By Chad Drury
Ottumwa Courier
OTTUMWA, Iowa — The picture of the current status of ambulance service in Wapello County is a flat tire that, if not repaired, could rupture.
The Wapello County Emergency Medical Services Advisory Council took the first steps in a plan that hopefully inflates that tire and makes it durable for years to come.
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The council met in a joint session with the county board of supervisors and the Ottumwa City Council to reveal its Phase 1 findings on making EMS an essential service Monday at Bridge View Center. Gaps exist and funding is short at the moment, but there is a path to a plan.
“Each call feels deep and real. The stakes are high, and the pain in the eyes of patients and families is as real as it gets,” said Tim Richmond, who has led EMSAC through his role as the county’s director of emergency management. “EMS is deeply personal and emotional, and in every call, no one person makes a difference.
“It takes dispatchers, neighbors, family, firefighters, officers ... That’s what EMS is in a community like ours. All of us showing up together.”
All have a role in what the opening phase of an EMS service looks like.
The proposed approach, for the first year, is a hub-and-spoke system featuring six “spokes” surrounded by an all-encompassing “hub” of a staffing pipeline through various partners, with the Indian Hills Community College EMS Academy as the accredited program.
The six spokes are dispatch, first response, community teams, alternative transport, community paramedicine and public education. Only two of them — first response and public education — are in place. All others are either a work in progress or long-term goals.
However, the other recommended approach for the first phase is to create two, 24-hour advanced life support (ALS) crews in which there is at least one paramedic on each ambulance, with ORMICS continuing the ALS service.
ALS service can have a combination of paramedics and EMTs, and has more capabilities in treating patients in the field than a Basic Life Support (BLS) crew. However, the increase in staffing is a daunting task.
“I believe to make it work, we need eight paramedics just on the day shift alone, six of them full-time and two of them part-time,” ORMICS interim manager Robert Vaughn said.
“When Robert is talking eight on a shift, you really have to triple that in order to figure out the number of people, you can factor in vacations, and the goal is really to allow people to be able to have some time off,” ORHC CEO Richard Bergmann said. “It’s not just the number of people. They’re busier on their own shifts and that contributes to some of the burnout.”
Officials pointed to a response gap over the summer, specifically June through September. While a two-crew benchmark was met 79% of the time, there was still a gap, mostly due to staffing and overlapping calls. The advisory council endorsed the two-crew model as a floor for a countywide service, with “surge capacity” from other agencies countywide.
Also, a supplemental ambulance from the Ottumwa Fire Department was recommended. That ambulance would relieve its own fire crews, who held scenes for 56.3 hours waiting for a transport in June through August.
“It would not replace our EMS partners, but we would support them when primary transport units are committed and no ambulances immediately available,” said deputy fire chief David Cronin, who sits on the advisory council. “Our goal is to provide a 24/7 service.”
Another area the council wants to address is the rural areas, where on 30% of rural calls, first responders were paged but unavailable during the summer months. There was over a six-minute difference in the median wait time when a first responder was available and when they weren’t.
One of the ways to address the rural issue is by having community response and assist teams, such as United First Aid, which has worked well in Van Buren County for three years.
“The idea with any ambulance is that it would respond anywhere in the county,” Richmond said.
Lori Reeves, who also serves on the advisory council, also put it in succinctly:
“We need a village, not just a college,” she said, in training residents locally.
The biggest issue is funding. The City of Ottumwa, if the fire department is to increase staff to staff an ambulance as part of the system, will need to find funding during its budget discussions even though it currently faces a $600,000 shortfall. The county also would be expected to contribute to the cost of the system.
Though the advisory council is expected to address interim funding requests at its meeting Wednesday, much of the costs will be weighed next year. If a levy is involved, the county could levy up to 75 cents per $1,000 of valuation this fiscal year, or $1.50 per $1,000 beginning in fiscal year 2028.
The county could also use a 1% income surtax either by itself or with a levy. However, both the levy and surtax would need 60% of the vote to pass.
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