Seeking balance
Taylor County is continuing to look at options when it comes to improving response times and staffing of the ambulance service.
Last winter the county approved a new contract with Aspirus to run the ambulance service. The result of that contract was a significant jump in the cost of ambulance services to county residents.
While state law puts the responsibility on providing ambulance services onto villages and towns, longtime practice in Taylor County is to handle it at the county level and spread the cost over all county property taxpayers. Under terms of the current contract, the county pays $1.9 million per year to maintain a department that has 19.8 full time equivalent (FTE) positions and 5.4 FTE on-call positions. Under that system bases in Gilman and Rib Lake are at times only partially staffed with an EMT stationed there to respond and begin treatment at the scene while a full crew is on its way from Medford to transport the patient to the hospital.
See COUNTY on page 10 According to regional director Bob Kirkley of Aspirus Emergency Medical Services, this has allowed response times to remain within acceptable levels with the transport crew arriving either before or when the patient is ready to be loaded into the ambulance and transported. While the current system is working, there is also potential room for improvements.
At the December 12 law enforcement committee meeting, members heard from Kirkley on three additional options to provide emergency medical services to the county. He said each option has its pros and cons.
For example the benefit of the current system is that the higher staffing reduces overtime expenses, it presents a fixed cost to the county except through scheduled yearly increase, it has a 12-week schedule that is built out for current staff and they are able to cover calls without needing to rely on mutual aid, and there are on-call shifts available for occasional “volunteer” personnel.
The negatives of the current model are that the three bases are not fully staffed at all times, bases at times have one provider on the schedule because of the lack of fulltime or on-call staff, staff have to move locations, there are high costs and low volumes in the Rib Lake and Gilman locations and there are continued complaints from Gilman and Rib Lake residents without full time covers.
The committee had asked Aspirus for the options based on their experience with running the service after being shot down by the county’s finance committee over wanting to hire an outside consultant to look at the system last summer.
Other options presented by Kirkley included: Full time staffing of all three bases by increasing the EMS staffing level to 25.2 FTE which would remove any use of oncall or volunteer staff for anything other than multiple ambulance calls. This would bring with it a cost of $2,237,025.19.
“This is exactly what all the residents want, but the cost will be extreme,” Kirkley said. He also noted that there are already low volumes in Rib Lake and Gilman where the service is paying for staff.
A third option Kirkley presented is to go from three sites to two ambulance sites which will allow the staffing to drop to 16.8 FTEs. On-call will be used for vacation and for second-ambulance calls. This would have a cost savings to the county with an annual cost of $1,567,485.35. However the potential negative would be the capital outlay of two ambulance garages with crew living areas unless one of the ambulances stays in Gilman and one stays in Medford. He noted that in this scenario Gilman would not be the ideal location based on where calls are coming from. He said this could lead to increased concerns and complaints from the Gilman and Rib Lake residents without full time coverage. In the long-term it could also mean a reduction in the number of ambulances owned and outfitted by the county.
A fourth option wold be a full-time ambulance staffed in Medford with three providers and one provider stationed in Gilman, one provider stationed in Rib Lake and chase vehicle utilization. This would involved 21 FTE positions and a total approximate annual cost of $2,065,603 along with the purchase and upkeep of an SUV ambulance. This higher cost option also does not address concerns about fulltime coverage in Gilman and Rib Lake and would reduce coverage availability at outlying bases.
Ambulance representatives ranked the four options putting option three, which would reduce the number of bases from three to two, as being the most feasible from a long-term standpoint for the county. While it would result in a large capital outlay to relocate the ambulances, having them in more centralized locations would provide consistent coverage to the county. The increased response times would be offset by being more centrally located.
They put the fourth option as their second choice noting it would maintain coverage for the county at current levels but still not require a full crew on-site 24 hours a day, seven days a week. Transport times will be increased, but it still has consistent staffing at all locations.
Remaining with the current set-up is the third choice. “The system is not perfect, but coverage is quite good for a rural area with staffing concerns and geographical drawbacks,” Kirkley said.
The fourth choice would be to go to full staffing of each of the existing locations. “Should not be considered, unless other sources of funding can be found,” Kirkley stated. “The amount of transports in the county does not support a three ambulance service.”
“We are covering what we have, the problem is it is expensive,” Kirkley said of the current model.
Committee member Lori Floyd questioned if the ambulance service considered using first responders for the crew.
Kirkley explained that they would have to be credentialed by Aspirus and follow the Aspirus licensing requirements to be part of the ambulance crews. He said he would welcome them to do this.
“Is that an Aspirus rule or a state law?” Floyd asked.
“As the service we need to make sure they are kept up to date with required trainings,” Kirkley said. He noted this is what the county is contracting with Aspirus to provide.
If the county were to go to two more centralized ambulance locations, they noted the ideal locations would be just north of Medford and along Hwy 73 north of Gilman. Alternatively in Medford and the other near Perkinstown. The Medford station averages between 60 to 70 calls per month based on the population density of the region. The other two stations in the county see a combined 40 calls per month with Gilman getting typically about 14 calls a month.
“You want ambulances closest to where the calls will be,” Kirkley said.
Floyd noted that the only option that will reduce response times is by having 25 FTEs. “Every other option we have the longer response times,” she said.
Kirkley noted they are currently at three minutes from the time of the call until they are out the door and on the way.
Committee member Darrell Thompson objected to reducing the number of stations stating that the option with full-time crews at each of the three locations is the only one that, to him, meets the requirements of the county code to equal coverage for all county residents.
“This is the one I would feel is acceptable for the people I represent in Taft and Roosevelt,” Thomspon said.
Kirkley said it is also necessary to look at what is financially responsible, what is ethically and what is morally responsible for the coverage area.
“We are going with options for what was asked,” he said, noting the county asked them for alternative options.
“We realize there will be days we don’t have 24-hour coverage,” Kirkley said. He noted that it weighs into decisions people make about where they live. He gave the example of where his family members live in the Upper Pennisula where the nearest hospital is over an hour away.
“We are willing to do whatever we need to do,” Kirkley said.
“We will get complaints no matter what,” said committee member Chuck Zenner.
Committee chair Lynn Rosemeyer said she has been actively promoting in the community having more people serve as on-call and encouraging businesses to let employees leave for calls.
No action was taken on the options, with the ambulance representatives to come back in January with data showing where the calls are coming from within the county.
In other business, committee members: • Received word that a new contract was signed with Aramark to provide food service for the jail inmates. The previous contract had lapsed and the new one has been renewed to 2028. Under the contract, Aramark will charge $3.90 per meal, up from $3.52 under the previous contract. Inmates are charged for their meals. The previous contract actually expired in 2019. Last year the county made $46,000 in revenue from meals.
• Received a proposal from sheriff Larry Woebbeking for the creation of a jail administrator position which would be responsible for overseeing the jail operations and would be above the two jail sergeants. This would eliminate the need for the jail corporal position. He said this would cost about an additional $8 per hour in staffing costs compared to current staffing levels and would help protect the county from potential lawsuits from inmates. He noted the jail has one of the biggest turnovers in staffing and many state regulations that must be followed. “It is what you don’t know that hurts you,” Woebbeking said.
Law enforcement committee chair Lynn Rosemeyer listens as sheriff Larry Woebbeking explains what he sees as a need for the county to hire a dedicated jail administrator. Woebbeking said the jail has the potential for lawsuits if regulations and rules are not adequately followed. BRIAN WILSON/THE STAR NEWS
