Nothing makes me appreciate ambulance service more than waiting for one to arrive. When it does, it’s honoring an unwritten yet essential contract with the public to help us when we need it the most.
On Father’s Day 1979, I was stopped at a busy Cheyenne intersection on Warren Avenue. The light turned green, I pulled forward and was stunned to see an east-bound car speeding up instead of braking.
My poor Datsun was T-boned. The car bounced off one in the next lane, and came to rest on someone’s front lawn. My glasses flew out the window so I couldn’t see; my feet were stuck under the brake pedal, and I couldn’t move.
Unless you were wearing my crushed cowboy boots that day or stuck in traffic behind us, you might not consider responding to the accident as an “essential service.” I assure you it was.
More than 40 years later, though, unlike law enforcement and fire protection, emergency medical services like ambulances are still not considered “essential.” As such, no official entity in Wyoming — no city, town, county or state agency — is obligated to make sure EMS is available in our communities.
I’d hate to need an ambulance and live somewhere without access to one.
But in many rural parts of Wyoming, ambulance services have been on life support for years. There’s a long list of reasons for this: high fixed costs, unstable funding, low Medicare and Medicaid reimbursement rates, a disappearing volunteer workforce and first-responders required to pay for their own training.
The result is a patchwork of ambulance services throughout the state, operated by hospitals, local governments and private providers under contract. At least 10 ambulance services have closed in rural areas in the past decade, including five in 2021.
Earlier this year, the Legislature passed Senate File 43-EMS districts, to allow a board of county commissioners to form an emergency medical services district and fund ambulance operations through local taxes. Sponsored by Sen. Cale Case (R-Lander), it’s a step in the right direction, but the law likely won’t help every community in need because it requires a vote to raise property taxes to fund new districts.
In April, the Joint Labor, Health and Social Services Committee proposed helping local governments pay for ambulance services, instead of just giving them another unfunded mandate. On a narrow 7-6 vote, the panel directed the Legislative Service Office to draft a bill that would make EMS services “essential.”
The Wyoming Hospital Association and EMS providers testified that the designation, plus an influx of funds through a new state-backed grant program, would help stabilize services. The move would reduce the huge accessibility gap between urban and rural communities.
However, never underestimate the power of the far-right Freedom Caucus to let grandstanding political theater get in the way of common-sense good governance. At the committee’s June meeting in Evanston, the caucus defeated the draft bill, citing the need to know how all the money the state put into the system was spent before authorizing any tax increases.
In reality, the state hasn’t directly put any of its own money into EMS. But that hasn’t stopped some lawmakers from dismissing the service gap problem as a local issue and claiming the state has already spent too much trying to solve it. In 2009 the Legislature used $500,000 in tobacco settlement funds to create an EMS Sustainability Trust to assess providers’ needs. Wyoming also put $5 million in federal COVID-19 relief funds toward stabilizing EMS agencies and $10 million into starting regional pilot programs.
The use of tobacco money that fell from the sky and one-time federal pandemic aid does not support any argument that we’re wasting state funds. Yet that’s the claim made by two Republican Cheyenne GOP lawmakers: Sen. Lynn Hutchings and Rep. Ben Hornok.
Hutchings demanded to know “where that money’s gone so that we can make an informed decision.” Hornok said the bill can’t go forward unless the fiscal impact from implementing SF-43 is determined, “and we don’t have that.”
However, we do know a lot about factors that will get worse the longer state lawmakers sit on the sidelines and throw stones at a dysfunctional system without offering any solutions.
The average ambulance staffed by two EMTs to provide basic medical care costs about $525,000 a year to operate. That’s a national average, and a Governor’s Healthcare Task Force report indicated it may cost much more in rural and frontier regions. In any event, the tab isn’t going down.
Ambulance agencies are reimbursed by insurance companies for the cost of transporting patients to hospitals and other health care facilities. For an ambulance to break even, the Wyoming Department of Health estimates it needs to provide about 650 paid rides annually — a figure difficult to reach in low population areas. More than one-third of all Wyoming EMS calls are uncompensated, so local governments and ambulance companies must make up the costs.
For many years, ambulance providers have primarily used volunteers. That type of labor force is now in increasingly short supply. Individuals want to spend time with their families. And who can afford to work for free?
That leaves paid staff to make the system work 24/7. Yet the Legislature decided to make a difficult situation even harder in 2020, when it cut 30% from the budget of the state’s Office of Emergency Medical Services. Most of the funds were for training and certifying ambulance staff.
For legislators who say the state can’t afford to enact the essential services EMS draft bill, I have a few observations.
This year you took a record $1.4 billion from improved mineral severance tax revenues and federal COVID relief funds and socked both into savings. How do you justify that while leaving our broken ambulance system clawing to find some way to pay for itself in hard-hit rural areas?
Many state lawmakers insist they are “pro-life.” Why isn’t this stance followed when it comes to investing in an ambulance system that does everything it can to save lives?
The Legislature wants to ensure potential new industries will be able to offer their employees “quality of life” opportunities and values if they settle in Wyoming. When some hospitals have been reducing or eliminating vital services like maternity care, has it ever dawned on the Freedom Caucus that no one wants to live where they can’t count on ambulance service?
My EMS experience way back in ‘79 had some miscues, including an apparently novice “Jaws of Life” operator who couldn’t understand how the tool was keeping my legs pinned inside, causing more pain each time he used it. My heart sank when he plaintively asked a coworker, “What the hell do we do now?”
That’s when an off-duty EMT who stopped when he saw the crash took things into his own hands, grabbed me by my shoulders and single-handedly pulled me out of the hatchback. In a few minutes I was in the hospital, grateful someone grasped the immediacy of the problem and helped me.
That’s the kind of reaction we need today.
We need to listen to fewer lawmakers with MAGA agendas and more professionals like Eric Quinney, chief administrative officer for Uinta County Fire and Ambulance in Evanston. He told Joint Labor members Wyoming can’t pretend that levying taxes to save family, friends and strangers is a bridge too far to cross.
“EMS needs to be an essential service because people have that expectation, and I don’t think that’s ever going away,” Quinney said. “When people dial 911, they want somebody to respond.”
Opposition to the draft bill was the Freedom Caucus saying it doesn’t believe the government owes people anything, even basic emergency medical care. There aren’t many areas that better illustrate we are our brothers’ and sisters’ keepers, and we’re not going to forsake that principle just so politicians can honor another empty anti-tax pledge.