Lately, due to our recent request to put an increase of the healthcare sales and use tax on the ballot, I’ve heard comments suggesting that Emergency Medical Services (EMS) should “operate like a business.” While I appreciate and agree with the theme of efficiency, the reality of how EMS is required to operate is very different. The typical supply-and-demand model from a business textbook doesn’t translate well when lives are on the line.
When someone dials 911, there is no “out of stock” option. EMS must respond immediately with trained professionals and fully equipped ambulances—day or night, anywhere in the county. Unlike a business, we can’t market to influence demand, refuse service when it’s unprofitable, or adjust prices to cover costs.
Here in Utah, EMS agencies don’t even set their own rates. Rates are fixed at the state level, while actual payments are determined by Medicare, Medicaid, and private insurers. Agencies like Grand County EMS collect only about 29 cents of every dollar billed. No business could be expected to survive on one-third of its billings.
Another major difference is the cost of readiness. The true “product” of EMS isn’t the ambulance ride—it’s having skilled crews, equipped units, and a staffed station ready 24/7, whether or not a call comes in. We use data from previous years to determine how many ambulances must be staffed throughout the year so that we’ll be ready when seconds matter. That constant preparedness is expensive, but it’s what ensures that help arrives quickly when our community needs us most.
Over the past decade, our call volume has increased nearly 70%, and our longest calls—interfacility transfers to higher-level hospitals several hours away—have risen 71%. We’ve managed these increases by adjusting staffing, investing in better training for our workforce, and consolidating into a single station. But no amount of efficiency or cost-cutting can change the fact that the current financial model for EMS is broken, because it lacks adequate and ongoing dedicated support from community funding.
Some people point to private EMS companies as proof that the system can be run like a business. But those models only work in high-volume urban areas. In rural America, call numbers are too low to cover the cost of readiness. That’s why private contracts often collapse or leave communities without service.
You’ve probably heard the saying: “Good, fast, or cheap—pick two.” Nowhere is that more true than in EMS. Our community deserves care that is good and fast, but keeping that standard isn’t cheap.
At Grand County EMS, our Board members work hand in hand with leadership to make sure every public dollar is used wisely. Budgets are reviewed line by line, spending is closely monitored, and every decision is made with the goal of stretching resources as far as possible—while never compromising the safety or quality of care our community deserves.
This year alone, we’ve implemented significant cost-cutting measures. We froze spending on everything not directly related to 911 response—including staff education, mental health resources, and employee uniform stipends—deferred vehicle and radio replacements, and left some staff positions unfilled while others stepped up to cover the gaps. In total, these steps represent nearly a 10% reduction in our 2025 budget. While these choices demonstrate our commitment to frugality and efficiency, they are only short-term solutions. Postponing equipment purchases and underfunding workforce support does not eliminate those needs—it simply pushes them down the road, often at a higher price. In other words, today’s savings can become tomorrow’s larger expenses, and the underlying financial challenge remains unsolved.
Grand County EMS has proven to be a careful steward of public funding. What we need now is sustainable, stable support to match the essential role we play. Because EMS isn’t a business—it’s an essential service, and too many a lifeline.
Andy Smith, Executive Director Grand County EMS SSD
Elizabeth Tubbs, Board Chair
Jim Webster, Board Vice Chair
Jason Taylor, Board Treasurer Moab City Representative
Rani Derasary, Board Member
Ed Weeks, Board Member Castle Valley Representative
Taryn Kay, Board Member
Melodie McCandless, Board Member Grand County Commission Liaison
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