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?

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?

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.

Veteran Wyoming journalist Kerry Drake has covered Wyoming for more than four decades, previously as a reporter and editor for the Wyoming Tribune-Eagle and Casper Star-Tribune. He lives in Cheyenne and...

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  1. This Orwelling-named “Freedom Caucus” will end up destroying the freedoms and values that Wyoming has long stood for. And who’s to blame for this destruction of Wyoming? Why it’s us, the gullible Wyoming voters who are taken in by these loud-shouting idiots who run for office. Come on Wyoming! Just because someone has an “R” after their name on the ballot does not mean they represent Wyoming values. In so many cases it’s the exact opposite. Think before you vote!

  2. Ambulance service with paid staff is expensive, but worth it. You want a higher level of skills than found in a volunteer fire department.

  3. I was blessed on June 30th by the quick response of the Sheridan EMS, Fire and Police Departments. I am grateful for their kindness and professionalism.

  4. Great article Kerry. It would really be nice if elected legislators in Cheyenne really cared about the people of the state. Not much hope that will change anytime soon.

  5. What a great article. I did not know that EMS was not considered essential services. It NEEDS to be! Access to health care should not be limited to the rich or those living in big cities. Why oh why do our legislature put so much in permanent savings and leave the cities, towns and the citizens starving?

  6. Why do they never care about specifics when it comes to money for policing, military, and border control?

  7. As crude as this might sound, “back in the day” in rural areas (and this would include a large portion of Wyoming), transport of the sick or injured was largely conducted using “scoop and ship” principles, often by the local moritician and a VOLUNTEER, in a hearse with NO on-site care, such as dressings, i.v.’s or meds provided. Those days, fortunately, are long gone, and current management for patient well-being and care provider, often legal-wise, now rightly requires rigorous training of the ambulance staff — there are few “volunteers” remaining! With low reimbursements, especially in rural areas (read, Wyoming), this will require a very LARGE outlay of cash to have a reputable and readily-available ambulance service.

  8. Kerry, Thank you for once more “hitting the nail on the head”; identifying the problem, the solution AND the roadblocks.
    As you note, the money is available is certainly available, and the State chooses to spend $s on MUCH-less worthy sources than EMS for our small communities.
    People leave the State to the surrounding States BECAUSE we do not have those resources in small communities, and until the Legislature has the will and the gumption to prioritize and call it the essential service that it is, we in the State are left poorer for it!
    It’s not a new problem. The remarkable recent book, “American Sirens” by Kevin Hazzard traces the roots of EMS in America, and the struggles with funding. It’s just sad that 60+ years later, Wyoming still has not figured it out like the rest of the developed World has. Thanks again for your work and solutions.

  9. Is it lack of common sense or pure grandstanding the Freedom Caucus is doing? My brother was a volunteer firefighter/EMT under Eric Quiney when he died in the line of duty. I remember my sister-in-law saying how calls for the elderly would often come in the middle of the night and not all the EMT’s liked those because they often weren’t life threatening, could mean a long night and possible transport to Salt Lake City – she’d always nudge my brother and say “you know you have to be there for them” and he’d roll out of bed and be there for them. There are people in this state who are willing to volunteer their time for training and serve their community if they are valued and supported. But then you have the Freedom Caucus who are putting money and politics over human lives, their own constituents who put them office. I think most Wyomingites would be surprised to learn the EMT/Ambulance services AREN’T essential services. I have yet to see any “good” the Freedom Caucus has done for Wyoming, unlike all the volunteer EMT’s around the state who are always there for us when we need them.

  10. Thanks for keeping us informed on this. We take for granted that if we call 911 for emergence assistance, it will come. In Riverton, there’s people making money by selling policies for emergency flight service should that be needed. So is that the plan for emergency ambulances for only those who can afford insurance policies to be able to get help? As in your case as an example, would an ambulance only have responded if it was known whether you had a policy or not?

  11. One reason we sold my enchanting cabin which was down a dirt road 20 plus miles from Dubois which,at the time, had only a small clinic, not always open,and was 60 miles from Jackson which did have a hospital, but might be unreachable in bad weather ,was the lack of proximity to medical care. Dubois did have an EMT operated by volunteers but if you have a stroke or a heart attack you have 30 minutes to get to a hospital. Even for sixty somethings who seemed basically healthy the rural health scene was iffy. One friend was lucky to have a heart attack while shopping in Jackson and even there she had to be life flighted to Idaho Falls which had a cardiologist.. Richard, my partner, who did some chainsawing ,then drank a martini had a heart palpitation in the middle of the night ,but did have a pill for it. Still it was getting scary. We moved to Denver where the health care is 10th or 12th in the nation and all too soon we had another reason to be glad. Wyoming isnt for sissies.

  12. Another ridiculous concern from those that can’t govern!
    Come on Wyoming, we don’t have to live in the 50’s!

  13. Of course it’s not “affordable” ….. until one of them need it. Then the humanitarian arm of government better be there. Until then, the rest of us can just keep our fingers crossed.

  14. The Freedom Caucus members will be the first to complain when they are lying there dying and no EMS is available. And they will blame it on everybody but themselves. Then they will want to support something like this and blame this very situation on somebody else. Sad times for this state.