Answering the Call: Small Town Wisconsin EMS Facing Critical Juncture
From our earliest years we are taught what to do and who to call when someone has a medical emergency. What our parents didn't tell us after we dial 911 and share the numbers of the address we practiced so hard to remember is what actually happens next. Unfortunately, in many of Wisconsin's smaller communities over the years the answer to that question has become increasingly unpredictable.
In rural Wisconsin, the question first and foremost on the other end of a 911 call is how many folks were able clear their other life commitments on this day and be ready in the event another has a moment of need. That answer varies depending on the time of day, who had to work out of town, and whether child care was available. In just the past two decades, the obstacles of being able to provide aid have grown while the number of individuals willing to step forward and serve as volunteer emergency medical services (EMS) responders has declined. Across the state, EMS agencies are having a harder time both finding new responders while at the same time hanging onto the ones they have.
“People who give their time are the backbone of our rural communities and what many folks don’t realize is that also includes who is coming when we call 911,” Charles Tubbs, Director of Dane County Emergency Management said.
Rural communities define the character of our region. Wisconsin is flush with tiny map dots linked by 15 minute road trips. We know who has the best fish on Fridays and burgers for lunch, or this year's top football team. We've all heard the well-seasoned (and sometimes half true) tales of small town connectivity that start with "did you hear," and end with "donchya know." Unfortunately one of the things we don't know with the certainty we should who's ready to respond when life's unthinkable happens and we need to call 911 for an ambulance.
Small communities depend upon people giving their time and local businesses their financial support to make them tick. We can always count on someone to pull together the annual church dinner and we know who's coordinating the sale of tickets for this year's school fundraiser. Unfortunately the people in these communities trained and available to drop what they're doing and go help a family in life's hardest moments are declining by the year. Volunteers who started "the local rescue squad" in the 1970s or 80s and kept them going through decades since have reached ages where climbing into wrecked cars down icy embankments is no longer safe or viable.
“The challenges facing rural EMS aren’t unique to this area or even Wisconsin, it’s a nationwide issue deserving of a national conversation,” Tubbs said. “Taking care of one another is fundamental – it’s one of life basics – and we need to make sure when people need emergent help that it’s coming.”
Training requirements and time commitments have increased and in turn so too have expectations of responders to receive some compensation for all their effort and the risky work they do. Meanwhile, the tax base and populations in many of these communities remain stagnant, making it increasingly challenging of towns, villages, and small cities to raise the revenue needed to adequately fund those give their time.
"When community based ambulance services started up over 40 years ago people could volunteer on the rescue squad and maybe leave work once or twice a week to take a call,” New Glarus Area EMS Chief Kris Mueller said. “Now these same services have more calls, fewer employers are letting workers leave to help out and families are so busy running to sporting and other obligations for their kids they don’t have the time to train and run on an ambulance.
The increasing difficulty to find people to provide timely, front line care in small towns presents the latest challenge in the ongoing effort to ensure people – regardless of where they live – have access to the same quality medical care as those who live in more affluent cities and suburbs.
“EMS involvement enhances access that some of our rural areas may otherwise not have,” Dr. Darren Pipp, Chief Medical Officer for SSM Health at Monroe Hospital said. “With a focus on improving health outcomes within our communities, we feel strongly that supporting rural EMS is a worthy cause.”
"EMS has reached a pivotal juncture where unless changes are made soon we could very well be sitting here in the near future facing a very real rural healthcare crisis," Mueller said.
While training requirements to be a Wisconsin certified Emergency Medical Technician (EMT) have increased, the dollars to make the work possible that results from that training has stagnated. Combine that with challenges of keeping jobs in small towns, people commuting to the closest city for work, and an overall national decline in volunteerism and the cumulative result is a rapidly shrinking pool of people able to answer a call to community public safety service. Those who remain willing and able to help face more hours of training and work just to keep doing what they're doing.
“The entire model of how community-based ambulance services came together and were kept running the past 40 years needs to be re-thought with a recognition by everyone - including both the state and federal governments - that very little today is the same as it was in 1975 when EMS work started across Wisconsin," Mueller said.
“We want people to step forward into EMS and public safety work to help keep our families safe and secure,” Tubbs said. We have to take care of those who want to take care of us.”
“Regrettably, EMS agencies across the state are struggling with a lack of funding and staffing challenges all while call volumes increase," State Representative Sondy Pope said. "This is especially true for rural EMS which serve geographically large areas and often rely on volunteer personnel. We must ensure our EMS providers have the emergency vehicles, equipment, training, and staffing necessary to protect public safety." Pope has represented smaller communities across mainly rural Dane and Green Counties in the Wisconsin State Legislature since 2002.
To remedy the deepening challenges facing rural emergency medical services agencies the State of Wisconsin recently issued millions of dollars in grants to ambulance services. These much needed funds will help modernize equipment for critical public safety services that until now relied upon holiday fundraising letters, dinners, and other community donations for what would otherwise be assumed as basics needed for emergency medical care.
"The absence of consistent, reliable revenue has forced a lot of departments to cobble together fundraising efforts that themselves take a lot of work and people power to pull off," Mueller said. "People and time are already finite and now we're asking them to not only help get an ambulance out the door but also raise money to make sure that it's equipped. We're asking responders to raise money just to allow them to do the work communities expect them to do."
EMS personnel like Mueller will be monitoring the upcoming state budget for indications the most recent round of state grant dollars will be more than a one-time shot in the arm. For agencies like hers, sustained financial support can help provide incentives she hopes will help renew community interest in working on an ambulance.
“Recently, Governor Evers announced that his 2023-25 biennial budget proposal will include a new $10 million shared revenue public safety supplement specifically to help address local EMS, police, and fire costs,” Pope said. “I support the Governor’s ongoing efforts to bolster funding for our local governments to improve and sustain EMS and other services to keep our communities safe.”
Mueller acknowledges sustainable funding is one important solution to the workforce shortages and fundraising challenges facing EMS in the state's smaller communities. The other she says is overall public awareness that the need is now for creative collaboration to figure out how emergency care will be provided in the decades to come.
“EMS has reached its all hands on deck moment,” Mueller said. “When people call 911 they deserve to know someone is coming.”
For Dr. Pipp, keeping EMS going strong in outlying communities can be the real difference in how sick patients are who come into his emergency room. “Often EMS providers are the first interaction in critical care cases and their early involvement directly contributes to positive outcomes in life-saving situations,” he said.
“EMS agencies are essential to protecting the health and safety of our communities," Representative Pope said. "We call on them when we are in an emergency, and first responders show up for us when we are most in need. That is why it is absolutely critical that we adequately fund EMS so they have the resources necessary to provide fast and high-quality emergency medical care to those in need."
“It’s important we come together as a region and state and make sure those who are willing to give their time and talent to helping others are able to do so with the resources they need,” Tubbs concluded.