Willing to put in the work

According to an assessment from Safe Tech Solutions, a consulting firm that specializes in emergency medical services, the long-term sustainability of the Ennis Ambulance Service is questionable. Stakeholders of EAS met in the Madison Valley Bank conference room to discuss the assessment Aug. 12. 

The stakeholder meeting echoed the community’s confusions and disagreements about the EMS. The willingness to have productive discussions about community needs was a success, though nothing was decided. With more consensus needed among the 11 stakeholder-individuals, another meeting with Safe Tech Solutions was agreed on within two months – the specific date has yet to be determined. 

Aarron Reinert, a partner at Safe Tech Solutions, helped assess Ennis Ambulance Service and facilitated the meeting. 

“You got a group here on behalf of, not only the ambulance, but the medical center and the city that want to do the work,” Reinert said.

The operational structure of the Ennis Ambulance Service depends on community involvement. 

A desire to be a part of EMS drives its membership, which requires flexible schedules, basic life support certifications and another reliable source of income. 

The men and women whom provide the EMS service operate as a non-restricted, on-call employees, according to the Fair Labor Standards Act. They are paid to be on an EMS run, but not for the time that they are available to respond. 

About seven individuals, with varying certifications that accompany the Basic Life Support service, are an essential operating resource of the Ennis Ambulance Service. Every stakeholder of the Ennis Ambulance Service agreed that the devotion and service of these individuals is not a debate; they are incredible. 

But recruitment and retainment are issues for the Ennis Ambulance Service. About a year ago, Patti Austin, Ennis Ambulance Service manager, started offering emergency medical technician classes to help recruitment. They have gotten at least one emergency medical technician, who is a reliable addition, out of the two classes. The third class will be held in December. 

“We understand the problems we have,” Ennis Ambulance Service responder, Art Behar said. “We’re professionals.”

The essential need for the community to provide devoted personnel for its EMS service, makes it an uncertain aspect of the service in the future. The other stakeholders, Madison County, Madison Valley Medical Center and Town of Ennis, suggested that outside funding could offer solutions. 

The Ennis Ambulance Service responds to a 2,000 square mile area, a little bigger than the state of Delaware, at almost no cost of the taxpayers. But it is a highly subsidized service. The Town of Ennis provides space, insurance and workers compensation as an enterprise fund of the town. 

“If they had to pay for insurance on their own, they couldn’t make it,” Ennis Mayor, Blake Leavitt said. 

The Ennis Ambulance Service revenue as a paid for service pays for workers’ wages and equipment. Insurance companies and Medicare and Medicaid payments make up most of Ennis Ambulance Services funds. They recently started a non-profit, Friends of Ennis Ambulance, to accept donations to help fund the EMS. The Ennis Ambulance Service, also recently, increased its rates. 

These recent fundraising efforts are too young to attach data to but are Ennis Ambulance Services’ reaction to struggling funds. 

The meeting’s facilitator, Reinert, has nearly 30 years of experience in EMS, starting his career as a volunteer in a small rural ambulance service in Minnesota. He is an expert in management, leadership, system design and applied practices in rural EMS systems, currently going through the same process with every EMS in Wyoming. Reinert was the chairperson of the National EMS Advisory Council from 2010 – 2012, which the U.S. Secretary of Transportation appoints to inform the federal government on the EMS community and issues. 

Reinert reported from the audited financials that over a two-year period Ennis Ambulance Service lost over $110,000. Mayor Leavitt deducted the cost of upgrading the ambulance service’s ZOLL EMS products, like defibrillators and vital monitoring systems, from the two-year period loss. He estimated Ennis Ambulance Service lost about $30,000. According to Behar, the enterprise fund has a reserve account that covers losses in Ennis Ambulance Service revenue.

Funding a paramedic or full-time advance life support staff for the Ennis Ambulance Service is not feasible, according to Austin. Last year Ennis Ambulance Service responded to 190 calls. The call volume in Madison County is low and revenue from the service cannot support the average yearly wage of a paramedic. According to ZipRecruiter, the majority of paramedic EMT salaries in Montana are between $33,000 and $50,000. 

Maintaining EMT skills is another concern that the low volume of EMS calls produces. Reinforcing training through infield experience is crucial for a paramedic. 

Dr. David Newton, rural family medicine specialist at MVMC, has offered Ennis Ambulance Service members to volunteer at the hospital to aid this concern. According to one Ennis Ambulance Service member, working in the emergency room has helped him stay current with his skills. Though, he is retired and has the time to do it. Others whom balance another job might struggle to find time to volunteer at the hospital. But it is a possible avenue for a paid paramedic to retain their skill sets.

Other needs in the community, such as hospital transfers and better access to advance life support EMS, incorporated the assessment and discussion. MVMC needs ALS transfer ability, which they can often find through Ruby Valley Hospital.

The Ennis Ambulance Service and Ruby Valley Hospital have mutual aid agreements to provide 911- services. A majority of the calls from dispatch are BLS, and RVH is an option when ALS is needed.

The Ennis Ambulance Service has strong sense of social responsibility to the community, but beyond that there is not an accountability process, according to the assessment. Currently, any contract between the city and Ennis Ambulance Service is “unclear.” The Ennis Ambulance Service grew up organically with a symbiotic relationship with the city and residents. As Madison County grows and health care becomes more complex, assurance for EMS will be needed. 

Finding those clear paths of assurances in the future is the purpose assessment and discussion. 

“Conversation is when you have openness to understanding,” Reinert said. “Conversations are hard but you’re having them, you’re having real conversation… There’s some give and take, and there are some passions and disagreements, and that’s real conversation.”