WORLAND, Wyo. – Luke Sypherd has been running the small volunteer ambulance crew for the past three years, servicing Washakie County, Wyo., Serving 7,800 county’s residents and transporting them 162 miles north to the nearest major trauma center, Billings, Mont.
However, in May, the Washakie County Voluntary Ambulance Service will no longer be available.
“It’s just going downhill,” said Mr. Sypherd. The work is hard, demanding, and almost entirely voluntary, and the meager income from moving patients to medical centers in small towns like Worland was severely eroded for much of 2020 as all but the sickest coronavirus patients hospitals avoided.
The Washakie County’s enigma reflects a worrying trend in Wyoming and similar states: Rescue workers serving much of rural America are running out of money and volunteers, a crisis created by the demands of the pandemic and a neglected patchwork 911 -System is tightened. The problem goes beyond geography: In rural New York state, Crews struggle to pay bills. In Wisconsin, senior volunteers are retiringand no one takes their place.
The situation is particularly acute in Wyoming, where almost half of the population lives in an area so empty that it is still considered a border. According to an analysis by the New York Times, at least 10 locations in the state are at risk of losing emergency services, some imminent.
Many of the ambulances that have disappeared are staffed with volunteers, and some are for-profit ambulance providers who say they are losing money. Still others are local contractors hired by municipalities who can no longer afford to pay them in the face of the pandemic’s budgetary crisis. Thousands of Wyoming residents could soon be in a position with no one around to answer a cry for help.
“Nobody can find a solution,” said Andy Gienapp, the youngest emergency services administrator for the Wyoming Department of Health. “The communities are facing the real crisis: ‘We don’t know how we’re going to do it tomorrow because nobody is doing it for free.'”
“Nobody wants to pay for it”
About 230 miles southwest of Washakie County, Ron Gatti is preparing to close Sweetwater Medics, a small ambulance company in Sweetwater County that has 42,000 people spread over 10,000 square miles. In view of a budget crisis, the district is expected to end its contract with Mr. Gatti’s ambulance service in June.
The situation is a direct result of the pandemic, said Mr Gatti and district officials. Rock Springs, the town where Sweetwater Medics operates, was looking for budget cuts. The ambulance contract was one of them. Mr. Gatti’s company suggested moving to a public, tax-assisted service funded by the county, he said, but the money wasn’t there.
“Everyone wants it and nobody wants to pay for it,” said Jeff Smith, a Sweetwater County commissioner.
Instead, the regional hospital will have to respond to emergency calls independently after June 30th.
Mr. Sypherd, who is also the president of the Wyoming EMS Association, keeps a list in his director of ambulance companies, large and small, that are in imminent danger of shutdown. There are Sweetwater Medics that could be gone by fall. Sublette County’s service was recently saved after voters approved a small tax increase to fund a new hospital and ambulance. Albin near Laramie no longer has enough volunteers to fill his crew.
“The ambulance in Albin is fiscally sound. There’s just no one to give it to, ”said Carrie Deselms, who runs the program.
Fremont County, home of the state’s Wind River Indian Reservation, is expected to lose its only emergency medical service, American Medical Response, a national not-for-profit that recently merged with the company that has been serving the county emergency medical services since 2016.
Now American Medical Response says its profit margins can’t justify staying there. The company has informed district officials that it will not be bidding back when its contract expires this summer.
“Call volumes in Fremont County have decreased, making it impossible to cover rising operating costs without a subsidy,” said Randy Lyman, regional president for Global Medical Response for the Northwest, American Medical Response’s parent company. “The income alone was simply not enough.”
April 25, 2021, 4:17 p.m. ET
An unsustainable model that will continue to be burdened
There is a misconception fueled by stories of astronomical bills and post facto fees that emergency medical services is a sustainable – even lucrative – business model. The truth, medical professionals say, is that these bills are rarely paid in full, by Medicare, private insurance, or otherwise. Even in New York City, which operates ambulances alongside its fire department, ambulances alone don’t make enough money to survive.
“The income does not nearly cover the full costs of operating the UMS,” said Frank Dwyer, a spokesman for the fire department.
For years, paramedics and paramedics have warned that these unreliable sources of income put the country’s emergency medical systems at risk of collapsing. Experts say the current rural service crisis will almost certainly materialize at some point, but the pandemic has accelerated it.
“It’s a universal problem,” said Tristan North, senior vice president at the American Ambulance Association, which represents aircrews in rural and urban areas. “If you have fairly constant volume, you can get some economies of scale and have a better idea of budgeting, while in a rural area it is far less predictable because you have a smaller population.”
Critical to an ambulance’s survival is its ability to move patients to hospitals, which can result in billing for transportation. That limited source of income dried up during the pandemic as crews were prevented from moving all but the sickest patients, according to workers across the country.
Rather than transporting patients to hospitals, crews were instructed to provide on-site care, said Gienapp of the Wyoming Department of Health. “EMS is not paid for this,” he said.
At the same time, many of the usual types of medical emergencies that helped keep ambulances afloat disappeared either because people were less moving or because they were afraid to go to a hospital and expose themselves to the coronavirus.
“There isn’t enough EMS volume in this entire service area to make this a profitable, balanced business,” said Gatti of Rock Springs. “This is an essential service that doesn’t pay for itself.”
In dense urban areas like New York or Los Angeles, there are enough people and everyday illnesses for an ambulance to get close to the upkeep and enough tax base for cities to support it. But in places like Wyoming, the least populous state and one Notoriously averse to tax increasesEvery missed transportation in 2020 was a critical loss of revenue.
Unlike fire and police departments, many states do not consider ambulances an “essential service”. Only a handful of states require local governments to provide these.
For most of the country, access to an ambulance is a lottery. Some municipalities offer them as a public service funded by taxpayers, while others contract with nonprofit ambulance companies. Most rely on the willingness of volunteer companies like Mr. Sypherd in Washakie County, backed by a patchwork system of public and private funding streams.
But EMS experts across the country say fewer and fewer people are willing to volunteer for the job, a phenomenon accelerated by the stress of the pandemic. Many communities expect volunteers to take the time to do work, which few people can afford.
“The donated work is no longer there,” said Gienapp.
Same job, new patch
On May 1st, Mr. Sypherd will put on a new uniform.
For more than a year, he had known that Washakie County’s system was unsustainable. To make sure an ambulance remained in Worland, Mr. Sypherd reached out to Cody Regional Health, a hospital system near Yellowstone National Park, and began to see if the agency would take over his ambulance company.
It’s a trend that is growing in importance in rural states like Wyoming: in the absence of volunteer rescue workers or sustainable funding from local governments, some troubled emergency services are accepting takeovers of local hospitals and health systems.
The system is not ideal, experts admit, and it could leave large parts of rural America worryingly far from emergency medical services. Given the alternative, many crews like Mr. Sypherd reluctantly accept help. In May, the Washakie County Ambulance Service will become an ambulance company of Cody Regional Health and will employ many of Mr. Sypherd’s original crew members.
“It’s the right thing,” said Phillip Franklin, the director of the ambulance program for Cody Regional Health.
So far, Mr. Franklin and his team have taken over two struggling ambulance companies in northwest Wyoming and are trying to help others with their workload.
The reality, he says, is that without the help of systems like Cody’s, many of the ambulances in rural Wyoming will be down.
“Someone will always have to subsidize rural America,” he said.