When the Central Valley Ambulance Authority added a fourth 24-hour ambulance in 2005, it was responding to about 6,500 calls per year.
“Today, total (calls) exceeded 12,000 for that same number of medic units,” said Jada Trammell, director of the agency, which responds to about 80 percent of Skagit County’s medical calls.
While the county’s population has grown 20 percent since 2000, the number of those 65 and older has increased 70 percent, according to the Washington Office of Financial Management.
The increase in calls and decrease in reimbursement rates from Medicare and Medicaid have prompted Skagit County to ask voters to approve an emergency medical services levy that includes an increased rate from the current levy.
The six-year EMS levy on the Aug. 7 ballot asks voters to assess a property tax of 44 cents per $1,000 in assessed value. This is an increase from the current rate of 37.5 cents per $1,000.
The increase equates to $17 per year for a $262,000 home — the county’s median home value.
An increase in revenue is necessary to keep the level of care high countywide, county representatives said.
“We’re trying to deal with the increasing costs of providing care,” said county EMS Director Jeff Sargent.
The semi-governmental Central Valley Ambulance Authority receives about 60 percent of its funding from the levy. The levy also supports Skagit 911 and the two other ambulance providers — the Anacortes Fire Department and Aero Skagit.
While the current levy is expected to bring in $6 million in 2018, Sargent said the new levy should bring in $8.2 million in 2019. Part of that increase would go to creating a one-year reserve fund, which will help the system withstand a levy vote failure in the future.
Banking on a yes
Neither the Central Valley Ambulance Authority nor the county have prepared for a possible levy failure.
The ambulance agency’s board will meet July 19 for a workshop to begin creating plans for 2019, Trammell said. While most of the conversation so far has been based on a successful levy, the board will consider preparations for the alternative.
“Central Valley is aware of the possibilities and is planning for every outcome,” she said.
Skagit County residents have supported EMS levies since the first in 1978 because they like the service they receive, Trammel said.
Skagit County Commissioner Ken Dahlstedt said he thinks voters understand that costs have gone up, and they will pay more because they value the service.
“We believe the levy is going to pass,” he said. “If you plan to fail, you probably will.”
The 2012 levy included the first increase since the 1978 levy. That was approved by about 80 percent of voters, Dahlstedt said.
He said this shows him there’s widespread support and appreciation for ambulance services in the county.
If the levy fails in August, the county would put a levy request will go on the Nov. 6 ballot.
“The EMS levy failure is such a bad option, there’s no way I can’t be supportive of the increase,” said Eron Berg, Sedro-Woolley city manager and attorney.
Making the system better
Fire chiefs, ambulance providers and city representatives have been discussing the levy increase for most of this year and have repeatedly asked Sargent for a vision about how the EMS system should operate, only to be told it wasn’t the county’s place to dictate how the system should be.
While he said he is reluctant to tell the Central Valley Ambulance Authority and others how to run their agencies, he and county commissioners have in recent weeks showed more interest in creating a countywide plan for improvements.
Among these improvements is one that has a strong consensus: Making better use of county EMTs.
Most of the county’s professional firefighters are also trained EMTs, and each of the rural volunteer fire departments has at least one EMT on staff, Sargent said.
Skagit County is unusual in that generally, EMTs do not transport patients to hospitals. Paramedics, who have more training and cost more, do most of the patient transports.
In an attempt to better utilize existing resources and reduce the Central Valley Ambulance Authority’s workload, fire chiefs and paramedics have been calling on the county to expand what is called basic life support, or BLS, integration, where EMTs respond to lower-risk medical calls, keeping paramedics free for more serious ones.
Two fire departments, Sedro-Woolley and Skagit County Fire District 13 on Fidalgo Island, have been participating in a pilot program for BLS integration, and both the county and the Central Valley Ambulance Authority want to expand it.
Sargent, who has served as EMS director for about 10 months, said he’s open to suggestions but doesn’t think it’s his or the county commissioners’ place to dictate how the system should change.
“I’d be happy to come in and design a system for someone ... but they’re always going to see it as Jeff’s system, not their system,” Sargent said.
In an attempt to address the concerns of EMS stakeholders, Sargent provided a list of system-wide revisions he’s hoping to implement in the first two years of the new levy cycle.
The list of eight initiatives, presented at a June 12 meeting, include expanding BLS integration to more fire departments and improving 911 dispatch technology.
“These are things I think the system needs to do,” he said. “It will be a lot easier to attain with more levy funding.”
A significant shift
In recent weeks, Sargent has begun to consider a significant shift in the ambulance system — eliminating the Central Valley Ambulance Authority altogether and putting the city fire departments in charge of ambulance delivery.
City leaders have said they’re interested in exploring this idea.
Bryan Harrison, city administrator for Burlington, said the movement toward a systemic change is the most encouraging thing he has heard in years of debating the county’s EMS system.
Harrison, who is a member of the Central Valley Ambulance Authority board, said the board has been asking the county repeatedly for guidance on how to continue to grow and develop the system.
“We’ve asked for you to define what is possible,” he told Sargent at the June meeting. “Having you list out eight initiatives ... this is helpful to narrow that.”
Harrison said Sargent has done a lot recently to specify what sorts of changes are on the table in the immediate future.
Berg started out skeptical about the county being serious about change, but said he has seen an effort from Sargent to make progress.
“I’m expecting and looking forward to the county commissioners putting forward a detailed plan for the future,” he said.
He said he hopes the conversations continue if the levy is passed.
“I would say I’m really hopeful things are different,” he said.
In response, Sargent is asking others to give him a chance.
“I know a lot of people have been here 18 years, but I haven’t,” Sargent said. “We’re gonna take another run at it.”
Sargent said the contracts with the county’s three ambulance providers expire at year’s end, meaning the conversation about system improvements can’t stop after the levy vote.
“We’ve got to answer their questions,” he said. “Regardless of the levy, we need to have contracts ready to go by January 1.”
Those contracts will have an expanded scope of work for these agencies, which will include working on many of the system revisions proposed on Sargent’s initiatives list.
“We have to continue this conversation so we aren’t here in six years again,” he said.