‘EMS in Idaho is broken’: Lawmakers move to reform underfunded emergency services

(Idaho Statesman) — In rural Idaho, most emergency medical service providers are volunteers, and some services are funded by bake sales or other community fundraisers.

That’s because the state doesn’t deem emergency medical services (EMS) essential, the way it does police and fire services, so local EMS providers rely on a patchwork of resources, with no statewide coordination of coverage.

Meanwhile, population growth coupled with recruitment and retention barriers and a drop-off in able and willing volunteers is putting pressure on existing staff.

“EMS in Idaho is broken, simple and easy as that,” Peder Humlen, deputy chief of Ada County Paramedics, told the Senate Health and Welfare Committee last week.

A new Idaho Senate resolution seeks to take a step toward reforming the existing EMS funding and coordination structure. Sponsored by Senate Majority Caucus Chair Mark Harris, R-Soda Springs, the resolution asks the Idaho Department of Health and Welfare to draft legislation recognizing EMS as essential and establishing a statewide EMS coordination and funding system.

The proposal follows a 2021 study by the Idaho Office of Performance Evaluations, which found that EMS, particularly in rural areas, are understaffed and underfunded. Seven in 10 emergency medical service personnel in rural Idaho are volunteers, the study found, and just 18% of Idaho EMS directors said in a survey that they’re able to maintain sufficient staff, leading to longer wait times for service and lower standards of care.

“Funding is an issue, personnel is an issue, burnout is an issue,” Harris said during a Tuesday debate in the full Senate. “Our EMS need some help, and this (resolution) is the first step toward getting them the help they need.”

The resolution now heads to the House, after approval from the Senate. Nine Senate Republicans opposed it.

North Idaho Republican Sen. Scott Herndon, of Sagle, said he opposes a move toward consolidating local EMS providers under Department of Health and Welfare control, because it would hinder local accountability.

“I am very concerned about the regionalization we’ve done already in our district, but even more so about the possibility that we might consolidate, at some level, EMS services at the state level, especially if it ultimately ends up in the Department of Health and Welfare,” Herndon said Tuesday.

Study reveals structural issues facing EMS

According to the 2021 study from the Office of Performance Evaluations, a nonpartisan research group, emergency medical services in Idaho are administered by “a complex network of agencies,” including local governments, private entities and nonprofits.

Those agencies are required to share patient care reports with the Idaho Department of Health and Welfare’s Bureau of EMS and Preparedness, but the data is inaccurate and incomplete, the study found. The state bureau has “limited authority and capacity to expand its support of EMS agencies,” the report said.

Additionally, the state does not have a statewide structure for governance of EMS, according to the report, and such a structure could limit redundant services, require statewide EMS coverage and mandate cooperation among EMS agencies.

RELATED | Report: Idaho’s emergency medical services lack resources

More than half of EMS directors surveyed by the researchers said they do not have adequate funding to meet emergency medical demand in their communities.

“We are putting on a band-aid for a major hemorrhage, and it’s not working in rural Idaho,” one director said, according to the report.

Nearly all emergency medical services are delivered without requiring proof of insurance or ability to pay, the report said. But EMS agencies often fail to recover their treatment costs because of low insurance reimbursement rates and uninsured patients who can’t pay for the service, the report said. And the cost of equipment, from ambulances to stretchers, are increasing.

The 2021 study wasn’t the first time the Office of Performance Evaluations brought attention to EMS funding and oversight.

A 2010 study by the group came to similar conclusions, that the statutory framework for emergency medical services in Idaho “had not kept pace with the evolution of EMS” and the state did not follow nationally recommended EMS funding practices.

The new Senate resolution asks the Department of Health and Welfare to come up with legislation next year that would create a statewide EMS planning, coordination and funding system “to ensure reasonable availability of EMS across the state.”

Decline in volunteers hurting EMS providers

Increased demand for emergency medical services, driven by rapid population growth across the state, is straining local EMS agencies, which are struggling to recruit and retain staff, EMS leaders told the Senate committee last week.

“The issues that we’re facing in EMS are at the worst I’ve seen them,” said Shawn Rayne, chief of Ada County Paramedics. “We used to get 70 people (who) would apply for one position that we had open. I can’t fill all the vacancies that I have right now.”

Rayne and dozens of other medical providers served on a task force that met last year to study EMS governance, coverage and funding. Rayne said he learned that Ada County Paramedics, which serviced 36,000 calls last year, is facing similar problems to the emergency service agency in rural Clark County, which serviced 89 calls during the same period.

A key difference for rural providers is their reliance on volunteers. The pool of qualified and willing volunteers is shrinking, and while all states have EMS volunteers, Idaho relies more on volunteers than 40 other states, the Office of Performance Evaluations study noted.

“We are asking these folks to leave jobs that sustain their family … to go help folks in need, and they are no longer able to do that,” said Wesley Anderson, who works with a private EMS agency in Ada County as well as a volunteer agency in Horseshoe Bend. “They are no longer able to provide for folks when they cannot provide for themselves.”

Harris said one challenge facing the task force was resolving tension between assisting struggling EMS providers while maintaining local control of public agencies. Under the proposal, the Department of Health and Welfare’s EMS bureau would be a “hands-off” clearinghouse for training and licensing.

“They’re fiercely independent, and we want to keep it that way,” he said of the local agencies.