Todd Allbaugh discusses challenges of rural emergency services with Office of Rural Health’s James Small

Host Todd Allbaugh welcomed Wisconsin Office of Rural Health’s James Small to Civic Media’s “The Todd Allbaugh Show” Wednesday, June 18.

The Office of Rural Health works in tandem with the University of Wisconsin School of Medicine and Public Health, and James serves as the office’s Rural EMS Outreach Program Manager.

James gave Todd and the listeners an in-depth look at the current challenges his organization faces in their attempt to provide emergency services across the state.

To begin with, James took a moment to explain his previous experience working in EMS and share where he’s from – the latter leaving Todd shocked at the answer.

TODD: “Tell us, as we like to say, a little bit about yourself, where’d you grow up, and how’d you get into this?

JAMES: “So, I grew up on Washington Island, up in northern Door County -”

TODD: “Oh my God, did you really?”

JAMES: “I’m a graduate of Washington Island High School, which is the smallest public school in Wisconsin.”

TODD: “That is amazing. I never met anyone who grew up in Washington Island!”

James explained that he began his career in EMS on Washington Island, following in his father’s footsteps. He obtained his Bachelor’s degree in Criminal Justice at Carroll University in Waukesha, receiving additional EMS training while attending school, earning a paramedic’s license. James worked in law enforcement for 25 years, becoming a police and fire chief in two separate municipalities in his last 11. He joined the Office of Rural Health in July of 2022.

After discussing James’ history in the field, Todd asked how the program is faring, and if recent developments in university funding has had an effect.

JAMES: “Our program is 100% federally funded, which has brought some certainty… and I think that’s now been resolved.” 

James goes on to discuss how the program is being addressed politically.

JAMES: “From a political standpoint, I think this is a really unique space relative to some other issues, because it’s not really partisan. I haven’t had anybody come up and talk about it in a partisan way. There’s different ideas on how to fix it, but there’s a general consensus that there’s a lot of challenges in this space, there’s a lot of funding issues in this space, and there’s a work force issue in this space. That’s agreed upon. Just how you get to those solutions varies a little bit, but I think more that’s based on personal philosophy rather than partisanship.”

Todd then asks James to talk about the core mission of the program.

TODD: “Help us understand a little bit, because we hear you’re at the UW School of Medicine and Rural Health, so what is the mission of this relatively new program?”

JAMES: “Most of my work is done with local government. So, our goal of the program is to work on reliability and sustainability of the EMS response system itself. A lot of that depends on funding from local government, it depends on organizational structure of the systems… but where the gap really existed was to work with these local governments, particularly the small local governments that don’t have the resources, to help walk them through that process whether it’s ‘how do you increase funding?’ ‘How do you maybe take your two volunteer ambulances and push them together and create one full time ambulance?’… A lot of those kinds of discussions.”

The discussion then pivots to the challenges smaller areas face, and what causes the complications to appear.

TODD: “James, when you look at the current state of things across the state, what do you find the biggest challenge for these municipalities, and the second part of that, what’s the cause in your opinion?”

JAMES: “I’m not sure on the cause. I think that we’ve seen a decline nationwide in availability of EMS services, particularly with volunteer services. There’s just a decline in availability of volunteers, I think is the best way to say that. I don’t think that there’s a lack of people wanting to go into it. Our licensing data doesn’t say that… At any given point, we have about 18,000 people that have licenses in the state. What we do see when you get into the licensing data is that seven and a half percent of them are leaving the field every year and turning in their license. And that’s not even counting the people that are going from one employer to another.”

James goes on to discuss how rising cost and inflation has hindered EMS operations.

JAMES: “So, maintaining a workforce, when you think about that, every 12 years we have to train the equivalent of the entire workforce, that’s problematic. And then, as we’ve seen the cost increase, that becomes very challenging, I think, particularly for the small municipalities to make that lift and use the tools that are available to create the finances that are necessary to pay for things, because they may be going from… a volunteer staff member to a full-time staff member, which is considerably more expensive.

JAMES: “We also have hyperinflation in this space, whether it’s on…equipment, personnel costs are outpacing CPI by two to threefold going back almost 10 years. So, you know… where a few years ago you might have been hiring a full-timer for $50,000 a year, that position might be 80 or 90 (thousand) now.”

TODD: “Is that paid with benefits on top of that?”

JAMES: “With benefits on top of that and, as you know, health insurance is anybody’s guess on how that goes year to year.”

Todd then asks James if he’s noticed if more elderly residents are calling 911 after a fall, to which James reveals some eye-opening statistics.

TODD: “I heard this from other people around the state: do you see an increase of these calls, yes, partly because of the access to the 911 system… but also, an aging population… A lot of this is life service calls, is it not?

JAMES: “Yes, and there’s been annually an increase of call volume statewide that’s been going on for decades now. There was just a study done by the Department of Health Services, looking at what the reasons for an EMS call were, and one in six EMS calls in Wisconsin is for a fall, like you’re describing. The other thing that they found during that study is that Wisconsin is number one in fall-related mortality in the United States.

TODD: “Really?”

JAMES: “So we have lots of falls, and we have lots of people that die from falls.”

In the final segment of the show, Todd allows James to make his case on why people should consider getting into emergency service work.

TODD: “Is there something I have not asked you yet that you want to make sure people across the state know about this program, and/or anything you want to say about funding?

JAMES: “I think the biggest thing right now, if someone’s interested in this career, come into it. Come try it. Go take a class. There’s all the technical college systems have EMS training centers associated with them. Go down to your local volunteer fire department. Even if EMS isn’t for you, maybe the fire department’s for you. But find a way to get involved in your community… these departments are really integral in our small communities to building that sense of community. So get out and be part of it.”

Listen in to the “The Todd Allbaugh Show” every weekday from 2 to 4 p.m. on the Civic Media Network.