Bill Tarrant, director of the Jordan Valley Emergency Medical Services Authority, turns the key on his oldest ambulance. It takes a moment to start up. He reads out the mileage – it’s 161,395 miles.
Tarrant took it out of service a few months ago. It’s 20 years old, and it was racking up repair bills. But he has a plan to revive it.
“Basically, if you go pick up a pickup truck at the dealership, take the bed off it, but keep the frame there, that's what these sit on,” he explained. Mechanics can replace the underlying truck that the ambulance sits on top of, doing away with any efficiency or safety problems that come with the truck’s age, while keeping the old interior.
This process, called ‘remounting,’ costs closer to $190,000, much less than the $350,000 that JVEMSA would pay for a brand new ambulance. Having another ambulance would help JVEMSA accommodate the 3-hour trips to larger hospitals in Ann Arbor and Grand Rapids, which they run multiple times a week.
But even at that lower cost, he doesn’t have the cash right now. On August 6th, voters will decide whether to give him more to work with, through an increase to their local EMS millage rate that would raise an estimated $529,947 for their operations budget, and $211,979 for their vehicle and equipment budget.
They’d put it towards remounting that ambulance, replacing aging cardiac monitors and, Tarrant says, towards hiring more staff and paying for their benefits.
Tarrant loves running this EMS. He likes that it’s a hometown service, for the community, not a for-profit company. And he’s been in EMS his whole career. He started out “at the age of 16, working in my first ambulance call for a volunteer, and then I went full time in 1990,” he said. He raised three kids working various EMS roles.
But the pathway he took is becoming less common in rural communities. “We don't have volunteers in the area like we used to for staffing,” Tarrant said. “We have about two to three people that still live in the area … But to keep two ambulances, 24/7, for our taxpayers, it's actually required us to hire some full time people.”
He recently brought on two people full-time, but in order to be fully staffed, he’d need two more paramedics and three more EMTs.
Tarrant hosted a months-long training EMS course, with help from a Michigan state grant, but he was only able to offer the graduates part-time work.
With their new certifications, they left East Jordan for places they could work full-time, with benefits. “We became a turnstile,” Tarrant said. “We trained them, and then they were gone.”
Emily Bergquist, who oversees EMS for Michigan’s Department of Health and Human Services, says this is a problem all over the state in rural areas – urban and suburban agencies draw away talent. “They can offer a lot more money and benefits in order to start a career,” she said. “How do you ask someone to give up the opportunity to start their career, in order to stay somewhere where you know you can't be invested in?”
Bergquist also explained that EMS revenue is a lot more limited than say, a hospital emergency room, since they can only bill for transporting patients.
“If that ambulance is not transporting a patient, or if it's a first response agency that doesn't transport patients, they have no mechanism whatsoever to recoup the cost of running their agency,” she said, meaning rural ambulances that respond to fewer calls make less money. Jordan Valley EMSA has raised its transfer revenue through running non-emergency transfers for a local nursing home, but has still struggled to meet their needs.
Bergquist sees EMS staffing and budget shortfalls as an equity issue. “Everybody deserves to have highly skilled clinicians come to them in their time of need,” she said. There’s no legal guarantee that an ambulance shows up when you call, she added. “Is it possible for everyone to have one? That is fundamentally what's in the community's hands.”
Beyond East Jordan, voters in Emmet County and Wexford County will decide on millage renewals for their emergency medical services, along with many other counties across Michigan in the primary election next week.