EMS agencies, communities work to make Wyoming safer amid serious challenges

Luke Sypherd stood in the ambulance bay at Cody Regional Health last summer trying to explain why emergency medical services are so important — and why it’s been so hard to communicate that idea to the public. Sypherd works with Cody Regional’s EMS wing, and is also president of the Wyoming EMS Association.

He wants people to understand that “disease and death cost a lot,” but well-funded, and therefore well-functioning, EMS can help reduce those costs in the long run.

There are a plethora of studies demonstrating how EMS timeliness can save lives and limit long-term disability. That includes instances of severe trauma , str oke and heart attacks.

“The estimated effect of a 1 min reduction in response time was to improve the odds of [out-of-hospital cardiac arrest] survival by 24%,” one such study in the United Kingdom found.

Wyoming and other rural places are struggling with how to pay for emergency medical services, which generally don’t enjoy the same funding certainties as fire and police.

Yet there are clear long-term costs for those who are permanently injured because they didn’t receive care fast enough. If someone survives a heart attack but suffers heart failure, for example, the median cost is about $24,000 per person annually, according to a 2020 meta analysis. And the Centers for Disease Control and Prevention has estimated the value of most adult lives at over $10 million.

“Mortality rates and morbidity are extremely expensive to our economy,” Sypherd reiterated. “If somebody’s injured and is out of work, workman’s comp, right? So who’s paying for that?”

Ultimately, many in the EMS community acknowledge that they can do a better job of explaining what they do and what the absence of emergency services would mean for families, neighbors and communities. But they’re having to do that while working harder to prove their worth, often performing tasks that are not in the job description.

There’s also a belief that in remote parts of Wyoming, people won’t ever be able to financially support speedy EMS access, which stifles efforts to fix the problem.

Going beyond just funding, in this third and final part of WyoFile’s series, we look at the need for fast responses to cardiac emergencies and what some EMS agencies — and communities — are doing to keep residents safe while the cash flow remains low.

To the field

When Buffalo Bills safety Damar Hamlin went into cardiac arrest after taking a hit to the chest in January 2023, it reignited a call for CPR training and access to devices like automated external defibrillators — or AEDs — on football fields. That training and equipment, and the quick response by medical personnel at the scene, have been credited with saving Hamlin’s life.

And in Wyoming, those resources can be particularly important at events like school football games where an ambulance might be 30 minutes or farther away.

Max Mills is the athletic director, science teacher and a first aid/CPR instructor at Meeteetse School. In early November, he said there’d been six or seven home football games that season — including teams at the elementary, junior high and high school levels — and only one had EMS on standby in case something bad happened.

In one instance, no ambulances were available when a student suffered an injury, Mills said. So they had to call in a helicopter, which took another 45 minutes to arrive.

It’s not for a lack of EMS agencies trying, he noted, but a lack of staffing and resources. Because of that, Mills said, the school trains everyone they can on CPR and first aid.

“Parents, teachers, cooks, bus drivers, maintenance — we train everybody,” he said. “We know that there right now, if I were to call 911, on a really good day, I’m at best 30 minutes from an ambulance showing up here at school.”

It’d be impossible to require EMS standby at all football games in Wyoming, said Trevor Wilson, commissioner with the Wyoming High School Activities Association.

“It’s not available,” he said. “So [an EMS requirement] has not been discussed — at least with our association, for a long, long time.”

At the same time, Meeteetse School had seven AEDs around on its campus including one in the crow’s nest at the football field last year thanks to a grant, Mills said. The devices are portable and can deliver a shock to a person with an abnormal heart rhythm , which can occur during cardiac arrest. They’re designed so that no prior training is required to use one.

The Wyoming High School Activities Association has also discussed requiring emergency action plans at schools and making sure AEDs are readily accessible in case of emergencies.

“All our schools have the AEDs,” Wilson said last year. “But we could probably use a few more.”

AEDs are important because even when EMS is delayed, the devices can help restore a normal heart rhythm, increasing the chances of survival.

Justin J. Boutilier has researched a variety of scenarios involving EMS, AEDs and bystander interventions. He’s an associate professor at the University of Wisconsin, Madison, and he found that the most survivable scenario involved someone suffering cardiac arrest in public where they were noticed by others and received CPR or AED intervention before EMS responded in a mean of nine minutes.

Around 62%-75% of people in those ideal scenarios survived through hospital discharge, the study found. Obviously, the ideal scenario does not occur in the majority of cases, though. Only about 10% of people survive cardiac arrest in the U.S.

“Survival from cardiac arrest is — in general — quite low, even in places that have great EMS systems,” he said.

In 2020, the Wyoming Department of Health announced it secured a $4 million grant that would pay to distribute hundreds of AEDs to non-transporting first responders around the state. Efforts to disperse supplies from this grant are ongoing, but about 1,500 AEDs were already in the hands of 121 first responding agencies late last year, according to agency Business Operations Administrator Dirk Dijkstal.

Law enforcement was prioritized in that effort, but the devices have also gone out to fire departments, national park services and ski patrols.

“Wyoming’s rural nature requires some pretty creative solutions sometimes,” Dijkstal said. “I think that this is going to be a very beneficial effort, and the EMS Association has done an amazing job of getting it out into communities.”

Boutilier has also been looking into the use of drones to deliver AEDs directly to those in need. That is, if someone calls 911 to report someone going into cardiac arrest, an AED can be flown directly to them instead of them having to search for it. And it’s not just a pipe dream.

“The first save [using a drone-delivered AED] happened in Sweden,” he said.

AED-laden drones would require significant investments, though — money EMS agencies could use themselves. And there’s a serious concern about funding just to maintain emergency services in Wyoming.

Also, an AED isn’t always the solution. It wouldn’t help someone who’s bleeding internally from a car crash. Nor can it offer much to someone who was thrown off a horse and is lying in a frozen field with a spinal injury.

Getting the word out

Joey Benson works in EMS at Cody Regional Health. She said Sypherd and EMS Director Phillip Franklin have worked hard to make their department an asset to the hospital, even when EMS can be hard to financially support itself.

“So we perform a lot of other duties,” she said. “As the laundry department has staffing problems, we’re helping them. [We help with] security stuff because we actually have training in physical restraints and body mechanics.”

EMS agencies haven’t always been the best at working as a team to explain what they do for the communities they serve, Benson said. Towns and cities will need to support their emergency staff, too.

“One of the things that we have historically done very poorly is to stand up for ourselves and to be known,” she said. “Nurses and firefighters, they stick together very well.”

If EMS can send a clearer, cohesive message — either from within a single agency or as a group of agencies — Benson said that could help convince frontier residents and lawmakers to support their emergency services.

“You see what’s in front of you,” she said. “And so if you don’t see the actual benefits of something, then it’s easy to say, ‘Well, there’s other things I can focus on.’”

If Campbell County’s EMS crew is an example, outreach and a professional work culture can be one part of a sustainable funding solution.

That group is often lauded as the golden child among EMS agencies in Wyoming because it not only broke even, but made money in some areas.

“Sheridan and Gillette have enough volume that we are profitable,” Chris Beltz, director of urgent and emergent services at Campbell County Health, told WyoFile last year.

The agency’s change in tactics started around 2016, Beltz said, after SafeTech Solutions worked with the state Office of EMS to write a report reviewing the county’s EMS system.

“That report, I would say, was kind of an ugly look in the mirror for us,” he said. “And it really exposed our weaknesses that we had, from a cultural standpoint to a business standpoint.”

A major part of that was an overly lax work culture, Beltz said.

“We were described as somewhat of a club where employees got to do what they wanted to do when they wanted to do it,” he said.

So they overhauled everything from uniforms and rule enforcement to hiring. They also started offering 24/7 interfacility transfers, or ambulance rides for patients being moved from one facility to another.

“We really just thought instead of having to wait for a 911 call to come in, we should be providing value to everyone,” he said. “We went from doing 43 in one year to the next year doing over 100. And now we’re doing 300 plus a year in facility transfers.”

That’s led to a bump in profitability too, Beltz said. While it meant more upfront costs for transfer vehicles and staffing, it paid off. Now, the EMS crew keeps expanding. They have people working in Sheridan and Newcastle and doing far-flung regional transfers.

“We’ve picked up a patient in Casper and taken them to Billings; we’ve picked up a patient in Billings and taken them to Coeur d’Alene, Idaho,” he said.

That agency performs more specialized ground transports, too, he said, filling a niche and helping prevent more expensive air transfers and longer wait times.

Beyond that, Campbell County’s EMS has worked to support hospital staff more during downtime and increased involvement at community events. That’s helped get the agency’s name out there and explain what the medics offer the community, earning more public support.

“So we went from this out-of-sight, out-of-mind department that only showed up when the pagers went off to [one where] we try to get involved in everything and be as valuable as we could,” he said.

Still, Beltz acknowledged that in more rural places with fewer people and longer distances to cities, something like this may be harder to pull off.

It takes a significant upfront investment in transfer vehicles and enough potential transfers to make that cost worth it.

Sometimes it can be hard to invest in an organization that appears to be floundering, though, something the town of Mills knows well.

In Mills, just west of Casper, there’d long been a cash-flow problem within the fire department, Mayor Leah Juarez said. It led a former mayor to pursue a volunteer department, firing employees in the meantime — but Juarez decided to take a closer look at the finances.

One big problem, she said, was that a larger company they’d hired to bill for ambulance rides didn’t recoup a lot of the money that was owed, either via poorly filled out paperwork, billing delays or lack of follow-through on obtaining payment.

“What we figured out was the billing company cared more about big hospital bills than they did about ambulance runs,” she said. “And that’s fair, they make a percentage of everything they collect.”

The company didn’t bill for more than $700,000 in ambulance rides over one year for their fire department, she said. So, as part of the solution, Juarez said the city hired someone in-house to do the billing. The department collected $117,00 and $119,000 over 2021 and 2022, respectively, she said.

“In 2023, it’s $154,000,” she said.

And so far this year, they’ve collected $239,000, with another $60,000 billed. While it doesn’t entirely pay for the department and the employees Juarez has retained, it helps, she said.

Like other towns, Mills also started concentrating more on patient transfers, since those garner more money. However, being near Casper’s Banner Wyoming Medical Center means fewer transfer opportunities, Juarez said.

Ultimately, there are countless ideas for how to “fix” and sustain the rural EMS system — among them more volunteer incentives , better and more timely government reimbursements, community EMS, taxes, consolidation, an essential service designation, better billing practices — but it’ll be up to EMS agencies, communities, states and national leaders to make it happen.

In a recent survey of 1,003 Wyoming adults, AARP Wyoming found that around 80% believe EMS should be considered an essential service. The same amount said they’d be willing to pay more per year to support the community EMS system.

More than half believe insurance companies should pay for EMS in Wyoming, a third believe services should be covered via property taxes and 30% think EMS should be paid by those who use the services.

“Three-quarters (73%) of Wyomingites believe that communities should pay for EMS in the same way as they pay for police and fire department services,” the survey found.

That said, two thirds of Wyomingites weren’t concerned about being able to access EMS when they need it.

“It’s gonna take work, it’s gonna take time,” Sen. Fred Baldwin (R-Kemmerer) said during an AARP webinar on EMS. “But we can’t just walk away from it, because we’ve lost services. We’ll lose more services. And when we lose services, we lose lives.”

This is the third and final story in WyoFile’s series “ A critical call .” To read earlier stories, go here .

The post EMS agencies, communities work to make Wyoming safer amid serious challenges appeared first on WyoFile .