by Ian Marynowski
The Wayne & Garfield County Insider
During the Wayne County Commission’s April 1 meeting, Bicknell emergency medical technician and nurse Josie Moosman took the podium before the commission with an emotional appeal regarding the current state of emergency medical services in the county. “Our EMS services are crumbling,” Moosman said, and cited a lack of support, both from the local government and EMS leadership, as cause for poor staff retention and difficulty in providing emergency medical service.
While many Americans take for granted the ability to call 911 and quickly receive law enforcement, fire or medical services, the role of EMS in that system has been muddy. “Back in the 70s, at some point, we made the really dumb decision that EMS should be billed as a health care service instead of a public safety service,” said Andy Smith, Grand County Emergency Medical Services Special Service District Director. Smith also serves as a leading member of the Rural Emergency Medical Services Directors Association of Utah, a group whose mission is to unify and empower rural EMS directors to lead emergency services into the future.
This small but important distinction between “health care service” and “public safety service” has meant that ambulance services are treated more akin to a taxi cab ride, resulting in patients being charged—and ambulances getting paid—only if transport to a hospital was completed.
“It’s a perverse incentive, for an ambulance service to pay their bills, they have to transport them to the hospital. And the service wasn’t guaranteed. It’s the way EMS has been from the beginning, and that’s why urban areas that have a lot of transports are usually better funded,” explained Smith. “But not everyone needs to go to the ER, especially in rural areas where it can be really far away.”
The need to streamline EMS with other emergency services drove the creation of REMSDAU in 2018. The organization lobbied and, eventually, they were able to transfer the Bureau of EMS to Utah’s Department of Public Safety in 2020. This change has caused EMS to be considered essential to public safety, securing general fund appropriations, tax money and additional access to benefits for first responders, disincentivizing needless transports by providing other sources of funding.
While this administrative change offered hope for the future of rural EMS across Utah, the feeling was clearly not mutual for Josie Moosman as an EMS technician. For residents of Boulder, Utah, in Garfield County, it meant the loss of their ambulance in May 2023 due to a lack of trained EMTs and funding. Issues with emergency medical services have appeared multiple times in commission meetings in both Wayne and Garfield counties over the past year.
“EMS has become busier and busier in rural Utah,” Smith said. “We’ve always paid for the service one way or another and usually that was on the backs of volunteers. We call that the ‘volunteer subsidy.’ Because they weren’t paid, and we didn’t have to bill for their work, volunteers basically subsidized the ambulance service. But over the last decade that volunteer subsidy has been going away.”
Ron Harris, a volunteer advanced EMT in Garfield County and Health and Safety director of Ruby’s Inn, has seen the industry change dramatically since first becoming certified in 1989. Being someone who wears many hats, he understands the difficulties that volunteer first responders face.
“Either people are moving faster than ever or I’m getting slower, but it just seems like I’m busier now than I’ve ever been,” said Harris. “People just don’t volunteer their time as much. Fire departments are seeing it all across the nation, EMS is seeing it all across the nation, volunteerism is down and even full-time departments are struggling to stay staffed.”
He explains that this could largely be due to people’s time just being more valuable in today’s economy, making it harder to justify being on call for a modest stipend, or clocking out from a well-paid job to go out on a call. Josie Moosman attested to this in her Wayne County Commission statement, explaining that in 2022 she was paid $3,214 for 1,178 hours of work, or roughly $2.73 an hour.
“We get our stipend at the end of the year, and it’s nice to have for Christmas,” said Harris, “but I can’t make a living at it.”
Despite this, Garfield County has been able to retain a strong volunteer ambulance force.
“People aren’t in this for the money,” said Harris “It’s our community. We’re responding to our neighbors, our friends, people we know.”
To help people who care get involved, Harris and his wife, Susan, a nurse at Garfield Memorial and EMT herself, host a biennial EMT course. The 140-hour training comes at an extremely discounted price if students agree to wear a pager for the ambulance. This program introduced thirteen new EMTs to Garfield County in 2024, bringing the total to eighty-five.
Wayne County partners with Sevier County to offer a similar education program and has been maintaining a staff of around forty part-time EMTs. While these numbers may sound fairly reasonable, they still leave holes in the schedule. Each ambulance requires two EMTs to run, and they need to be available 24/7. With four ambulances, Wayne County would need nearly fifty full-time employees to be fully staffed.
While these subsidized education programs are good at bringing new personnel in the door, they do not offer much for keeping the schedule filled out long term. Many first responder jobs are subject to high rates of burnout, whether it be from the emotional stress of the job, the burden of continuing education or even the lack of work to do. Creating a remedy for burnout often involves starting with providing a place where people want to work and have the resources to thrive.
“When I look at my budget, I know I can’t afford to pay my firefighters much, but if I can get them the best equipment possible and the resources they need to be successful, maybe that will keep them excited to show up,” said Chris Whetton, the Wayne County Fire District chief. His sentiment is reflected almost unanimously throughout the various counties and districts in rural southern Utah.
Garfield and Grand counties are both able to maintain several state-of-the-art ambulances, and Tiffany Martineau, Wayne County ambulance director, along with her predecessor, Cassidy Brown, were able to secure additional grant funding beyond her normal annual budget to purchase and outfit a new ambulance. Additional money, before payroll, must also be spent providing for mental health support and opportunities for staff and volunteers to continue their education through workshops, online learning modules and physical practice.
“In my experience in rural areas, the pay is important, but only to a point. What’s more important is making sure they have good equipment, good culture, good protocols, a good environment,” explains Smith. “And all of those things take money, even if it’s not for actually paying people. So at the end of the day, money is a major factor in providing this service.”
Smith explains that REMSDAU aims to ask the state legislature to provide more opportunities for funding and supporting rural EMS.
“Counties and cities in these rural areas need to sit down and say, OK, we know this isn’t sustainable the way it is. It’s really hard to run rural service, let’s figure out the best we can do with the funding and the situation that we’re in,” Smith said.
Whether it involves hiring a limited number of full-time EMTs, or cross-training firefighters and law enforcement to be able to perform medical duties, or providing more community education to help accelerate a patient’s access to care, the structure of rural EMS is due for some updates.
“Let’s let our community decide what they want out of an ambulance service,” Smith said.
This article was originally published by The Wayne & Garfield County Insider (www.insiderutah.com). Reprinted here with thanks!