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‘We are in trouble and we need help:’ Wisconsin fire, EMS leaders unite in plea for funding

Wisconsin EMS and fire leaders join forces to provide an overview of EMS legislative and regulatory requests to support front line response to COVID-19

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On Apr. 15, 2020, the Professional Ambulance Association of Wisconsin, Wisconsin EMS Association, Professional Fire Fighters of Wisconsin, and Wisconsin State Fire Chiefs Association conducted an online press conference to discuss the mobile healthcare situation in Wisconsin.


I recently reported on how the leaders of a few of our national associations united to tell the story of EMS on the front lines and to draw attention to the shortfalls we are all encountering daily from PPE to funding. EMS providers of all denominations are also coming together at a state level to tell their story and appeal for assistance and funding to ensure the continuity of operations. On Apr. 15, 2020, the Professional Ambulance Association of Wisconsin, Wisconsin EMS Association, Professional Fire Fighters of Wisconsin, and Wisconsin State Fire Chiefs Association conducted an online press conference to discuss the mobile healthcare situation in Wisconsin (watch the press conference in its entirety below).

1. Chronic underfunding and COVID-19 are reaching critical point

The leaders collectively identified to virtual attendees – including many state TV and print media outlets – that EMS in Wisconsin has been chronically underfunded for years and with the advent of the COVID-19 pandemic is placed under yet more pressure. They reinforced the message that the cost of readiness, response and recovery has increased to a point that some providers in Wisconsin are already close to spending their entire annual budget.

The combined associations call to action and request for funding is further highlighted by the fact that the last rate increase of any kind for EMS was in 2008, for just 1%, with no adjustments for inflation. Ambulance providers in Wisconsin are paid 42% of Medicare rates, which GAO studies in 2007 and 2012 demonstrated were below the cost of providing service. Such is the state of underfunding and insufficient reimbursement, that an ambulance provider covering 1/3 of Milwaukee, including some of the lowest income areas, recently gave notice that they will no longer provide 911 response starting in September, citing low Medicaid rates. Many more services, without an increase, could potentially follow.

2. Increased PPE and decontamination supplies are unrecoverable costs

Professional Ambulance Association of Wisconsin President Chris Anderson said, “We are wanting to point out that we are at a higher risk, we don’t slow down and we don’t stop. We must treat every response that the patient is COVID-19 positive, and that is because we just don’t know. We must, therefore, use PPE on every call.” The increase in equipment used in a COVID-19 response and time spent has added an estimated $35 per call. Anderson reported that the cost of PPE alone has increased fivefold and decontamination supplies add additional and unrecoverable costs.

To assist with offsetting costs, the collective associations are asking the state government for an increase in Medicaid rates to keep the EMS system in Wisconsin afloat. Wisconsin State Fire Chiefs Association President Chief Timothy Bantes identified that the cost of readiness had gone up, including increasing costs of both equipment and labor with no matching uptick via reimbursement. Bantes described the “hand to mouth” approach to funding a state essential service such as EMS, “We don’t want to not be able to go to the call, but we are heading that way. At the local level, we need to be ready to handle this, but there is no meat left on the bones – no budget reserves, local budgets are so tight it’s unbelievable.”

3. A call to action to support EMS

The represented associations estimate that an additional $7.5 million is required to cover costs. Under the Federal Families First Coronavirus Response Act, Wisconsin is expected to receive some $2.2 billion in federal aid. Jerry Biggart, Board Member of the Professional Fire Fighters of Wisconsin, described $7.5 million “in terms of the state budget, this is a rounding error.” He added that, “we are not trying to scare everyone that we are going away, but we are in trouble and we need help – save some of the $2.2 billion for EMS.”

The associations left their members and press conference attendees with a call to action to contact their state legislators and ask for support for sustainable EMS funding during the COVID-19 pandemic and beyond, lest the lack of legislative action result in fewer staffed, stocked and ready ambulances to provide lifesaving care for patients during a Midwestern COVID-19 surge.

Additional resources on EMS funding

Learn more about the challenges in equipping and funding EMS agencies for COVID-19 response with these resources:

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.