Stevens County’s ambulance system should be OK for this year, Sheriff Brad Manke said.
But when asked about the outlook for next year, Manke hesitated.
“Next year remains to be seen,” said Manke, who runs Stevens County Sheriff’s Ambulance.
Ambulance services across Stevens County, including Stevens County Sheriff’s Ambulance, Deer Park Ambulance and Chewelah Rural Ambulance, are battling shrinking funding, staffing shortages and the rising costs of keeping ambulances running. Emergency medical services leaders warn that without immediate action, some services could be forced to close, leaving rural communities in northeastern Washington with dangerously long wait times for medical transport.
“Worst-case scenario is we close the doors and then you call 911 and need an ambulance, and maybe one could come from Arden, maybe Chewelah, Deer Park, Spokane, Pend Oreille County. It’s not an ideal situation whatsoever,” Manke said.
But with other ground transport services facing the same issue, it’ll be hard to know which would be able to come through, he said.
Manke said the crisis has been building for years. Each ground transport service maintains its own budget but operates under a fee-for-service model – relying on reimbursements from insurance, Medicare and Medicaid instead of a tax levy.
This has become increasingly unsustainable, with payments falling short of the actual cost of providing care, he said.
“Most of our citizens don’t even know that their taxpayer money does not fund the EMS system,” Manke said.
Fire Chief Mike Bucy of Stevens County Fire District 1 described the EMS system as a “patchwork” of coordinated services, with first responders from Fire Districts 1, 4, 5, 7 (Arden Fire Rescue), 8, 12 and Northport Fire and Rescue providing basic care until an ambulance arrives. The only current EMS levies in the county exist in Fire District 1, 4, 5, 7 and 12.
All EMS agencies are supported by a Trauma Care Council that responds to each of their needs and concerns.
Bucy said fire districts can collect up to $1.50 per $1,000 in property value through local levies for fire protection, but the EMS levy rate is capped at 50 cents; the lower levy typically funds first response efforts, not ambulance transport.
Amber Jones, director of operations for Deer Park Ambulance, emphasized that Stevens County Sheriff’s Ambulance and Deer Park Ambulance are the only advanced life support agencies in the county, while Chewelah Rural Ambulance is a basic life support agency.
“These are the only transport agencies in the entire county for a county that’s basically the size of Delaware. It’s really difficult,” Jones said.
Volunteer shortages also are increasing the need for paid personnel, which drives up costs. Jones said Deer Park Ambulance has 30 volunteers. That’s a 20% decline from the past couple of years, she said.
“We have the ability to use volunteers, which (Stevens County Sheriff’s Ambulance) does not have the availability to do, but it makes it difficult to maintain current staffing levels if there is no resolution,”sais Jones.
Jones said Deer Park Ambulance has some funding left aside for needed upgrades and equipment, but already knows next year’s budget will be tight.
Manke said a single ambulance can cost around $250,000 – not including patient care equipment. Currently, the Stevens County Sheriff’s Ambulance has no funding left for replacements.
“We don’t have any rainy day fund. We don’t have any money saved to buy new ambulances. When the wheels fall off our current ones, it’s just moving forward not to be self-sustaining,” Manke said.
“We need a total EMS fix in Stevens County,” he said.
Bucy added that although rural communities get fewer EMS calls, those calls are often more serious because residents tend to delay care.
“They think, ‘Well, it’s going to take them a while’ or, ‘I’m OK, I’ll see if I get a better’ type of mentality,” Bucy said.
“So then you look at areas of Chewelah, Loon Lake, Suncrest, Kettle Falls, even Colville, if the sheriff’s ambulance were to fail, what are those populations going to do? Do we have everybody drive themselves to the hospital when they’re having a heart attack? That’s not appropriate, and it’s not public service,” he continued.
While Joe Paccerelli, fire chief of Stevens County Fire District 7, said he can understand the other transport agencies’ concern, he believes their challenges stem from difficulties in managing their funding efficiently.
“If you want my honest opinion, yes, EMS is a constantly growing thing. Yes, it is massively expensive to do. So am I going to run around like Chicken Little, saying, ‘Oh my God, we can’t provide this service?’ No,” Paccerelli said.
He said his district has been able to strategize and use their fire levy to cover all fire department expenses and their EMS levy to fund EMS-related costs within the district. For services outside the district boundaries, they operate on a fee-for-service model and use the funds saved from those operations to manage and purchase new equipment.
“And I’m not arguing that on their behalf. That’s their agency, and if they’ve got a comment, they can give it,” Paccerelli said.
“… The only thing I’ve done as a fire chief was to ask the county commissioners to take an honest look at the service that they’re getting right now from the service they have and the offers being made to them from the other service, and give them a fair and transparent review. That’s all I’ve ever asked, because I as a chief will not take a stand on either side of the line or against either agency,” he added.
Back in December 2021, Bucy said he spoke during a public meeting, warning the county commissioners the emergency medical service system has only “three to five years of life left before it collapses.”
“Well, now we’re four and a half years into it; we’re at that point of critical collapse,” Bucy said.
Manke said he also raised concerns to commissioners nearly four years ago, making it clear that if the current system fails, “the commissioners need to figure out how to do something to save the service.”
However, Stevens County Commissioner Greg Young said it’s time for action.
“It’s been a three-year conversation that I’m sitting here going, ‘We need to quit talking about this and solve the problem.’ But how are we going to do it? Who do we need to get in the room to figure out how to solve it?” Young said.
Manke said the county commissioners are looking at potentially forming an emergency medical service district in the northern third of Stevens County and have it governed by a board, similar to a school board or a fire district.
“Then after the district is formed and the board established, they go out to the taxpayers and ask for a property tax levy times amount of cents per $1,000,” Manke said. “That little bit of property tax would be integral in ensuring the service, not only that it survives, but you have equipment in the future.”
Bucy has discussed with state legislators the option of implementing a 0.2% or 0.3% sales tax instead, which would extend the cost beyond local residents.
“Sales tax is a unique way to generate revenue versus an EMS levy. If you have a levy to support ambulances, that’s a 100% burden on the taxpayer, where sales tax is about a 75% burden, because you have out-of-county people coming in,” Bucy said.
“Canadians come down to shop at Walmart and other places in Colville and Kettle Falls. You’ve got Spokane County people coming in. You’ve got hunters from all over the place. You’ve got skiers coming from all over the place. So the sales tax base takes at least a small percentage of burden off the taxpayer,” he added.
While several options are being considered, Young said any sort of levy likely won’t be on the table until next year. In the meantime, he said he’s still looking for ways to sustainably fund the EMS ground transport services without raising taxes.
“It’s just a lot of stuff pending right at the moment,” Young said.
Bucy emphasized citizens need to be aware of the challenges that northeastern Washington could face and urged Stevens County leaders to look out for their citizens.
“The No. 1 goal of the government, whether it’s local, state or federal, is to protect the public,” Bucy said.