Frederica Freyberg:

Directors of emergency medical services across Wisconsin are warning of a system on the brink. This is according to our next guest who says there is not enough money and there are not enough people to perform the lifesaving work. And that EMS has relied too heavily on volunteers for too long. James Small is the rural EMS outreach manager for the Wisconsin Office of Rural Health. Thanks for being here.

James Small:

Thank you for having me here today.

Frederica Freyberg:

How is the EMS system on the brink?

James Small:

Right now in many communities around the state and around the country this isn’t just a Wisconsin issue, this is a national issue that’s going on. There is many communities that have historically depended on volunteers or near volunteers where they’re being paid small amount but not a full-time wage for providing EMS and response. And what we’re finding is that we’ve had a decline in the number of people available to do that. And there is not the financial resources to replace them with full-time staff. So as you look around the state at what the system looks like, about a third or maybe a little over a third of the ambulance services in Wisconsin today are not able to staff 24/7, 365 like they are required to. So one in three let’s say. In addition to that, there is another third that are concerned that they can’t do that through 2023. So within the next year they may have system outages too. One of the challenges with that is that it then places the burden on their neighboring services to handle their calls. And there’s even been situations where somebody has called 911 and the ambulance never made it to their house because they couldn’t get an ambulance for them.

Frederica Freyberg:

Do you feel as though stakeholders, lawmakers are aware of what you’ve described as a crisis?

James Small:

Yes. In the discussions I’ve had in the last few months with the — in the legislature, I believe they’re very aware that there is a crisis and are planning on working towards a solution to that in the next legislative session.

Frederica Freyberg:

Does a solution to that, I mean, is it money? Is that what municipalities need?

James Small:

Oh, that’s probably first and foremost the area we need to go down is increasing the funding to local municipalities. Right now the funding that comes from the state through the shared revenue program is the same amount it was in 1993. To put that in perspective in 1993 is when I got my EMS license originally and I’m eligible to retire in three years. So I could conceivably have worked my entire career under the same amount of shared revenue as what is being placed out there today.

Frederica Freyberg:

How long has the issue with EMS been a situation?

James Small:

It’s been growing for probably 20 years at this point. It just reached this crisis point. Six years ago, the legislature did a legislative council study committee which looked at issues and looked at solutions relating to this but never really got any traction implementing any of the ideas that were brought forth from that committee. I think now we’re in a different political environment where maybe some of those ideas can be brought forth again.

Frederica Freyberg:

Is there a region of the state where this is most acute?

James Small:

In the more rural areas it’s more acute for the most part. But I think that as you go around the state, you will find that most regions have areas that are having difficulties. Right now we’re conducting a study of the statewide system and we’re seeing reports from all over the state describing system outages and lack of staffing and so on.

Frederica Freyberg:

Is there a dollar figure for what it would take to try to replace the aging volunteer population with full-time paid staff?

James Small:

I would imagine that’s in the hundreds of millions of dollars. I don’t know exactly whether it’s $200 million or $500 million or upwards of that. But in addition to the EMS, there is also the fire response issues with the volunteer fire departments that are very similar. Law enforcement has similar issues also with funding and not enough people. So public safety as a whole is having a lot of challenges right now that we need to figure out solutions for going forward so we can at least stop the bleeding and start building things back to where we need to have response capability. You know, you look at some of these tragic incidents that happen around the country. If one of those happened in certain areas of our state right now we don’t have the capability of responding to those incidents.

Frederica Freyberg:

So what is the situation like for people like yourself who dedicate your life’s work to saving others?

James Small:

It’s challenging. I think that what we’re seeing is that people are burned out. You know, you have numerous services around the state that are being operated on maybe 3 or 4 volunteers trying to cover 24/7, 365. That’s a huge burden to put on somebody that also has a full-time job that’s supporting their family and then doing this to help their community. The reason the system hasn’t collapsed yet is because these people are so dedicated and they’ve done everything in their power to make it work but we’ve hit this point where they can’t anymore. In some cases, the system failures are happening because a dedicated employee has passed away so they’ve lost that contribution that person was giving because they worked until they died. There are services right now that have an average age on the roster of over 70 years old. This isn’t sustainable where we’re at and we’re imminently looking at a collapse of the system in regions around the state.

Frederica Freyberg:

That’s sounding the alarm. James Small, thanks very much.