STEVENS POINT, Wis. — Emergency medical services consolidation is becoming an increasingly necessary solution for many rural areas struggling with declining volunteerism, rising costs and increased response times.

The Northwoods EMS District, made up of four cities in Vilas County, Wisconsin (Boulder Junction, Presque Isle, Winchester and Manitowish Waters), is a case study for EMS leaders and local government officials. A recent round table at the Wisconsin Association of Cities The conference highlighted the district’s formation process, the challenges it faces, and key takeaways for other municipalities considering similar consolidation efforts.

Identify the need for consolidation

Rural EMS services across the country are facing dwindling numbers of volunteers and overworked staff. In far northern Wisconsin, as in many rural areas, response times often did not meet state regulations, with some reaching 90 minutes or more. The four towns involved recognized the need for change after community feedback revealed that two-thirds of residents were dissatisfied with current EMS service levels. As a result, local government officials began exploring consolidation as a means to improve service reliability and sustainability.

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Hire a consultant to guide the process.

Manitowish Waters Town President John Hanson, along with leaders from the other towns, decided to hire Dana Sechler, an experienced EMS leader and consultant. The towns also received data and technical assistance from the Wisconsin Office of Rural Health EMS Office.

Sechler’s experience in systems design played a crucial role in guiding cities through the consolidation process. Gathered and analyzed data from participating agencies and identified critical issues, such as inefficient deployment of EMS personnel and fragmentation of services.

Some important facts informed city stakeholders and elected officials:

• Response time averaged about 30 minutes, with some outlier times of 90 minutes or more.
• Eighteen volunteers completed all responses across 4 services over the past year. Although 64 people in total were registered, only 32 people responded to the calls, because many of those people were from multiple services.
• The four cities’ ambulance services collectively responded to 600 calls, but due to multiple requests to dispatch an ambulance, there were actually 376 individual 911 calls.
• All four services failed to provide continuous service during the year.

A year-long study resulted in a 70-page report that provides practical recommendations to cities. Sechler’s goal was to deliver data-driven solutions while recognizing the passion and dedication of existing EMS providers.

Steps towards consolidation

The study revealed stark realities – volunteer burnout, long response times and fragmented services – while confirming that existing services were on a path from failure to failure. The four cities took the following steps to create the Northwoods EMS District:

1. Public commitment. Each town held informational meetings and public hearings. After presenting the consultant’s findings, the town boards passed resolutions to officially create the Northwoods EMS District by the end of 2023.
2. Shared financing. The total cost of creating the district was $400,000, distributed equally among the four cities. A tax based on $100,000 assessed property value provides permanent funding for the Northwoods EMS District. The final tax is being finalized and will soon be approved by each city board.
3. Leader recruitment. One of the district’s first tasks was to recruit key personnel. Jason Joling was hired as EMS chief and Jesse Mabie as deputy chief. Both are tasked with administrative responsibilities for launching the district. Once the service is operational, both are expected to respond to some 911 calls as well.

Initial challenges and key successes

Joling explained that forming a new EMS district is not without challenges. The district lacks a mission, motto or patch. The district also needs to obtain vehicles, equipment and hire staff. They have made progress in staffing two 24/7 ambulance stations, including:

• Staffing plan. The Northwoods EMS District will operate two paramedic-EMT ambulances 24/7/365, responding from two stations. The district needs to fund 35,000 hours of coverage per year.
• Salaries and benefits. To attract and retain full-time staff, the district is budgeting $18 per hour for paramedics and $25 per hour for paramedics, along with benefits such as participation in the Wisconsin Retirement System and health insurance.
• Community presence. While the Northwoods EMS District will eventually handle all transports, all four cities will maintain an EMR presence to act as first responders. The district hopes to train and cross-credential EMRs for future roles within the consolidated system.

Conclusion

The Northwoods EMS District is a testament to the importance of proactive leadership, community involvement, and expert guidance in navigating the complex EMS consolidation process. For other rural communities facing similar challenges, consolidation may be the key to building a more resilient and effective EMS system.

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