Pinedale EMTs Push for Paid Service
Increasing runs and volunteer burnout cited as justification
by Rob Shaul

"Once you get past 200 runs per year, it changes things," said Pinedale EMS Director and Emergency Medical Technician (EMT) Gary Wilson. In 1999, Pinedale EMTs logged over 390 ambulance runs - and the number of runs has been increasing 20% /year since 1994, says Mr. Wilson. Gary and the 14 other EMTs who met with the Journal in the Pinedale Ambulance Barn last Monday evening say they are simply getting "worn out." For this reason, the Pinedale EMTs are pushing the Rural Health Care District Board to fund three paid EMTs to relieve the pressure and workload on the volunteers.

A volunteer ambulance service can handle 200 runs per year, argue the EMTs, but 400 runs per year and up is asking too much. Though the number of ambulance runs has doubled in the last six years, the number of volunteer EMTs has increased only by approximately 25%. In 1994 there were approximately 16 volunteer EMTs in the Pinedale EMS; currently there are 22.

And of these twenty-two volunteers, the bulk of the runs are handled by a core group of four or five volunteers. Each ambulance run takes a minimum of two EMTs, and an average of three. In 1999, four of the volunteers, Cori Laster, Gary Wilson, Carla Kujat, and Wendy Boman combined for 381 medic runs - nearly one-third of the 939 total individual medic runs for that year.

Further, because Pinedale is at least 77 miles from the nearest hospital in Jackson, the average duration of a Pinedale ambulance run approaches 5 hours. This donated time, in addition to standby time at football games, rodeos, and other events, plus time spent training and doing community education activities, translates into hours upon hours of community service from the Pinedale EMTs. This amounts to too much time spent away from jobs and family. "The load is becoming overwhelming," say the EMTs.

Paid Service Proposal

Pinedale EMTs are pushing the Rural Health Care District Board to hire three paid EMTs to take calls and help relieve the volunteers. The three paid EMTs would make $1,200/month the first year, $1,600/month the second year, and $2,000/month the third year, and would be required to be on call at least 60/hours per week. Further, the paid EMTs would be responsible for the administrative paperwork and maintenance duties.

The idea behind the proposal is two-fold, says Mr. Wilson. First, to provide one highly skilled paid EMT on the first ambulance run of the day, minimum. Secondly, the paid EMTs would give some measure of relief to the core group of volunteers currently handling most of the runs, and relieve the volunteers of some administrative and maintenance responsibilities. "Basically, we want to create a professional and stable service and not wear any people out," says Gary Wilson.

In addition to paid EMTs, the Pinedale EMS is proposing increasing compensation for volunteers. Depending on their skill level, volunteers are currently paid between $10 and $15 per run, plus 24¢ per mile. In addition to this compensation, the EMTs propose paying volunteers $1/hour for call time - when they must be within five minutes of the Ambulance Barn. The Pinedale EMTs also propose creating a retirement fund for EMTs and paying for EMT uniforms, which the volunteers currently buy themselves.

Though this compensation for volunteers is an increase, several of the EMTs last Monday stated emphatically that they don't volunteer for the money . "Money's not the issue," says Kris Hunt, simply. "If I leave my job [for an ambulance run] I'm taking money out of my pocket," says Wil Gay.

EMTs vs. The Clinics

Thus far, the Rural Health Care District Board has given a lukewarm response to the Pinedale EMS proposal for paid EMTs. The primary concern is cost. However, the Board is actively considering a $150,000 office space expansion for the Pinedale Clinic. Pinedale EMTs see this as placing clinics above EMTs.

More specifically, EMTs feel the office expansion plan fails to recognize the vital medical care provided to a patient by the EMTs before the patient ever arrives at a clinic. The Pinedale EMTs openly resent this, pointing out that the doctors who run the clinics are paid by the Board, plus have their own businesses, as opposed to the volunteer EMTs. Yet, though the EMTs are volunteers, their work is just as important to the health of the patient, and they are expected to perform just as professionally. "It's my belief that pretty soon the Board needs to treat EMS as important as the clinics," says Mr. Wilson.

Further, several of the EMTs commented that on after-hours runs to the Pinedale Clinic, they feel the doctors take advantange of the volunteers. Instead of calling in their nurses to assist and paying them overtime, the doctors use the "free" EMTs as nurses, increasing volunteers' time away from work and family. Mr. Wilson says the Board is aware of this issue, and Board Member John Linn has begun asking questions about it.

Overall, Pinedale EMTs don't think money is the issue. First, they argue, the county-wide EMS service is in the black, bringing approximately $135,000 into the District each year by billing patients for ambulance runs. Essentially, the service is self-funding.

Second, they believe the District has more than enough money to fund the paid EMTs. This year the two mills the District levies will bring approximately $746,000. Of this total, $420,000 will go to pay the doctors' contracts at the clinics, another $100,000 will be spent on clinic maintenance, $60,000 goes to District administration, and 30,000 pays for utilities at the clinics. This leaves an approximate surplus of $136,000. In addition to this surplus, the District has approximately $580,000 in cash reserves.

The Pinedale EMT proposal will cost approximately $50,000 the first year and $90,000 after three years. They simply think the money is there and the Board should committ to emergency service and support the volunteers.

Board Concerns

"It's probably time that we did this," says Rural Health Care District Board Member Gregg Anderson of Daniel. "We're asking quite a bit of our volunteers for the number and length of runs." However, Mr. Anderson says he does have some "budgetary concerns" about the proposal. He says the question is whether or not the paid EMTs can be funded, as well as paying for the capital needs at the clinics. "We have to maintain our property," says Mr. Anderson. "Building maintenance is always going to be part of our budgetary concerns."

Despite his concerns, Mr. Anderson says he supports the Pinedale EMS proposal.

Board member Dave Racich of Pinedale isn't so sure. "I don't see how the Board can afford this right now," he says of the Pinedale EMS proposal. He's more open to developing an hourly rate for the volunteer EMTs on ambulance runs rather than moving to a paid service supplemented by volunteers.

Part of the budgetary solution would be to increase the ambulance rates, says Mr. Racich. He supports increasing the current rates, and says this money could then be used to fund a paid service or to better compensate volunteers. However, because of Medicare and Medicaid rules, it will take the district approximately 18 months to increase ambulance rates.

Concerning EMT resentment toward what they perceive as the Board's putting the clinics first, Mr. Racich says he knows where the EMTs are coming from, but explains that it's not quite that simple. Mr. Racich says the Pinedale Clinic needs the additional space to handle increased patient loads and office visits. The Pinedale Clinic is seeing increased business, just like the Pinedale EMS. "We can't have just the EMT service or both clinics," he says. The Board is responsible for all these services.

Board Member John Linn of Big Piney is also lukewarm to the Pinedale EMS proposal. He acknowledges there is a problem, but isn't convinced a three-member paid EMT service is the solution.

Mr. Linn wants to take a broader look. For example, he notes that the Pinedale EMS covers calls from the Jonah Field, even though the field is closer to Big Piney ambulances. He says giving Jonah to the Big Piney EMS would decrease the number of runs for the Pinedale service.

Also, Mr. Linn notes that the Pinedale EMS makes several non-emergeny runs for Sublette Center in Pinedale. The Board should consider asking Sublette Center to make its own non-emergency transports, which would decrease the number of runs for the Pinedale EMTs.

Mr. Linn thinks the money may be there to fund the Pinedale EMS proposal, but is "hesitant to jump in there, just because we have the money." He adds, "I don't know that we are fixing anything. It [the Pinedale EMS proposal] may be the cure for 2 or 3 peoples' problems, but not the best thing for the entire service."

What About Big Piney?

The Pinedale EMS proposal points to the question of whether a paid service should also be funded for Big Piney. This would increase costs, and therefore increase budgetary concerns. However, one of the outcomes of the dissolution fight a few years ago was that the Rural Health Care District Board should, to the greatest extent possible, provide equal services at both ends of the county.

From the Pinedale EMS perspective, the determining factor should be the number of ambulance runs a service makes, not driving a political bargain.

For its part, the Big Piney EMS doesn't want a paid service, says Ambulance Director Donny Pope. "Once in a while we get a little slim," says Mr. Pope of his 20 EMT volunteers, "but still we get it pulled though." Mr. Pope says his service handled approximatley 150 ambulance runs last year.

Further, Mr. Pope feels a paid service could hurt recruitment and retention of volunteer EMTs. "What is the incentive for unpaid volunteers to get involved and stay active?" he asks. "We don't want it at this time."

Asked if the Big Piney EMS would be upset if Pinedale did get three paid EMTs, Mr. Pope responded diplomatically. Though he doesn't think the District can afford a paid service, he said, "If that's what the Board wants, it's up to them."

Equality at both ends of the county is an important issue for Board Member Dave Racich. Even though the Piney EMTs may not want a paid service at this time, Mr. Racich believes providing a paid service just for Pinedale would be a mistake and forgetting the lessons of the dissolution fight.

Both Board members Gregg Anderson and John Linn have met with the Big Piney EMTs. "We've talked to the EMTs in Piney," says Mr. Anderson. "The view is they don't have the workload that Pinedale has. They don't see a dire need for one right now."

All John Linn would say is that the two services have "different philosophies" on how to do business.

Looking Ahead

Pinedale's situation is "not an uncommon occurrence around the state," says Jim Mayberry, who directs the Emergency Medical Service Division at the State Department of Health. Mr. Mayberry says Lusk, Afton, and Saratoga are facing similar problems with overloaded and overworked volunteers. "The ambulance service is probably the least-funded agency within the EMS network," he says.

Mr. Wilson says there have been Board suggestions that they simply recruit more volunteers. "We can't just go out to the community and get more people," says Mr. Wilson. "No, the volunteer base is just not there." Furthermore, it takes 140 hours of coursework to earn a basic EMT certificate, and the Pinedale EMS sees just a 50% retention rate of those people who do begin the course work.

Pinedale EMTs clearly feel underappreciated. At their open house last weekend, the EMTs distributed handouts making their case for a paid service and openly lobbied voters and employers to call Rural Health Care District Board members to support the paid EMT proposal. The handout included a form letter for employers and the names, addresses and phone numbers of the Board members. "This is loyalty to our community, to our neighbors. This is commitment to provide life-saving interventions to those in need. This is dedication to our way of life, and preserving it. Help us better meet the needs for our county's growing demand of emergency services. Let your county representatives know you support this proposal."