New ambulance district will replace four volunteer ambulance services in small town

STEVENS POINT, Wis. — Consolidation of emergency medical services is an increasingly necessary solution for many rural areas struggling with declining volunteerism, rising costs and longer response times.

The Northwoods EMS District, formed by four towns in Vilas County, Wisconsin—Boulder Junction, Presque Isle, Winchester, and Manitowish Waters—provides a case study for EMS managers and local government officials. Recent panel discussion at 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.

Identifying the need for consolidation

Rural ambulance services across the country are facing dwindling volunteer numbers and overworked staff. In far northern Wisconsin, as in many rural areas, response times often did not comply with state law, in some cases reaching 90 minutes or more. The four cities involved recognized the need for change after community feedback showed two-thirds of residents were dissatisfied with the current level of ambulance services. As a result, local government officials began to explore the possibility of consolidation as a means of improving the reliability and sustainability of services.

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Hire a consultant to guide the process

John Hanson, Chairman of the City of Manitowish Waters, along with other city leaders, decided to hire Dana Seckler, an experienced EMS executive and consultant. Cities also received data and technical assistance from Wisconsin Department of Rural Health Services Emergency Medical Services.

Sechler’s experience in system design played a critical role in guiding cities through the consolidation process. It collected and analyzed data from participating agencies and identified critical issues such as ineffective use of emergency personnel and fragmentation of services.

Some important data was shared with city stakeholders and elected officials:

• Response times averaged about 30 minutes, and sometimes took 90 minutes or more.
• Eighteen volunteers completed all responses between the four services last year. Although there were a total of 64 people on the list, only 32 people answered the calls because many of these people belonged to multiple services.
• The four cities’ ambulance services collectively responded to 600 calls, but due to numerous requests for an ambulance, there were actually 376 individual 911 calls.
• All four services were unable to provide continuous service throughout the year.

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

Steps to consolidation

The study revealed the harsh realities of volunteer burnout, long response times and fragmented services, and confirmed that existing services are on a path from failure to failure. Four cities have taken the following steps to create the Northwoods Ambulance District:

1. Public participation. Informational meetings and public hearings were held in each city. After presenting the consultant’s findings, city council passed an ordinance to formally create the Northwoods Ambulance District by the end of 2023.
2. Co-financing. The total cost of creating the district was $400,000, which was distributed evenly among the four cities. The tax levy, based on a property’s $100,000 assessed value, provides ongoing funding for the Northwoods Ambulance District. The final fee is being developed and will soon be approved by each city council.
3. Selection of leaders. One of the district’s first tasks was to recruit key personnel. Jason Joling was hired as EMS chief and Jesse Mabee as deputy chief. Both have administrative responsibilities to get the district up and running. Once the service is up and running, both are expected to answer 911 calls as well.

Initial challenges and key successes

Joling explained that forming a new ambulance district is not without its challenges. The district does not have a mission, motto or badge. The district also needs to purchase vehicles, equipment and hire staff. They have made progress in staffing two 24-hour ambulance stations, including:

• Personnel plan. The Northwoods Ambulance District will have two paramedic and EMS ambulances operating 24 hours a day from two stations. The district must fund 35,000 hours of lighting annually.
• Salary and benefits. To attract and retain full-time staff, the county is budgeting $18 an hour for EMTs and $25 an hour for paramedics, as well as benefits such as participation in the Wisconsin Retirement System and health insurance.
• Community presence. While the Northwoods Ambulance District will eventually handle all traffic, the four cities will maintain Emergency Medical Services (EMR) to serve as first responders. The district hopes to train and cross-qualify EMRs for future roles in the consolidated system.

Conclusion

The Northwoods EMS District is a testament to the importance of strong leadership, community involvement, and expert leadership in the complex process of EMS consolidation. For other rural communities facing similar challenges, consolidation may be the key to creating a more sustainable and efficient EMS system.

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