EMS at a crossroads

A two-part series will examine EMS services as they exist in Jefferson County, their strengths and weaknesses, and how the Wisconsin Policy Forum views possible ways collaboration among departments might help.

JEFFERSON — An in-depth study of Emergency Medical Services capabilities and challenges in Jefferson County by the Wisconsin Policy Forum has found that greater collaboration among existing providers and potential involvement by county government could ease challenges and help in preparing for the future.

The Wisconsin Policy Forum, a statewide, non-partisan, independent policy research organization analyzes issues affecting local governments and, in this situation, gives leaders options in developing plans for dealing with staffing shortages and growing demands affecting EMS units.

“Our research and facilitation activities encourage elected officials and community leaders to find effective, data-driven solutions to pressing policy challenges and promotes productive discussion among the public and private sectors,” the group’s website said.

Each of the sets of collaboration options outlined in the study would further efforts to produce consistent and higher-quality service, according to WPF President Rob Henken.

“While some could be added at no cost, or with minimal expense, others would require considerable new investment,” Henken said. “Consequently, elected leaders could opt to start small — perhaps with a mix of small-scale and sub- regional collaborations. Conversely, given the importance of EMS to the region’s well-being, they may see the value of immediately moving toward countywide enhancement and consistency.”

EMS first became part of the national medical scene in the 1970s. These days, the availability of quality, timely emergency medical response and paramedic care has become a normal expectation for most Americans. The report said that, less visible is the fact that EMS systems were built on operating practices that have begun to weaken in light of growing calls for service, a changing workforce, the need to accommodate new medical practices and technologies, and municipal financial constraints.

The Jefferson County study was launched early in 2020, in part, with a meeting at the Jefferson County Fair Park Activity Center, to examine the state of EMS here. The onset of the coronavirus two months into the study made it more timely and necessary, Henken said.

“Like other communities across Wisconsin, Jefferson (and Dodge County’s) municipal service providers are facing emerging challenges from increased service demands and reliance on staffing models that may not be sustainable,” the report stated. “In addition to analyzing these challenges, the analysis explored how enhanced service sharing and collaboration among the county’s EMS agencies might allow them to confront their mutual challenges more effectively and perhaps at a lower cost than efforts to do so alone.”

Emergency medical services, ranging from basic first response, to advanced paramedic care, are provided by 13 distinct agencies in Jefferson County. Eleven of the 13 actively participated in the study through a survey, group meetings, and individual interviews.

The study found that, for the most part, EMS providers in Jefferson County operate independently and without county-wide consistency, employing staffing and operational models that meet their perceived needs and objectives.

Five, including Watertown, Waterloo, Johnson Creek and Ixonia, are combined fire/EMS agencies. Others focus exclusively on EMS response. Ryan Brothers Ambulance is a for-profit company that provides EMS under contract for several communities.

These departments include both “career departments” that use mostly full-time personnel who staff shifts at stations on a 24/7 basis, as well as departments that rely mostly on paid-on-call staff who are called in to respond to emergency medical incidents when they arise. Some also use paid-on-premises staff who are hourly, part-time workers, but are assigned to regular shifts.

Specific findings from the analysis of service models and operational data from the various providers included:

  • Wages vary widely across the several providers that use paid-on-call and paid-on-premises staff and several reported challenges in recruiting and retaining those personnel.
  • EMS provider locations are dispersed fairly evenly across the county, with all but three licensed to provide advanced life support services. There are differences in ALS capacity and responsiveness in different parts of the county.

“Medical direction is provided by six different medical directors, which may result in inconsistent protocols and standards of care, and which may impede efforts to cross-credential personnel to work in different departments if such a strategy is desired,” the report said.

The forum found that EMS dispatch is fragmented across the county.

“Consequently, mutual aid efforts may not be as effective as they could be and data collection is not standardized,” the study said.

Average response times reported from individual providers vary, and those conducting the analysis said this is understandable because of the different operational and service models employed.

“Nevertheless, it appears that strategies to improve response times in some areas of the county may be merited,” it said.

The study indicated that, between 2016 and 2019, nearly all EMS providers who participated in the research experienced call volume increases, with most growing by more than 10%.

“Given projections of continued population growth, particularly among those age 65 and above, increases in call volumes will likely continue,” the study said.

Addressing future challenges, the report said the analysis of EMS services in Jefferson County does not raise immediate red flags.

“Departments have been able to reasonably accommodate growing call volumes thus far,” the report said. “Station locations are distributed evenly across the region and most are able to provide an advanced level of response. While response coordination could be improved, current support through mutual aid is working relatively well.”

“While not severe at this time, (EMS challenges and opportunities for improvement) may intensify in the future and may limit the ability of the county’s providers to keep pace with the expectations of citizens and to improve service for the region as a whole,” the study said.

In staffing, the ability for those using paid-on-call and paid-on-premises models to attract, recruit, and retain staff has been challenging for some time. The study said causes include low wages, odd work hours and high training costs. Some officials expressed concern that, with the loss of even one or two additional POC or POP staff, they may be unable to respond to calls at certain times of the day.

“In terms of consistency in quality of care, response times differ among the providers and may not be satisfactory in all communities,” the report said. “Medical direction is provided by physicians from six different (locations), which means there may be inconsistencies in training expectations and protocols. Finally, there are inconsistencies across the board regarding skill maintenance.”

The report included a study in average response times for EMS agencies in Jefferson County. Watertown’s time from dispatch to turnout was 1.4 minutes, while Jefferson’s was 2 minutes. Johnson Creek’s was 3.5 minutes and Fort Atkinson’s was 3 minutes. These departments all used shift staffing. The paid-on-call agencies of Lake Mills, Ixonia and Waterloo showed times of 4.7, 7.5 and 5.6 minutes, respectively.

“Shrinking rosters may make it difficult for agencies to send out a second or third ambulance when multiple calls come in,” the report said. “Also, some departments may be unable to send mutual aid during busy times, thus prolonging response times in circumstances when such aid is needed.”

It also said, “Multiple dispatch centers in the area may pose an obstacle to enhanced service-sharing efforts involving ‘closest unit responds’ or joint response frameworks. The fragmentation prevents uniform data collection and also may impede optimal mutual aid response times.”

The Forum found that there are times when a department seeking mutual aid may not reach out to the closest available neighboring provider. Instead, leaders call for mutual aid based on the strength of relationships between various providers or communities, as opposed to geographical proximity.

“Finally, some EMS providers appear reluctant to pursue collaborative strategies to address common challenges — not because they lack a cooperative spirit, but because they believe their challenges are manageable and that, consequently, there is no need to seek greater partnership with their neighbors,” the report said. “While we are in no position to dispute that assessment based on current circumstances, we suggest that growing EMS call volumes, intensifying staffing and financial challenges, and quality of care concerns may soon be cause for reconsideration. We also note that municipal administrators in the county appear eager to pursue a range of service sharing opportunities and could play a leading role with regard to future EMS collaboration.”

Part 2 of this two-part series will discuss collaborative options the policy forum has developed for Jefferson County’s EMS services and will include insights from Jefferson County Administrator Ben Wehmeier and Watertown Fire Chief Kraig Biefeld.

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