,973). Employee compensation accounts for 66% ($3,598,104) of it.
Collins said recruitment and retention has been a problem that has persisted in Sioux City . He said his department is always taking steps to make sure that EMS staffing is adequate.
“Today, we’re lucky enough to have enough staffing for that fourth ambulance, which is Medic 5 out in the Morningside area. But we always staff at least three ambulances every day. When staffing allows, we’ve staffed a fourth, and we’ve even been able to staff a fifth on a few occasions,” he said.
In January, the council voted to add four firefighter positions in effort to increase staffing on ambulances. The city has recently seen more firefighter candidates than EMT and paramedic candidates.
“Now, what they’re doing is rather than filling those positions with EMS people and fire people filling in part-time, they’re hiring people as fire EMS personnel,” Haden said. “For the first part of their careers, they can actually staff an ambulance full-time or close to full-time, as well as be available to fight fires, as well. They’ve hired several people under that model so far. But with retirements and everything else, of course, you always have people going out the other end while you have people coming in the front end.”
Haden said the city has a civil service list out and is looking to hire quite a few people in the coming months.
“I don’t have a time frame for when those people will get on, but we anticipate being fully staffed, hopefully, by the end of the year,” he said.
The city has seen more firefighter candidates than EMT and paramedic candidates.
Sioux City Fire Rescue started the new EMS division on Jan. 1, 2018 to fill the void left by Siouxland Paramedics, the nonprofit agency that stopped providing emergency services due to financial difficulties.
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