Taylor County EMS wants to grow to two full-time ambulances to cover rural areas of the county, but the provider is asking taxpayers to help foot the bill − at potentially twice its current budgetary allocation from the county.
A single full-time ambulance currently covers 800 square miles and is seeing increasing call volumes − from 1,000 a year in 2013 to nearly 2,000 a year in 2021.
The service is on track to see a similar number of calls this year, sad David Allman, its executive director.
The ambulance service also maintains a part-time ambulance as a backup, though 15 minutes needed to rally a crew. The second ambulance has handled roughly 16%-17% of call volume in the past several years.
A third ambulance can be activated if staff is available for times when both ambulances are busy – for public safety standbys such as fires or to help with area interfacility transports.
In 2021, it handled just over 1% of calls, while in 2020 it handled 0.35%.
About $2.42 million of a proposed $71.44 million expenditures being vetted by Taylor County commissioners is in requests from outside agencies, including the city of Abilene, volunteer fire departments and public health entities such as Abilene-Taylor County Public Heath District and Medical Care Mission.
More need in the county means more of a presence to cover it, while the service has only had small yearly increases in allocation, Allman said.
This year, the ambulance provider has two proposals for commissioners:
- Keep services at its current level at a cost of $995,000, an increase of $362,750.
- Increase funding to $1.26 million to transition to two full-time ambulances.
Current Taylor County funding for ambulance services
Last year, the EMS service was allocated $635,250, a roughly 4.8% increase from $605,000 in Fiscal Year 2021.
It requested $730,000.
Before that, the ambulance service hadn’t had an increase from the county since 2017, Allman said.
How does EMS want to expand services?
The full amount requested by Taylor County EMS would fund a full-time ambulance, staffed in Merkel, with another centrally-located in Caps.
“We want to place them where there’s infrastructure,” Allman told commissioners.
The full amount would provide the majority of operational costs directly related to 911 operations, such as payroll, workers’ compensation insurance, employee health insurance and various partial allowances for insurance, fuel and medical supplies.
Taylor County EMS currently has nine full-time staff and 30 part-time staff, Allman said.
A second full-time ambulance would require six additional full-time staff, he said, an expensive proposition in a state already seeing a shortage of EMTs and paramedics.
Ideally, a third ambulance someday would be stationed in Tuscola, Allman said, adding he he is certain other areas − such as Trent, Lawn and Potosi − would like to have their own station close by.
Why the need for more ambulance services?
Reasons for the higher call volumes include population growth in rural areas and the discontinuation of Merkel’s volunteer ambulance service around 2017, he said.
The presence of an ambulance in Merkel would help because the area is not served by first responders that routinely responds to medical calls before an ambulance arrives on scene.
By contrast, the southern and central parts of the county are covered by four first-responder organizations, three out of four licensed to provide advanced life support before an ambulance arrives.
The Merkel area has a large number of schools, existing infrastructure and proximity to Interstate 20, Allman said.
“The Trent, Merkel, Tye, Mulberry Canyon area comprises about 45-50% of our call volume,” Allman said.
Last year, the on-call ambulance, dubbed Medic 2, responded to 283 calls, he said.
A third ambulance, designated Medic 3, also is seeing more use, according to documents presented to commissioners, the two backup ambulances handling about 15% of calls, collectively.
If commissioners approve the full amount, the EMS service plans to maintain, subject to staff availability, the third ambulance for times both ambulances are busy, for public safety standbys such as fires, or to help with interfacility transports, Allman said.
The service provides mutual aid responses, including to the city of Abilene and locations such as Hamby.
What would better ambulance coverage mean for rural patients?
Increasing calls for an ambulance are significant because delays in service can be detrimental to patients with critical illnesses or injuries, Allman said.
An additional full-time ambulance would help reduce crew fatigue, while improving medical outcomes, he said.
Response now to Trent from the provider’s central station is 35 minutes, he said.
Roughly 60% of the provider’s calls result in a transport, a fairly consistent number, Allman said.
Many cancellations are received en route − a good thing because it keeps an ambulance in service. In some cases, people in rural areas don’t want or can’t sit in an ER because of an immediate need, he said.
Such calls often require a bit of extra time on scene with patients, Allman said.
Does Taylor County EMS charge patients?
The ambulance service charges a $200 fee for monitoring and assessment.
That fee is not covered by insurance, though Medicare and Medicaid are “looking to do that in the future,” Allman said, as a way to navigate callers away from emergency rooms and give them help they need on-site.
“Medicare sees a benefit from that because then they’re not paying for hospitalizations unnecessarily,” Allman said.
In cases of a car accident or other situation where a patient may not have called themselves, “we’re not sending them a bill,” he said, if they don’t want to be evaluated.
Of the calls it does invoice, the provider has a 75.6 % collection rate, which Allman said is “outstanding” for an EMS service.
Last year, it charged $1.11 million, which after contractual adjustments with insurance providers, became $741,355.
It collected $525,000.
“That’s pretty decent,” Allman said.
Is outside help available?
Outside help is not greatly available, Allman said.
The city of Tuscola gives the ambulance service a $600 donation each year, while other communities do not provide any extra support, Allman said.
In 2021, the provider received roughly $90,000 worth of donations and grants to help cover expenses, but it prefers to dip into fundraising money for items such as new cardiac monitors or stretchers.
“We recover and make a little bit of money from going out and doing … state deployments down to the border,” Allman said, including providing medical standby at a migrant detention facility.
That ambulance has, so far, recouped about $150,000 for Taylor County EMS, he said.
The service wants to try to stay away from events that might compete with rural firefighters, instead focusing on grants and other substantial fundraising opportunities, Allman said.
What are challenges in equipment and staffing?
The service has a number of challenges, including a need to replace three ambulances at roughly $325,000 each, Allman said.
Taylor County EMS has six licensed ambulances, though not all are able to be used simultaneously. Repair costs are always a concern.
There is also the reality of the shortage of EMTs and paramedics in the state, he said, making it difficult to maintain a crew of high-quality personnel.
Other ambulance services are able to pay $30 an hour for a paramedic, he said.
“There’s no way we can compete with that, even with these numbers that we’ve provided you,” Allman told commissioners, which provide “a little bit of an hourly wage increase.”
Allman said he wouldn’t expect the county to be able to compete directly with much larger services.
What do commissioners think?
During a first run at the budget, Commissioner Brad Birchum said the county’s approach has to be forward-looking when it comes to ambulance service.
“We can’t live 10 to 15 years ago, we’ve got to look at 10 years from now,” he said. “That’s that’s what we’ve got to anticipate, the growth of our county and the need for (emergency services).”
Birchum encouraged the ambulance service to pursue American Rescue Plan Act funds to acquire federal dollars to help with some of its potential growing pains, a plan other commissioners also encouraged.
Commissioner Randy Williams noted the county’s relationship with Taylor County EMS was forged when MetroCare pulled out of serving the county’s unincorporated areas in 2011.
“The intent was never that Taylor County was going to take on totally funding an ambulance service,” he said. “So that’s one of the reasons we try to be really careful we don’t start getting so much money involved in that ambulance service − because it looks like we’re funding an ambulance service.”
People living in the city limits of Abilene, fully 85% of the county’s population, may not be a fan of paying for rural services, he said.
But there is potentially some shortsightedness in that, Williams said. A trip outside of town on U.S. Highway 277 toward San Angelo easily can turn hazardous, and drivers likely would want an ambulance to respond.
“This is a safety issue for everybody,” Williams said. “We are not required by law to fund an ambulance service, but we do it to help, just like we do with the volunteer fire departments. It’s the right thing to do.”
Williams said in his own talks with Allman, he has encouraged the service to start looking for more revenue outside of county taxpayers’ pockets.
“They’re providing services to people that live in the city of Merkel, people who live in the city of Tye, people that live in Buffalo Gap, people that live in Tuscola and even Lawn,” Williams said. “I really would like to see those municipalities join in the financial support of those services that are being brought to their citizens.”
Commissioner Chuck Statler said it’s understandable that growth in the county’s unincorporated areas understandably feeds Taylor County EMS’ strain to grow.
But the county has to look at needs with a fair eye, he said − and in the case of EMS services, as “a customer and a contractor relationship.”
“They are not a county entity, (so) we need to look at it as a business arrangement,” Statler said.