By Amanda Parks
The Woodward News
WOODWARD COUNTY, Okla. — Rising costs, staffing shortages and low reimbursement rates are putting increasing strain on emergency medical services in Woodward County, according to EMS Director Pebbles Luddington.
Luddington told county officials that call volume is increasing while revenue is not keeping pace, creating ongoing financial challenges for the essential service.
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“Call volumes up, reimbursements are down,” Luddington said.
She said EMS billed more than $3 million last year but was forced to write off about $1.6 million due to insurance agreements and unpaid balances.
“We billed over $3 million … and we had to write off $1.6 million of that,” she said.
A major issue is how Medicare reimburses ambulance services. Luddington said federal rules only pay for transport to the nearest appropriate facility, even when patients must travel farther for specialized care.
“Medicare will only pay for going to the closest appropriate facility,” she said.
That means when patients are transported to Oklahoma City instead of Enid, EMS absorbs the additional cost she said.
“We’re only getting the mileage to Enid, then we have to eat the rest,” Luddington said.
The service also faces staffing shortages, with a need for additional EMTs, paramedics and even dispatchers.
“We’re hiring. We’d love to have four or five more EMT paramedics, one dispatcher and another part-time dispatcher,” she said.
Luddington said emergency calls are handled through a coordinated system between EMS and the E-911 center, led by Director Ben Smith , with multiple types of responders working together.
When a 911 call comes in, it is first received by E-911 dispatchers, who determine which agencies are needed — including EMS, fire or law enforcement — and relay that information.
EMS also uses trained emergency medical dispatchers, or EMDs, who follow structured protocols to assess the situation and guide callers through immediate care while ambulance in route.
“It’ll come on the dispatch side, and it’ll automatically code what that is going to be — ALS or BLS...or whether we have to activate lights and sirens,” Luddington said, referring to advanced or basis life support levels.
She said dispatchers will provide instructions as to CPR, delivering a baby or applying a tourniquet while crews are en route.
Pay remains a major barrier to recruitment. Entry-level EMTs start around $14 per hour, which Luddington said is difficult to compete with.
“Every time I go to Buc-ee’s, I take a picture — their bathroom personnel start at $23 an hour, and we’re starting EMTs at $14,” she said. “It’s not OK, but it’s what we can afford to do and it’s not OK.
“We pay 100% of their health insurance, we pay their dental, we pay their vision. We passed legislation two years ago now to get on the OPERS retirement system, that’s been a great addition to hopefully, recruitment and longevity.
Despite financial strain, Luddington said the department has taken steps to improve patient care, including adding blood products on ambulances — a move she said has already made a difference.
“We saw the need and added it, knowing it wouldn’t pay for itself,” she said. “We’ve used blood three times, and one of those had a positive outcome.”
At the same time, equipment costs continue to climb. Luddington said the price of a fully equipped ambulance can now approach $780,000.
“We’re up to $780,000 today … from a Band-Aid to cardiac monitor,” she said.
Commissioners noted that Woodward County EMS is one of the few services in the region staffed 24 hours a day with paramedics, often assisting surrounding counties when needed.
“We’re very good at helping each other get those patients to where they need to go,” she said.
Luddington said long-term solutions will likely require changes at the federal level, particularly in how EMS is funded and classified.
“Until the federal government says we’re essential…we’re just reaching for a lot of things,” she said.
When COVID hit they had all the tiers to get the shot, Luddington advised they were on tier six.
“We were on tier six as EMS, we weren’t even on the first tier to get the boosters, otherwise we’re just fighting with legislation to become essential,” she said.
She said although the federal government does not classify EMS as an essential service, local legislators are working to change that.
“Our House representative (Carl) Newton and our senator ( Casey) Murdock are very helpful in running legislation for us and things like that at the state level,” Luddington said.
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