MANTI—Last year, Sanpete County spent $1.12 million in federal coronavirus assistance money buying new ambulances and emergency equipment for the four emergency medical services (EMS) groups in the county.
But a thornier need has emerged, Christy Johnson, a registered nurse, president of the Ephraim Ambulance Association and secretary of the Utah Rural EMS Directors Association, told the Sanpete County Commission last week.
“We have really good equipment. We have new ambulances,” Johnson told the commission at its Dec. 7 meeting. “Now we don’t have people to staff them.”
A few weeks ago, she said, a man in Manti had a heart attack. The 911 center, part of the Sheriff’s Office, paged the Manti ambulance group twice. No one responded. The 911 operator paged the Ephraim Ambulance Association. It took Ephraim 20 minutes to get to the scene. The man died.
For decades, communities in Sanpete County have relied on volunteers to provide emergency medical services, Johnson said. But that gravy train appears to be running out. “Just like in life, you can only hold out so long,” she said. “We’re on the dying side. We’re in trouble.”
The purpose of her appearance was to ask commissioners for $40,000 to hire SafeTech Solutions, a Minnesota consulting company, to analyze EMS in Sanpete County and recommend how it should be reorganized and funded.
The commissioners, who were just finalizing their proposed 2022 budget, said, as Commissioner Reed Hatch put it, “We haven’t budgeted for this. We don’t have any extra money lying around.”
Johnson said if the county could come up with even $10,000, she believed the EMS groups in Gunnison, Manti, Ephraim and North Sanpete could come up with the rest.
“If I had $40,000 in Ephraim ambulance money, I would do it in a heartbeat,” she said. “Because I know this is going to give us a direction. These people have worked with tons of other agencies. This is what Grand County used…to give them the direction they needed to now have sustainable EMS.”
Much of Johnson’s presentation focused on gaps in EMS in the county.
She spoke to the commission at about 2 p.m. on a Tuesday. She said if someone in Manti had an emergency right then, there was nobody locally to help. The Manti ambulance group had told her, “We cannot provide EMS service Mondays, Tuesdays or Wednesdays. None at all.”
“If you’re in Fairview, there is no service today…If you have something in Moroni, you have no service today.”
Johnson said if there is an emergency in Manti, 911 operators call her organization in Ephraim. “So we’re taking Ephraim out of its service responsibility and taking care of another service area,” she said.
“I have a backup unit most of the time, depending on the day. Right now, I think we’d be okay…I think we could have another crew respond and be able to take care of our needs.”
Johnson said the ambulance based in Mt. Pleasant frequently transports patients from Sanpete Valley Hospital to hospitals on the Wasatch Front. “If they’re out on a transport, Ephraim’s covering that [part of] the north end also.
“If Manti’s not covering and you have something in Sterling, Gunnison is coming over. The only agency Ephraim does not support or cover is Gunnison. We are supporting pretty much the whole county. And there are times…we aren’t able to respond,” she said.
“So I’m very concerned. We have a broken system and we’re playing with people’s lives…We need to figure out where we need to go in the future to protect us.”
“I feel for you, Christy,” Commissioner Scott Bartholomew said.
Another issue, she said, is fragmentation. EMS organizations have to be state licensed. There is a different license holder for each of the four EMS organizations in the county.
In Gunnison, the license is held by the Gunnison Valley Hospital. That service has full-time paid staff. In Manti, Manti City holds the license. The Ephraim Ambulance Association is an independent, nonprofit organization that holds its own license. Johnson said she wasn’t sure who sponsors the North Sanpete group.
While there are four agencies, ambulances are parked at six stations around the county. But she said only three of those ambulances are available 24 hours per day, seven days per week.
Commissioners Ed Sunderland and Reed Hatch both suggested reconfiguring EMS as a countywide service.
That’s what has happened in Grand, Garfield and Juab counties, Johnson said. But someone would have to figure out how to bring the four existing agencies under a single license and who would direct the operation.
“In Grand County, they were all volunteers…,” she said. “They’re all paid now. You see how much tourism they have down in that area. They wouldn’t be able to handle their call volume if they didn’t have a paid service. I think that’s what we’re eventually going to.”
The Ephraim Ambulance Association is pretty much a hand-to-mouth operation, Johnson said. It has no guaranteed funding stream.
While it charges for ambulance rides, it only collects 48 percent of those charges. Some people who are uninsured never pay. And Medicare and Medicaid only pay about 50 percent of billed charges. The service gets about $5,000 per year from the state. Ephraim City sometimes makes a donation. And the association can apply for competitive grants.
Another misconception is that people are motivated to volunteer because they get paid when they transport a patient and can get health insurance through their ambulance company.
Johnson said volunteers do get a payment, ranging from about $50 for a transport to a local hospital to $200 if they go beyond Utah County. With COVID cases clogging hospitals, volunteers sometimes have to take patients as far as Ogden or St. George, which can take a whole day. And volunteers typically have other jobs.
If an EMS organization offers health insurance, it is typically a high-deductible plan that covers the volunteer only, not his or her family.
Last year, she said, Snow College received $800,000 from CARES money to beef up its EMS training program. Her company has recruited some volunteers from the program. But she said many of the participants are Snow College students from other parts of the state who plan to go into medical fields and want the training as part of their education. They aren’t in a position to become volunteer EMTs in Sanpete County.
Ironically, Johnson said, under a state law passed by the last legislature, counties and cities are required to provide EMS, such as they have long been required to have fire departments. But the law was essentially an unfunded mandate. The legislature didn’t address how local governments are supposed to fund the service.
She reiterated her call for an independent study to figure out how to provide reliable EMS service countywide. “We look at $40,000 now. Or we look at the system failing,” she said. “And then what happens? We have to create it from scratch. I think this assessment is probably the cheapest way we’re going to find out what the direction is.”
