EMS Crisis in Wyoming: A Local Reporter’s View

In general, EMS issues are not well covered in the mainstream media. But every so often, a reporter does an excellent job summarizing the issues and possible answers in their jurisdiction, just as WyoFile journalist Madelyn Beck has done in her series on Wyoming’s embattled EMS industry. 

This three-part series is so thorough in its analysis that there’s no point in EMS World going over this ground ourselves. We recently interviewed Madelyn Beck about it to highlight why it is worth our readers’ attention. 

EMS World: Please tell us about Wyofile. 

Madelyn Beck: I am a health and public safety reporter for WyoFile, which is a nonprofit news organization based in Wyoming. We provide all of our content for free to any news organization that wants to run it.  

EMS World: Please tell us about your series on Wyoming EMS and the issues that the industry is facing. 

Madelyn Beck: Wyoming is the least populated state in the nation, and based on what we know about rural EMS nationwide, economies of scale do not work in a lot of rural areas. As a result, a lot of rural EMS agencies really struggle to make ends meet. Pair that with many other trends that are all coming together to work against EMS like increasing costs and decreasing volunteerism, and Wyoming almost seems like a warning case for rural agencies across the US. 

Add the fact that Wyoming is an increasingly popular place for people to retire because of the low taxes, and you can see continued challenges brewing out there where you have increasing need for higher level ambulance care and just a decreasing support for it in any way. If you had more young families moving in, perhaps you could encourage more volunteerism, but they’re leaving the state, not moving in.  

That being said, we are seeing some efforts here to bolster volunteerism. And we're seeing efforts in Wyoming to make rural EMS economically viable. This is why we’re seeing a lot of EMS agencies consolidating so they only have to have one billing office, for example. But the greater concern is all of these things put together still haven't shown a real true solution to this problem.  

The closest thing I've found to a solution is found in those rural EMS agencies in Wyoming that have really concentrated on getting as much billing done as possible [and] by doing as many ambulance transfers as possible. But there are certain areas in the state that are simply not going to be able to do that many hospital transfers, even though they're the most economically viable of things you can do when you're an ambulance service. 

EMS World: You had the following quote in your first article, which highlights the fact that EMS is not an essential service in Wyoming, and that many legislators don’t support the idea of it being designated as such. Here’s the quote:  

“‘Given that only 13 states have said that EMS is essential, I don’t see the need for Wyoming to do that,’ said Jeanette Ward (R-Casper), voting against an essential service designation last April. ‘And I think that generally, in general, when people call for an ambulance, one shows up.’” 

There's a lot of magic thinking’ in that statement. that someone else is going to solve the problem and it will just be there. Are you finding that's part of the problem in Wyoming’s political environment? 

Madelyn Beck: Yes, but just to provide a little context, that representative actually was just voted out in our latest primary.  

That being said, I think we are seeing a lot of that attitude because of Wyoming's ‘cowboy up’ independent philosophy where we take care of our own. I have another quote in the series from a lawmaker who essentially says, “we were able to throw our dad in the back of the truck when he got injured by a bull and we drove him to the hospital faster than he would've gotten there by ambulance.” And if you look at just one of the maps that I have in the series that shows how long it takes for an ambulance to respond in a lot of parts of Wyoming, that's true. You're going to get there quicker just going yourself, but is it going to be safer? And are your family or neighbors going to be around to help you? 

Then we have a number of Wyoming/Western ideologies coming together to oppose designating EMS as an essential service, such as “we take care of our own, we don't like taxes, and we're very independent.”  

The only good news: There was an AARP Wyoming survey that just asked how many people would be willing to pay more to sustain that system, and it was the vast majority of respondents. So that is something. 

EMS World: Let's talk about that. What could be the possible scenario for Wyoming to resolve its current EMS crisis, assuming it was funded as an essential service? 

Madelyn Beck: I think we need some idea of how we'd like that money to flow into EMS agencies, and that’s open to debate. You'll see in the comment section under my series a very robust argument over the best way to fund it. Should it be local governments that fund it? Should it be the state government? Should it be federally funded? Should it be the people who call the ambulance who are stuck with bigger and bigger bills?  

These are all arguments that people are making, and I think we as a state need to figure out and pick at least a few avenues to focus on because if we're arguing over all of the different ways and who to point the finger at, I'm not sure we're going to make any progress. I don't see the trends going in a way that would continue to support EMS in Wyoming over the long term. 

EMS World: Do you have any sense of where you think it may go, based on your research? 

Madelyn Beck: I think that if nothing is done at all, it will continue to get harder to support EMS in Wyoming, and we will continue to see more gaps in coverage. Just from what I've seen and the people I've talked to, there's certainly ambulances in the state where there's three people working there. If one of them is sick and the other one goes out on vacation, that ambulance can't run. And if nothing at all is done, we are facing a really tough situation in Wyoming.