Before a council chambers filled with local paramedics and emergency medical technicians, Grand County Emergency Medical Services (EMS) Director Andy Smith asked the county council for a new home for his department.
Increasing call volumes, uncertain funding streams, aging facilities and staff-wide “burn-out” have stretched Grand County EMS thin over the past several years, according to Smith.
On Oct. 17, Smith offered the county council a potential route forward: create a special service district for the oversight and management of Grand County EMS.
“The biggest benefit I think is engaging a single focused governing body … that can be really invested and help plan for the future,” Smith said.
In 2016, an outside assessment agency concluded that — as operating today — EMS “is not sustainable.” That agency recommended finding “the best and most appropriate ‘home’” for the service, which is currently housed as a department within county government.
Shortly after the assessment, a local stakeholder committee made up of EMS administrators, county council members and local health care representatives discussed a myriad of options, ultimately landing on the creation of a special service district focused on EMS.
Although he says the county has shown incredible support for the service, Smith told The Times-Independent that council members necessarily “have to think at that 20,000-foot level” while EMS needs a managing body “to be down at the 3- to 5,000-foot level right now.”
“Long term, a district just makes more sense for a department that’s as specialized as ours,” Smith added.
As their call volume continues to place Grand County EMS on par with some of the state’s busiest urban areas, Smith said the department’s staff numbers have remained roughly the same at 30 employees. Internal documents describe EMS as “overburdened and understaffed.”
At the current call volume growth rate, Smith told the county council that staff will need to serve 1,200 calls annually by the year 2020 — a number that he says calls into question their entire department in terms of sustainability.
“If we stay the way we are today [at] our current staffing numbers ... somewhere around 2019, 2020, we’re going to hit a call volume level of about 1,200 calls a year. I just don’t think we can keep up,” Smith said.
According to Smith, the department took several stopgap measures to address significant staffing shortages last year, including hiring six full-time paramedics to ensure continued 24/7 emergency coverage.
But county documents indicate that a second ambulance remains unstaffed for roughly 50 percent of its schedule, leaving the administrative team to pick up shifts with some staff consistently working more than 70 hours per week.
And Smith said that last year, “for the first time ever,” Grand County missed two calls, needing to bring in other ambulances to serve the community.
“It gets to a point where you can handle it, handle it, handle it, and then once you grow to a certain rate you have to say when do we add that next truck? When do we add that next full-time position? And that’s where we’re at,” Smith said. “We’re at this level where we can barely handle what we have with the staff that we have and we’re getting to the point where we need to add that next level.”
County council member Curtis Wells told Smith that he believes a more focused group to guide EMS through their challenges is “good.”
However, Wells questioned the special service district model in general, voicing concerns over fiscal management.
“I don’t disagree with you that a more specialized, focused group with a smaller scope of responsibility is good,” Wells said. “But in my opinion I see more financial mismanagement under the guise of special service districts than I do the county.”
In addition to his concerns regarding fiscal responsibility, Wells added that special service district and county board positions are sometimes difficult to fill, and that volunteers bring varied levels of engagement.
“This isn’t a ‘rec center’ or a Grand Center or another facility or a ball field, this is an essential service,” Wells said. “What you guys do is so important for the community, and such a vital service … this is not a special service district that would be able to withstand poor spending [and] poor management.”
Smith said he is “well aware” of the difficulties with the special service district model, but argued that if EMS had an involved board, the increased oversight could really benefit the service.
“I see that the involvement of the board as the main reason why this would survive. I think a special service district gives the department more flexibility to meet the changes that [are] coming down the pike while also having more oversight,” Smith said. “I see a governing board as being able to allow some of that flexibility but while also having a vested interest and more oversight.”
He told the council that the stakeholder committee considered many different options for EMS projected against long-term outcomes, including moving the service under the Canyonlands Health Care Special Service District (CHCSSD) umbrella, creating an independent non-profit, as well as joining with the Moab Valley Fire Protection District.
Wells questioned why the working group removed the CHCSSD option for Grand County EMS. The two entities currently share a percentage of the healthcare facilities sales and use tax, with CHCSSD receiving 75 percent and EMS receiving 25 percent.
Kirsten Peterson, the chair of CHCSSD, addressed the council, saying that the board currently has their “plate very full” with issues related to the Canyonlands Care Center.
“If everyone agreed that was the best place, we would do the best we could to take that on,” Peterson said. “But we really have had our plate very full with issues of the long-term care center. And to add the depth of bringing in a new entity that wants a lot of direction and attention to them I know would be asking a lot of the people we have currently.”
County council member Evan Clapper, who served on the EMS stakeholder committee, expressed support for a district with a single focus.
“I can really appreciate the single-mission drive in trying to have it in a place where they’re not trying to do two or three or fifteen different things,” Clapper said. “I would be in support of pursuing EMS having its own special service district and trying to crunch those numbers so that it all makes sense on paper, pencils out and come up with a sustainable model.”
Although he asked Smith to consider his concerns regarding special service districts, Wells said that the director plays a large role in their ultimate success.
“The good districts in the state and in the country ... the director does a very good job with the board … and I think you can do that [regardless of] if it’s an existing district or a new district,” Wells said. “And I think that’s a vital component to steady smooth sailing. Because this is a big animal.”
The county council is expected to consider a resolution to create a special service district for Grand County EMS in November.