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| A Brief History of Blaine County Emergency Medical Response | Back to Top |
- The two local hospitals [Moritz, owned by the City of Sun Valley; and Blaine County Hospital, owned by the County and located in Hailey] merged in 1991-1992.
- Discussions began in 1994 between the Sun Valley mayor and the Blaine County Commissioners about how to get hospital service in Blaine County out of the hands of city and county government and into the management hands of a professional hospital organization.
- After looking at various options, Sun Valley and the County entered into negotiations with St. Luke’s of Boise. A Definitive Agreement was signed; a ballot question about St. Luke’s resulted in community-wide approval; and a location for the new hospital location was selected [1996].
- The next few years were devoted to raising capital funds for the new hospital, but it was clear to the County Commissioners that closing the two existing hospitals and building one new hospital would result in large numbers of people being geographically further from Emergency Room care. The longer the ride from an emergency medical event or an accident to the ER, the greater the need for a higher-level of ambulance care personnel.
- About this same time, the County began preparations to upgrade the dispatch 911 service to Enhanced 911 [E-911] which would show dispatchers and responders where the emergency call was actually coming from. This effort culminated in a successful ballot question in 2002 to collect $1 per phone to fund E-911. The emergency and health care goals of the community, once E-911 became operational, were then complete: E-911; paramedic-level ambulance service; state of the art Hospital facility [St. Luke’s].
- The Blaine County Commission made the decision [1999-2000] to upgrade the EMT level of ambulance service to paramedic-level service. With funding from the Heinz Foundation and the St. Luke’s Foundation Board, eight EMTs [four from Ketchum and four from WRFR] became paramedics. By the end of 2002, we had 9 paramedics [the original 8 plus one EMT who paid for his own training.]
- At the time the decision [1999-2000] was made to upgrade to paramedic level personnel, new ambulances cost about $75,000 [now about $125,000]; gasoline was a dollar and small change per gallon; ,personnel costs and the medical coverage for them were much lower than now; and insurance reimbursements for ambulance fees [while never anything to cheer about] were much higher. Since that time, Medicare, Medicaid and private insurance reimbursements have dropped sharply. Finally, the State of Idaho began requiring, a few years ago, that Ambulance Districts have a Medical Director. This added another $50,000 to the Ambulance budget costs.
- Meanwhile, the Ambulance District has only been able to increase its revenues from property tax collections by 3 percent a year over the previous year’s tax collections. This minimal increase in revenues is substantially below the increasing cost of providing paramedic-level ambulance service. The result is a shortfall that can only be made up by the increased revenue from the $350,000 ballot question or by a reduction in the number of ambulance vehicles and personnel.
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| Is there something wrong with the present ambulance service? | Back to Top |
Fortunately, nothing is wrong with the present service; it is working just the way it was designed to do. We have well-trained professional paramedics and EMTs responding to the life-saving needs of the public. Our community is very fortunate to have this capability to save lives. The only thing wrong is that we no longer have adequate funding sources to continue providing the present level of service. |
| What is Paramedic-level ambulance service? | Back to Top |
The longer the ride to the Emergency Room, the more important paramedic service becomes. Paramedics have advanced medical training and can perform medical functions not allowed to other emergency responders. Additionally, the administration of heart medication, pain medication and a full complement of allergic reaction medication can only be delivered by paramedics. Without the requested revenue increase, service could slip back to intermediate care that does not include any of the 30 medications paramedics can carry or their medical skills. Paramedics can also be in contact with the Hospital while the ambulance is on route and paramedics can perform life-saving procedures as directed by the Emergency Room Medical Director.
First responders and EMTs also provide valuable CPR and first-aid response and are an important part of the overall patient care response team. However, they are limited by law in the amount of patient care they are allowed to provide. |
| Why does the Ambulance District need a funding increase at this time? | Back to Top |
The Ambulance District can only increase property tax revenues by 3 percent over
the previous year’s tax revenue. With the substantial increase in Blaine County’s population, and more distant development, over the past several years ambulance responders must cover more geographic territory, and they must do it more often. Our public is aging and in greater need of immediate life-saving capability. Some of our children have life-threatening allergies. Additionally, an increasing number of vehicle accidents are placing more strain on our ambulance response system.
Some of our residents don’t carry insurance and don’t pay for the ambulance services they have received. The costs of gasoline and motor oil, medical equipment, specialized Paramedic and EMT training to maintain proficiency, ambulance replacements, and medications have all risen exponentially in a few short years. Medicare and private insurance re-imbursements have dropped sharply. The present ambulance budget is no longer adequate to meet these financial challenges.
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| Why hasn’t this shortfall been addressed before now? | Back to Top |
The Ambulance District has not asked for a separate increase in funding since its inception in the 1980s; the District has managed to find efficiencies in past and current operations and has avoided asking taxpayers for more money. However, the rapid increase in operating expenses, the high cost of replacing ambulances, and the continuing reductions in reimbursement rates by Medicare and insurance companies, leave no alternative but to ask taxpayers for a small amount of additional funds to maintain the current level of service. The District will continue to look for efficiencies to hold-down increasing costs in the future.
The revenue increase will cover a large portion of the annual shortfall, but user fees for patients who require ambulance service will also be increased to an amount consistent with the rates charged in other communities for paramedic-level service. |
| Who benefits from paramedic-level ambulance service? | Back to Top |
Everyone benefits from the security and life-saving capability of paramedic-level ambulance service. Allergic children, older parents and relatives, ill or injured friends, all the people we care about in our community will be more likely to survive and lead healthier lives if paramedic emergency responders can treat them and get them to the emergency room faster. The loss of a single life, or the lifetime physical/emotional impairment of a single person, or the unnecessary prolonged suffering of a single patient or victim, any of which were due solely to the lack of paramedic-level ambulance service affects us all. Blaine County prides itself on the quality-of-life and care we extend to our residents and visitors. Surely the residents and visitors of our community deserve, and are entitled to, an adequate paramedic-level service for their emergency medical needs. |
| Why are there sometimes multiple responders and agencies at the same accident or medical emergency? | Back to Top |
Very few E-911 callers can accurately describe or evaluate what has taken place. Sometimes they are frightened or over-whelmed or just too often, inarticulate. The dispatcher hits the call button for all the necessary emergency agencies when the E-911 call comes in and tries to get more information from the caller while the emergency vehicles are on route. If the dispatcher later determines that not all the units will be needed, the unneeded ones are called back.
In the case of vehicle accidents, an ambulance is sent out; a fire rig is sent because the accident may require extrication equipment [to cut away metal] and may also involve gasoline spills or other Haz Mat materials; and of course the police or sheriff has to be sent.
For example: when an ambulance dispatch call goes out for the City of Hailey, both Hailey and WRFR are notified. If the on-duty county ambulance has just left on another call or is some distance from Hailey, it is to everyone's advantage for Hailey's First Responders to go to the scene, especially if they are likely to get there first. In addition, off-duty personnel also hear the page-outs and the location. If they are nearby they'll also respond. It will often seem as excess, but First responders may be helpful, and paramedics are the only ones who can administer drugs and other medications; so if the first on-scene isn't enough to stabilize the patient or victim, the next on-scene can save lives. What if the senior citizen who had fallen, fell because of a stroke or heart problem; what if the fall was caused by an embolism in a leg artery or a fractured hip? We shouldn't be wasteful with our response system, but we'd rather have a few too many responders than not enough. The Dispatcher System is working on protocols to limit the number of unneeded responders.
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| Are paramedics more expensive to hire than EMTs? | Back to Top |
Paramedics are required to participate in more hours of training than EMTs. In addition, they are also required to take continuing skill courses and to maintain their more advanced life-saving skill levels every year. As in all business models, more time equals more cost. However, the pay levels for paramedics are only marginally higher than for EMTs. |
| Who are Blaine County’s paramedics and EMT's? | Back to Top |
Our paramedics and EMTs are full-time and volunteer residents. These medically-trained women and men are cross-trained as firefighters and are prepared to respond to almost any emergency. They are local residents who give a huge amount of time to their community, both on-duty and off. Ketchum Fire and Wood River Fire each staff one ambulance 24/7; additional critical calls or overlapping calls require a second ambulance or third ambulance response from off-duty and volunteer members who drop everything and respond when their pagers go off. These women and men are often first on-scene because they are out working and playing in our community, but they set aside their own plans to provide advanced medical care to our residents and visitors. |
| What do our paramedics and EMT’s do when they're not out on ambulance calls? | Back to Top |
Unlike what you see on TV, our ambulance crews don't sit in front of a television set when they're not out on a call! They have a full day of equipment and station checks, as well as vehicle maintenance and other chores on the ambulances. Many paramedics and EMT's bring other skills - auto mechanic, construction, computers - to their departments, doing as much as they can to maintain and improve equipment while saving their departments the cost of outside vendors; and, of course, they are also firefighters who save our homes and businesses, and in the case of the Castle Rock Fire, our community.
Taxpayers get a lot of benefit for their money!
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| What happens if the Blaine County Ambulance District revenue increase fails? | Back to Top |
The most obvious and immediate impact would be that funds won’t be available to replace ambulances as they reach the end of their useful lives. The older ambulances in our fleet, the oldest of which has been in service for more than sixteen years, cost more money to maintain and are less reliable. Ironically, failing to replace them at the proper time causes operating costs to rise and takes them out of service for longer periods of time, thus leaving less money and equipment available to provide the ambulance service overall. Other critical and expensive medical equipment, such as cardiac defibrillators, needs to be replaced on a regular schedule, and this would become more difficult if the revenue increase fails.
A little more gradually, as costs for fuel, medical equipment, supplies, and personnel increase at a rate greater than the growth in revenues available, the present level of service and rapid time of response after an E-911 call, will gradually erode. Over time, staffing and/or overtime expenses would have to be reduced, meaning that the availability of back-up units when a primary unit is called out in an emergency would also be reduced. In events such as a serious multi-vehicle accident or collapsed building, where one ambulance wouldn’t be enough, the lack of back-up on-duty ambulances and personnel would have severe implications. While not as immediate as the impact of not replacing the District’s “rolling stock” and other equipment, the gradual erosion of our level of paramedic ambulance service is just as certain without the requested revenue increase.
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| How does the Ambulance District contract for services? | Back to Top |
The Ambulance District presently contracts for performance-based services to cover the entirety of Blaine County. Under the present contract format, the District has divided the County into two major ambulance service areas: one from the Greenhorn Bridge north and the other from the Greenhorn Bridge south. Ketchum Fire Department covers the north area. Wood River Fire and Rescue covers the south area. The performance level required under the contract is primarily paramedic and based on timely 24/7 response capability. To see details of the two departments' budgets, click HERE.
The Ambulance District Commissioners ask contract service providers to present annual budget requests including additional information to support the requests. Then the Commissioners and the providers negotiate a contract for services for one fiscal year. For details of the contracts themselves, click HERE.
Any agency, public or private, could offer to contract with the District to provide ambulance services as long as they are able to provide equal or better service at or below current contract costs. Over the past two decades several private ambulance companies and individuals approached the Ambulance District, inquiring about bidding for the ambulance service contract. Once they had calculated the costs of providing the service as a stand-alone ambulance-only business they withdrew their offers because they were unable to provide comparable service at a price anywhere close to the cost of local ambulance contract providers. |
| Does the Ambulance District revenue increase have anything to do with fire departments? | Back to Top |
Blaine County doesn’t provide fire services. Fire services in Blaine County are provided only by cities and rural fire districts with their own elected officials and taxing authority. The County has no authority over these fire departments. All the fire agencies are public bodies and maintain budgets and other public documents which the public can view at any time. The Ambulance District revenue increase is only to cover the costs of maintaining paramedic-level ambulance service to Blaine County residents and visitors … and for no other purpose.
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| Is the Ambulance District subsidizing fire departments or are fire departments subsidizing the Ambulance District?
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This is an oft-asked question, but it is based on the incorrect premise: that it might be less expensive to Blaine County taxpayers if there were separate departments for fire and for ambulance. In fact, it would be much more expensive to provide 24/7 ~ 365 day-a-year ~ service for fire and ambulance if they were funded separately in small counties like ours. There is a synergy and fiscal economy in using cross-trained personnel in both fire and medical service that makes 24/7 response possible for both emergency services.
One fire dollar plus one ambulance dollar equals more than two dollars of public benefit; it would cost much more to achieve 24/7 service if fire and ambulance were separated. In Blaine County’s case, one fire responder plus one ambulance responder actually gives the taxpayers the equivalent of more personnel, from a cost-efficiency standpoint. When paramedics and EMTs are not on emergency ambulance calls they are out shoveling snow from hydrants, generally being useful for maintenance and repairs on both ambulances and fire rigs, and available for fire emergency calls as well as building inspections and other fire-related duties. They often drive to these duties in their ambulances so they can be ready for immediate ambulance response if they are “paged out.” Taxpayers are getting big city service at small town prices. Some big cities can afford separate fire and ambulance services, but it doesn’t make economic or professional sense for Blaine County. |
| Does one ambulance provider benefit at the expense of the other? | Back to Top |
Ketchum Fire Department, as one ambulance provider, and Wood River Fire and Rescue, as the other ambulance provider, both obtain Ambulance District funding to provide performance-based ambulance service to our community. They present budgets, get approvals from the Ambulance Commissioners, and are paid on the basis of the amount of area covered, the number of calls responded to, and their costs of providing the service.
There is no arguing that higher property valuations in the north part of the county result in those taxpayers paying more taxes for every item on their property tax bills than areas of the county with lower valuations. The Ambulance District is no different in that respect than the present difference in property tax rates between the Sun Valley/Ketchum cities and Hailey/Bellevue cities.
However, it is important to remember that ambulance service is provided to residents of all parts of the County even when they travel outside of their cities for recreation, work, and leisure. Our residents often find themselves in areas of the County where the ambulance response is provided by either of the County ambulance contractors. A Hailey resident in need of an ambulance after a skiing accident or a Sun Valley resident involved in a vehicle accident at Timmerman Hill will be served by a Blaine County ambulance from outside their city service area. Ambulance service is a county-wide service paid county-wide and available county-wide. |
| How much is this going to cost me personally? | Back to Top |
On May 27 there will be a ballot question asking you to vote “YES” on Proposition 1 if you want to maintain the present level of paramedic ambulance service. The ballot question is for a permanent flat $350,000 a year. The cost to you the first year if you own property in Blaine County will be a flat $3.00 per $100,000 of valuation. For example: If you own a home valued at $500,000 the additional cost will be just $15 a year. As county-wide property values rise in the future, the $3.00 cost per $100,000 will actually go down below $3.00. No one wants to pay more taxes, especially in these difficult economic times, but the cost is so low that no one can afford to say anything but “YES” to maintaining paramedic-level ambulance service. Sooner or later all of us will need an ambulance for ourselves or for someone we love.
The ballot question will look like this: Shall the Blaine County Ambulance District be authorized to increase its budget from property tax revenues for the fiscal year beginning October 1, 2008 by the amount of $350,000, said amount to be a permanent increase in the base budget amount, therefore requiring a 66.67% voter approval pursuant to Idaho Code Section 63-802 (1) (g). Approval of this measure would provide funds for Ambulance District operations and replacement of ambulance units.
This ballot language is required, in this form, by State Statute. Unfortunately, the ballot question only focuses on the total increase of $350,000 rather than on the life-saving benefits of the Ambulance District and doesn’t indicate that the low $3 cost per $100,000 of valuation is all an individual property owner will pay. These attributes are more important than the total cost, even if we can’t include them in the ballot question.
You have to vote YES on Proposition 1 for this ballot item to keep the present level of service.
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| Will the $350,000 cover the shortfall? | Back to Top |
Actually the shortfall is greater than $350,000, but the difference will come from those who pay ambulance fees when an ambulance is used to transport them. The theory of ambulance funding is that the ambulance service needs a fixed level of funding in order to enable 24/7, 365 days-a-year standby-capability, but the people who require ambulance service must also pay additional fees. |
| What does the $350,000 get me? | Back to Top |
The levy increase will provide a maximum of $350,000 to the Ambulance District: with $125,000 going to a new ambulance; approximately $100,000 for six new cardiac monitors and defibrillators; and $125,000 for all other needs including, more costly gasoline and motor oil, replenishing medical supplies, creating a replacement fund for new ambulances, and continuing education for responders, including EMTs.
We will need a new ambulance in each of the next two years and continuing education forever. Future costs of providing ambulance service will continue to increase at rates higher than property tax revenues and any funds not needed each year for an ambulance replacement will help absorb other rising costs. The cardiac equipment will not need to be replaced annually. The revenue increase should cover the foreseeable cost increases as well as the current shortfall. Any savings in subsequent years may reduce the tax levy for that year. |
| Who is paying for the education campaign for the ballot question? | Back to Top |
The Wood River/Sawtooth EMS Association, St. Luke’s, and private citizens are paying for the information ads and materials to educate the public. No taxpayer funds are being used. Your private contributions to help with education would be gratefully accepted. |
| Where and how do I vote on May 27? | Back to Top |
The Ambulance District question will be on the May 27th ballot. The wording is straightforward and easy to understand. It asks you to vote YES on Proposition 1 if you want to provide funds for the Ambulance District to continue operating at the present level of service and equipment.
If you are voting on Election Day, you’ll go to your regular polling place. We encourage everyone to vote.
Many local voters are out of town in late May. It is imperative that you vote YES on Proposition 1 on this ballot question even if your plans take you out of town on Election Day. We need 66.6 percent of the voters to approve the Ambulance District ballot question. If you won’t be in the County on May 27, please see ABSENTEE VOTING OPTIONS below. Likewise, ask your adult children to vote as well, and explain to them how to do it absentee.
1. Go to: www.blainecounty.org to download a PDF copy of the absentee ballot request form.
2. Fill out the attached application and follow instructions on the bottom of the form.
3. Vote absentee in person at the election office on the main floor of the Blaine County Courthouse, anytime, up to the day before the election. Now, that’s convenient! |
| How can I help maintain this valuable service for my community? | Back to Top |
Letters to the editor are a great way to help inform your friends and neighbors. Calls and e-mails to friends are another easy way to encourage them to support this effort.
Please suggest that specific ambulance questions be referred to local ambulance providers or to the resources listed in this document at their daytime business numbers for answers to any questions you may have.
Tax-deductible donations to help with this education campaign can be sent to the Wood River/Sawtooth EMS Association ~ Box 100 ~ Ketchum 83340
Most of all, be sure to vote YES on Proposition 1 on May 27.
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| Where can I get more information about the Ambulance District? | Back to Top |
You can call Len Harlig (726 9308) or Blaine County (788-5500). There are articles and ads in the papers, pamphlets to read, and city council meetings to attend. You can also use the website to ask someone to call you with more information on specific questions not covered in this list of Frequently Asked Questions, or you can POST A QUESTION on the website so everyone can share in the question and the answer. |
| What can a Paramedic do that a basic EMT can’t? | Back to Top |
Paramedics are trained in advanced cardiac life-support and critical trauma interventions. In extreme emergencies a Paramedic can administer life-saving medications, interpret cardiac rhythms, and deliver defibrillation to cardiac patients. In cases of critical trauma injuries, Paramedics can intervene with extreme measures to support oxygenation and breathing. (surgical cricothyrotomy, pericardiocentesis and needle decompression of the chest) The Basic EMTs scope of practice allows them to provide basic life-support through CPR, AED and generalized first aid, but not more advanced care. |
| Haven’t we always had Paramedics on the ambulances? | Back to Top |
No. With the assistance of the Theresa Heinz Foundation and other local donors in 2000, then-current EMT employees were trained to be Paramedics; Advanced Life Support Service with Paramedics was initiated in 2001 and has expanded from an original 8 Paramedics to the current level of 23. The population growth of Blaine County and the increase in distant residential development required that Paramedic-level response capability had to increase as well. |
| Where do the Paramedics respond? | Back to Top |
Paramedics are currently staffed 24/7/365 with Wood River Fire and Rescue and the Ketchum Fire Department personnel. They respond to 911 calls for service in all of Blaine County. |
| How many Paramedics work in the Wood River Valley? | Back to Top |
There are 23 Paramedics serving the families of the Wood River Valley, Carey and Smiley Creek. Six of these Paramedics are “volunteer” Paramedics working other jobs. These volunteers respond when needed for emergency care. The other Paramedics in the Wood River Valley work for the local ambulance services and Saint Luke’s Wood River Medical Center. |
| How many ambulances are in the Wood River Valley? | Back to Top |
There are six ambulances in varying stages of age and condition. Two of them, one in Ketchum and one at the WRFR station in Hailey, are staffed and ready to respond as soon as an alarm goes off. These “first-out” ambulances are staffed with a minimum of one Paramedic. The other four ambulances respond with off-duty Paramedics and EMTs, and volunteers. Most of the time the “second-out” and “third-out” ambulance will also have a Paramedic responder on it. |
| Not every emergency is life-threatening, how does a Paramedic level provider improve those situations? | Back to Top |
Advanced level assessment and comfort measures are a large part of providing Paramedic level service. One example of comfort measures is pain relief for patients with orthopedic injuries. Reducing the level of suffering that patients are experiencing aids in their overall recovery and reduces the anxiety of the traumatic experience. |
| What role do Paramedics provide to the rest of the medical community? | Back to Top |
Paramedics are the liaisons between the actual emergency event and the rest of the healthcare continuum. They can relay critical information from the scene to Emergency Room physicians. This information can play an important roll in predicting injuries and guiding treatment of patients. Paramedics are also helping the rest of the pre-hospital community through education and guidance. With their higher level of care and training, Paramedics have been regular instructors for Back Country Ski Patrols, Mountain Ski Patrols, Law Enforcement, Community interest groups, and other regional EMS provider agencies. |
| What are the differences between First Responders, EMTs and Paramedics? | Back to Top |
First Responders or Emergency Medical Responders (EMRs) are the initial level of pre-hospital care providers. EMRs are able to provide some basic care at the scene of an accident or medical crisis, but their scope of practice does not allow them to provide patient care in the back of an ambulance.
EMT-Basics must complete 110 hours of training which includes didactic and clinical training. EMT-Basics must complete national testing in both written and practical form. EMT-Advanced requires 70 additional hours of training in advanced patient care.
Paramedics provide the highest level of pre-hospital care. Their more-intensive training allows them to perform advanced care in all emergency settings. The training to become a Paramedic involves extensive classroom, clinical and field internship totaling more than 1200 hours of training. Paramedics must complete and pass a field internship with a busy ambulance service, pass a comprehensive written exam and successfully pass a rigorous practical exam.
All three levels of responders are part of Blaine County’s emergency medical response team and should be admired for their service, but the community in 2000 committed itself to Paramedic-level emergency response because it provides the best chance of patient survival and recovery.
| EMR | EMT-Basic | EMT-Advanced | Paramedic | # of initial
training hours | 60 | 110 | 70 | 1200 | Written
Testing |  | | | | Practical
Testing | | | | | Prerequisite
Training | | | (EMT-B) | (EMT-B) | Field
Testing | | | | | Providers in
Blaine County | | Hailey Fire Dept.
Sun Valley Fire Dept. | Carey Fire/QRU | Ketchum Fire Dept.
Wood River Fire & Rescue | |
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