STEVENS POINT, Wis. — Wisconsin township leaders, who have an obligation to provide fire and ambulance response, learned about the factors that make an EMS agency sustainable and reliable, as well as how either consolidation or contracting are the two paths forward for delivering EMS in rural Wisconsin at the Wisconsin Towns Association annual conference, Oct. 8, 2024.
Because it is getting increasingly difficult and costly for towns to provide fire and ambulance services, EMS is a hot topic for Wisconsin’s town leaders and two presentations on EMS were filled to capacity with standing room only.
The session, presented by James Small, rural EMS outreach program manager, Wisconsin Office of Rural Health, also explored how EMS is staffed and funded with volunteers vs. paid staff, tax levies, shared revenue, debt financing, fire fees, EMS billing and creating an inter-municipal district or county-wide EMS system.
Memorable quotes on town-based EMS in Wisconsin
Here are five memorable quotes from Small’s presentation to Wisconsin town leaders, including town clerks, attorneys, managers, board members and chairpersons.
- “EMS is a wildly complex industry. It doesn’t work the way you think it should and it’s really expensive.”
- “There are eight ways to provide EMS and six ways to pay for it. The challenge is to figure out the combination that works for your town.”
- “There is something significant in the difference between an ambulance service with six active members and seven or more. Six or less, you’re likely to have reliability issues.”
- “Join a strong service to make a strong service stronger. You’re not going to see a weak service become strong.”
- “If a provider (you are considering contracting with) tells you EMS billing is enough to cover the cost of services, they are wrong.”
Key takeaways
The EMS-related mission of the Wisconsin Office of Rural Health, which is based in the University of Wisconsin School of Medicine, is to improve reliability and sustainability of EMS systems and provide free technical assistance to Wisconsin municipalities. The office’s services are funded by a federal grant. Here are four key takeaways from Small’s presentation.
1. EMS is an obligation of towns, but not cities and villages
97% of Wisconsin is rural and governed by 1,850 local governments, including 1,265 townships, 585 city and villages, and 11 tribal governments. Each of those governmental bodies is making EMS decisions, rarely with coordination with their neighbors.
Towns in Wisconsin have a statutory requirement to provide fire and EMS, but cities and villages are not required to provide EMS (that said, Small is not aware of any Wisconsin villages or cities that don’t provide fire and EMS).
Small gave the attendees questions, based on Office of Rural Health research, to assess reliability and sustainability of EMS in their town.
2. EMS is unreliable in Wisconsin
EMS services were asked by the Office of Rural Health:
“How many times in the past 12 months has there been a time on the schedule when a first-due ambulance would not have been able to respond due to a lack of personnel?”
Across the state, 41% of ambulance services responded that they didn’t have enough personnel to respond to a 911 call, making that ambulance service unreliable to its community. Rural (55%) and volunteer (63%) agencies were especially susceptible to lacking enough staff.
According to James, a reliable EMS system must answer zero. An ambulance service that doesn’t have a coverage schedule, relying on and hoping for members to respond, is also considered unreliable.
3. EMS is unsustainable in Wisconsin
EMS services were asked by the Office of Rural Health:
“How many people are doing 80% of the staffing in the previous year?”
Minimal EMS coverage requires 17,520 hours of coverage, the equivalent of seven full-time employees available to respond 24/7/365. In Wisconsin, the Office of Rural Health found that 21% of services had 2-3 people doing 80% of the work, while an additional 20% of services had 4-6 people doing 80% of the work.
James explains that the office’s research shows that an ambulance service with less than seven people is at high risk of unexpected service outage. In Wisconsin, 62% of volunteer-run ambulance services run with six or fewer people doing 80% of the work. In addition, volunteer systems in Wisconsin are four times more likely to fail.
4. Future of EMS in Wisconsin is contracting and consolidation
Although a few towns in Wisconsin still operate a municipally owned ambulance service, Small believes the future of EMS for Wisconsin’s towns is consolidation with other municipalities to form a new EMS entity or contracting for ambulance services from a financially and operationally strong EMS agency.
When contracting for EMS, Small made these important points:
- Equitable cost sharing is important
- Provider should not be subsidizing the cost
- Funding is sustainable to provide future services
- Towns receive the same service as the provider unless there are areas excluded
- Place emphasis on maintaining strong regional services
The cost of a dysfunctional system
Small closed the session by explaining the different routes for funding EMS. “EMS is really expensive and getting more expensive,” Small said. “A dysfunctional system is expensive.”
He called on attendees to develop a functional system that is reliable, sustainable and likely regional.
