Who responds when there’s no one left to call?

By Ginna Young

When someone is ill or injured, who do you call? No, not Ghostbusters! You call 911 and a tone goes out to your nearest ambulance service, which responds to the call and gets you the help you, or a loved one, needs.

However, as hospitals have closed and volunteers on all fronts decline, so too, have emergency medical services (EMS). Recognizing that something must be done to right the ship, an informational session was held, Jan. 8, at the Cadott High School, on the status of EMS in Chippewa County.

There, surrounded by EMS workers, municipal leaders and medical directors, the night began with Marcy Trubshaw, Chippewa County Emergency Management, telling a story. The story was of a family of four, who were traveling, when a car pulled right out in front of the family, resulting in a head-on collision.

An off-duty deputy sheriff happened to be on that roadway and pulled the kids from the car, then pulled the woman out, who was unconscious, with two broken legs, and managed to extract the man, just as the car burst into flames. Amazingly, everyone walked away from the crash, including the two in the car who struck the family.

“And the reason I know – was because I was the woman in the car,” said Trubshaw. “EMS is such a critical piece of the infrastructure.”

Although many say that the lack of EMS providers is an “up north” problem, 97 percent of Wisconsin is made up of rural area. EMS are provided as a function of local government, but 41 percent not reliable, which means that the call has to go somewhere, putting a strain on neighboring services.

“This is not an easy fix,” said James Small, Rural EMS Outreach Program manager. “There’s no cookie cutter to this.”

Most ambulance rosters have 20 active members, but only two or three people are doing 80 percent of the work, which is what’s happening in Cadott. There’s a concerning trend for Cornell, as they only have 11 on the roster, with two or three handling the majority of the calls.

Serving as the Chippewa County 911 Dispatch Center director, Tamee Foldy, of Cadott, knows first-hand, how the stress of unanswered EMS calls can affect the mental health of dispatchers and hospital workers.

If a service cannot answer a call because there’s no one scheduled to be on-call, that means the service has failed.

“That number has to be zero,” said Small. “That’s what we sign up for with a provider license.” It takes 15-30 minutes between the request and response time, and 25-30 miles, one way, for transport to an area hospital. Meanwhile, the EMS are aging out and younger people are not stepping up to replace them. One reason, could be the increased hours of certification to become an EMS, as well as hours upon hours of time driving to take the training, away from one’s family. To combat that, trainings need to be closer to the provider or virtual, or the hours needed for certification need to drop.

Another option could be to eliminate the “volunteer” aspect and make the service a paid, on-staff model, which is attractive to a lot of younger workers.

“The way things have always been, isn’t working anymore and we know that,” said Small.

Admittedly, Chippewa County is home to an elderly/ disabled population, which correlates to a large load of emergency calls. But, it doesn’t just stop there.

“It’s not just getting the patient to the hospital, it’s…the ripple effect,” said Trubshaw.

First, the EMS need to transport and get the patient off the ambulance, and into the hospital’s care as soon as possible, so the squad can return to their service area. With the squad out of service during that time, response lags and has to be picked up by neighboring services.

“Sometimes, we are three services deep, before we can actually get an ambulance to respond,” said Tamee Foldy, 911 center director.

As hospitals become full, EMS also have to transport patients somewhere else, whether that be in the state, to Minnesota, or, in some cases, the Dakotas. For example, in one week at the beginning of this year, Eau Claire Mayo and Marshfield Clinic hospitals saw 52 ED boarders, which means they are waiting for an in-patient bed.

When a bed is not available, the patients simply have to wait in the emergency department, attended by float nurses. Some beds remain full, because of outbreaks at nursing homes that are in “quarantine” or the patient has no transportation.

All of these factors contribute to declining mental health of first responders, which also has to be taken into account. The Wisconsin EMS Association (WEMSA) is working for PTSD coverage for all EMS volunteers, without a fee schedule.

Of the about 17,000 EMS in Wisconsin, only about 14,000 are registered with a service, which is attributed to many factors, such as taking a job in a full-time hospital setting, retirement or burnout. Those numbers may be on the decline, but emergency calls are increasing, each year.

“The biggest problem we’ve found, is funding for all this stuff,” said Rod Patten, president of the Chippewa County Emergency Medical Services Association/Boyd-Edson-Delmar and the City of Stanley fire chief/EMS service director.

Since there are not unlimited funds and some services are not covered by insurance, there has to be an external funding source to ensure sustainability.

“Every EMS transport for a Medicare and/or Medicaid patient results in a loss of revenue,” said Ashley Carothers, representative for WEMSA, adding that Medicare only reimburses around $500. “For simple math, it costs $2,000 to cover the cost of a 911 call.”

With 72 counties in the state, there are 72 ways of figuring out the EMS shortage and how to address it. Some emergent models that have come to light, are to look across county lines or institute an unrestricted countywide levy, but it’s not a onesize- fits-all approach. “We don’t want to weaken a strong service, to strengthen a weak service,” said Small. To make it work, each county must have involved municipal and EMS leadership, as well as community participation. Sometimes, Small shared, there is EMS obstruction to an objective.

“What it takes, is openmindedness,” said Small. “You gotta have an endgame, you gotta have a vision of where it’s going.”

To do so is going to take a lot of collaboration, in a long process, with some difficult conversations. To help with that, those present agreed to create a workgroup, to get the ball rolling.

Maybe a county-wide levy is the answer or to consolidate services, but whatever the solution, it can’t be allowed to go unchecked. More and more services are ending, with the latest Pardeeville, which is only two and a half hours away from Chippewa County, that closed at the end of 2024.

“It’s getting closer and it’s getting harder,” said Carothers. “Something’s got to give.”