• By KARI DEQUINE HARDEN Express Staff Writer
 
• Apr 19, 2024

Wood River Valley ambulance providers should take several steps to better coordinate their services, a consultant team hired by Blaine County told the Ambulance District board Wednesday.

Consultant Hilary Woolpert said the recommendations presented at the April 17 meeting were “phase one of deliverables,” referring to the initial set of recommendations specific to EMS operations. The recommendations followed a year of data collection and analysis. Additional recommendations for both EMS and firefighting will be presented in May.

The Blaine County Ambulance District is a separate taxing district governed by the county commissioners. It funds ambulance services that cover the entire county through contracts with the Ketchum and Sun Valley fire departments, Wood River Fire & Rescue and the Carey Rural Fire Protection District.

A first recommendation was to form an advisory committee to provide system oversight for all EMS operations.

“There are a lot of moving parts and moving pieces to EMS,” said consultant Richard Curtis, including dispatchers, first responders and hospitals.

The district should “develop and identify types of EMS services, performance standards and service levels for the community,” the team stated.

The team also recommended hiring an EMS coordinator, calling it a high priority.

While EMS Medical Director Malie Kopplin, who is also a physician, oversees the EMS and ambulance transport providers, Curtis said, an EMS coordinator would look more broadly at all aspects of the system. Curtis said an experienced coordinator would require a high salary, but the consultants had noticed “fragmentation in the system, and a lack of coordination in some areas.”

“We think it’s critically important to have a coordinator to stitch everything together, and make sure people are working closely together and in collaboration,” the team stated.

Other recommendations included increasing data collection, ensuring that EMS responders are located strategically to minimize response times, adding GPS units in every ambulance and enhancing “mutual aid” agreements among agencies to ensure that resources can quickly move to where they are most needed.

Another recommendation was to raise ambulance fees, which has not been done since 2012. Ambulance District board member Muffy Davis noted that any increase over 5% must go to a public meeting.

“Recognizing [that] fees haven’t been updated in over a decade, you are likely looking at more than 5%,” consultant Patrick McIntosh said.

Those fees are typically updated every one to two years, he added.

In May, a steering committee meeting will be held with the consultant team and representatives invited from each of the 10 jurisdictions: city of Bellevue, city of Hailey, city of Ketchum, city of Sun Valley, Blaine County Ambulance District, Carey Rural Fire Protection District, North Blaine County Fire District, Smiley Creek Rural Fire Protection District, West Magic Fire District and the Wood River Fire Protection District.

The team will present recommendations on potential countywide fire and EMS consolidation.

Davis said it will be important to get a better understanding from the team on whether the Ambulance District is getting an acceptable return on expenditures, and whether it needs to spend more or is spending too much.

After that, Curtis said, if revenues and expenditures aren’t matching, the board will need to determine if it needs to either decrease service to match available funding or increase funds to match the desired service level.

Blaine County officials have supported countywide consolidation on the basis of financial sustainability, based on a strategic plan and needs assessment completed in November 2021 and the resulting conclusion that the county cannot afford to continue to provide existing services.

Ambulance calls far outnumber fire calls in the county. Between 80% and 90% of calls are ambulance calls and 10% to 20% are fire calls, according to the most recent data.

Wood River Fire & Rescue Chief Ron Bateman said that the district has been fiscally responsible based on an increase in reserves by about $800,000 over the past five years. The current reserves sit at about $3.4 million, according to Blaine County Clerk Stephen McDougall Graham.

At the May meeting, the consultant team will also provide an “off ramp,” Fletcher said, for the 10 entities if they choose not to move forward with consolidation.

Ketchum and Wood River Fire & Rescue are in the process of combining through a joint powers agreement that Fletcher in the past has called a “parallel” effort to countywide consolidation, and one that does not necessarily preclude consolidation.

Ketchum Fire Chief Bill McLaughlin and Bateman have also said they welcome the valley’s other agencies to join their JPA process. West Magic and Smiley Creek joined the proposed merger between those two agencies on Feb. 12, the Express previously reported.

The Ambulance District provides more than 50% of total funding for the Ketchum and Wood River agencies.

At Wednesday’s meeting, the board said it was important to receive additional analysis from the consultant team in time to incorporate it into their deliberations for the fiscal year 2025 budget. 

West Magic and Smiley Creek join proposed fire department merger

Four agencies plan to band together by Oct. 1

A set of four county fire agencies is one step closer to merging following a special meeting on Monday, Feb. 12.

Representatives from the Ketchum City Council, Wood River Fire & Rescue, West Magic Fire District and Smiley Creek Rural Fire Protection District met on Monday in Ketchum City Hall, agreeing in principal to create a joint powers agreement, or JPA, between them. A JPA is a contract that allows the agencies to provide services in concert with each other outside of their standard jurisdictions.

West Magic and Smiley Creek have joined the proposed merger after Ketchum and Wood River in January presented a draft JPA for their two agencies. The proposed contract between the four departments arrives in the middle of a larger study of consolidating fire and ambulance services across Blaine County.

Many attendees—both among the agencies and in the crowd—wore tie-dye shirts with “one” written on the front along with a fire department insignia, showing a renewed interest in uniting the county’s services, which have been criticized in the past as being overlapping and inefficient.

At one point, Wood River Fire & Rescue Chief Ron Bateman read aloud a letter he sent last year to an unnamed fire official in Blaine County.

“We live in a near constant state of cognitive dissonance, because this doesn’t feel like a brother or sisterhood,” he said. “There is a long-term effect on our mental health.”

The region at large is serviced by fire departments of the cities of Bellevue, Hailey, Ketchum and Sun Valley, the Blaine County Ambulance District, Carey Rural Fire Protection District, North Blaine County Fire District, Smiley Creek Rural Fire Protection District, West Magic Fire District and Wood River Fire & Rescue.

Ketchum Fire Chief Bill McLaughlin said on Monday that one tricky part of the equation is that each of the four parties that was present at the meeting brings different levels of funding to the table.

“That’s going to be a discussion—making sure that everybody’s happy with how we’re splitting that up and trying to make it as equitable as possible,” he said.

Ketchum Councilman Spencer Cordovano said that he is OK with Ketchum footing a good portion of the bill but wants to hear if the community feels the same way.

“I see it as a contribution from Ketchum to the valley, and I see it as we happen to be the bank,” he said. “The question I pose to the residents of Ketchum is, ‘Are you okay with this contribution?’” he said.

Mayor Neil Bradshaw compared the proposed JPA to the contract that Ketchum has with Mountain Rides and the Sun Valley Air Service Board. In both those cases, Ketchum pays for a larger portion of the bill than other entities even though the deal benefits the community beyond Ketchum’s borders.

“It’s for the greater good,” Bradshaw said.

Don Hartman, part-time chief of the West Magic Fire District, said that sharing staff and resources will help hold emergency services personnel more accountable. He joked that, in West Magic, a small vacation community without much action for EMS and firemen, this is especially needed.

“We got to a point where we said, ‘leave your beer off the truck, and you have to take a test you have to pass, and you have to read,’ and we lost everybody,” he said.

West Magic Fire Commissioner Stacy McLaughlin said her community has seen these types of efforts work before.

“We watched it happen with the water rescue at Magic Reservoir, and that was one-hundred-percent due to the fact that people [met] at the table and got to know each other and exchanged numbers,” she said.

Blaine County Commissioner Angenie McCleary spoke during the public comment session and said she wants to see these efforts expand further.

“I would like to see this become even larger and have full-blown county consolidation,” she said.

The JPA between Ketchum, Wood River Fire & Rescue, West Magic and Smiley Creek calls for the agencies to form a governing board with a representative of each district.

In October 2023, Adam Christensen, a lawyer with Boise law firm Hawley Troxell, detailed the difference between full consolidation and a JPA and discussed what is allowed under Idaho state law.

Under a full consolidation, Christensen said, a new single district and legal entity would be created and existing fire districts would go away. That could happen in three ways: a voluntary agreement between all entities; a vote put to the electorate living in all entities involved; or a vote forced by the public through a petition.

If the organizations opted for full consolidation, the jurisdictions that agreed would be annexed into that new single fire district.

However, Idaho law does not provide a mechanism to consolidate an ambulance district with a fire district, Christensen said. Those, under statue, would remain separate and connected through a contract. In that scenario, though, there would only need to be one contract.

A JPA is not a true consolidation, Christensen said, and is formed only through voluntary agreement. He described it as more of an “umbrella” governing structure, with all funding contributions pooled together.

Christensen said there are positives and negatives to all approaches, but said the JPA can “be more easily undone or changed than a full consolidation because of the voluntary aspect.” The agreement would essentially be reviewed annually through its budgeting process.

There was general agreement among Ketchum City Council members that appointing to the board a representative of each district would be a good structure. But the addition of an “at-large” member to break ties between the four jurisdictions was a question that remained in the air on Monday.

Ketchum Fire Chief Bill McLaughlin said he has heard one legal opinion that recommends against an at-large position because “you’d be turning over everybody’s decision-making to someone outside,” he said.

Councilwoman Courtney Hamilton said that, in her experience, smaller boards are easier to work with and more efficient.

McLaughlin said there are two examples of JPAs that work well elsewhere in the state, including in Kootenai County in the Idaho panhandle. There, a JPA governing an ambulance district, Coeur d’Alene and eight fire districts works successfully. Madison County in eastern Idaho has a JPA that works well, too, McLaughlin said.

Complicating the situation is the inclusion of the Blaine County Ambulance District. The ambulance district is a separate taxing district governed by the Blaine County Board of Commissioners. It funds ambulance services that cover the entire county through contracts with Ketchum, Wood River Fire & Rescue, Sun Valley and Carey Rural Fire Protection District.

Differences in levies between the different jurisdictions could also cause issues, though council members said that if smaller organizations like West Magic and Smiley Creek can be brought on successfully, this shouldn’t be impossible to navigate.

Officials outlined a schedule for merging at Monday’s meeting as well. It called for the formation this month of an interim steering committee to guide the merging of the four agencies. Their JPA will be finalized and adopted by the end of March. Budget discussions will begin in April and contracts will be hashed out. By the end of the summer, budgets will be adopted and a new chief of the JPA will be hired. This is all with the goal of merging the four agencies by Oct. 1.

“The original timeline was aggressive, and we can still meet that Oct. 1 target with a lot of hard work,” McLaughlin said.

Wood River Fire & Rescue Commissioner Jay Bailet said challenge coins were made for each member of the Monday panel as a reminder of the importance of their efforts. The coins are emblazoned with “courage,” “commitment,” “creativity” and “compassion”—four words he said he hopes will guide the continuing discussions.

Bateman said that the end goal should be more than just a JPA.

“We can’t just exist as four agencies with a document,” he said. “We need to start integrating culturally and operationally.” 

BOISE, Idaho — During medical emergencies, we all depend on paramedics and EMTs to be on the scene within minutes - in situations where minutes can make all the difference. 

However, the increase in demand without more support has been stretching EMS services thin across the state.

Ada County Paramedics respond to just over a quarter of EMS for the state of Idaho. As our Gem State continues to grow, so do the costs associated with running emergency medical services. 

"That's very costly," Ada County Paramedics Chief Shawn Rayne said. "It's not the cost of the call when it comes in - the cost is truly being ready 24 hours a day, seven days a week."

Chief Rayne said only a few years ago, ambulances cost around $180,000 to purchase. Now, they cost around $250,000 before installing any equipment. 

Last year, Ada County Paramedics shifted from a 48-hour work week to an average of 56 hours, something their chief said the change is not sustainable for the long term. 

"Every day at Ada County, we have 14 ambulances on duty 24 hours a day," Rayne said. "The reality of today is that I need really 17 ambulances to provide that base of coverage, but then also to not work my people as hard as they're being worked right now."

Those are problems being have been scene across the state - in both urban and rural areas.

"Many agencies in the state, including my own, we're looking at maybe in two to three years, of potentially having to decrease our level of service," Rayne said. 

To avoid a situation like that, the state legislature's Office of Performance Evaluations created the EMS Sustainability Task Force to look at issues impacting EMS services. 

Over the past 50 years, a lot of things have changed with how EMS services provide care, with new advancements and equipment - but the way those services are funded hasn't changed.

"The funding model is really based on what we were doing in the 70's," Rayne said.

A number of different sources fund EMS services, including county taxes and insurance - but their largest source of money is from Medicare, a source that isn't providing as much as it used to.

"At the end of it all, we get about $340-$350 from Medicare on a bill that might be $800," Rayne said. "So that portion of our budget that was that fee for service has continued to kind of shrink. So we're really dependent on increased call volume to bring more revenue through the door, but as the call volume increases - we don't have the ability to put more resource on the road to address the increase in call volume."

To try and come up with a plan that will work for these agencies, the EMS Sustainability Task Force recommended three things they would like to see in the proposed 2024 legislation.

The first step is to officially designate EMS as an essential service in Idaho.

"By doing that, it puts the onus on the county commissioners in each county - not to provide it themselves or to have a county service provide it - but to ensure that it is provided within the borders of the county," Rayne said.

The recommendations also ask for developmental money to help counties establish EMS services, to make sure people have life-saving resources anywhere in the state.

"If we continue to see the increase in call volume like we have been, it's just gonna get worse," Rayne said. "So we really need to find these things that make EMS sustainable. Not only here in Ada County - that's certainly important to me and my agency - but across the state."

Rayne said they are not sure when the proposal will be discussed in committee, or if it will be during this legislative session. But they have received interest from some legislators. 

Fire chiefs propose merging by Oct. 1

Ketchum Fire Chief Bill McLaughlin and Wood River Fire & Rescue Chief Ron Bateman at a special Ketchum City Council meeting on Thursday, Jan. 11, sought feedback on a proposal under which their two agencies would merge by October.

The merger is to be governed by a Joint Powers Agreement (JPA), a draft of which the fire chiefs presented to the council on Jan. 11. It’s an agreement forged in the middle of a larger effort to study the consolidation of firefighting and ambulance services across Blaine County. McLaughlin said he and Bateman aim to use the merging of their two departments to reduce administrative costs, improve training and provide better service to the public.

A board governing the new, tentatively-named “Blaine County Fire and Rescue Authority” would be responsible for hiring a fire chief. McLaughlin recommended conducting a national search for the candidate.

“We would want to avoid a situation of having a fire chief coming out of one organization and being perceived as biased toward that organization,” he said. “We’d rather see a fire chief starting brand new—essentially as a neutral party—and the board make the decision based on their expertise.”

McLaughlin said he is planning to retire in the fall, providing some of the basis for the timeline. He said Bateman plans to retire in the near future.

Though Ketchum and Wood River Fire & Rescue are leading their own consolidation, McLaughlin said, the merger remains open to all the other agencies involved in a county-initiated consolidation study that’s currently in progress.

“Now we have the two entities spearheading it, but we may have additional partners moving into the future,” he said.

McLaughlin said the JPA allows the two agencies to have equal say in how the proposed fire authority is managed. And, if it doesn’t work out, the departments can split up.

The Ketchum City Council discussed how many members the fire authority board should have, how agencies should be represented on the board, and whether or not votes should be weighted based on the financial contribution of a particular representative’s department. Council members agreed that the board should have five members with equal voting power.

“It’s exciting to be at the initiation of something,” said Councilman Tripp Hutchinson. “And to have the opportunity to do it right without being hamstrung by the way things have always been done.”

McLaughlin warned that consolidation may not lead to immediate cost savings because of a rapid increase in demand for services.

He said his department has seen a 34% growth in emergency calls over the past three years.

“This year we are already on track for a new record for calls in January,” he added. “At this point we don’t see any evidence that the growth and need for services is going to slow down any time soon.”

Still, McLaughlin said that trimming the number of fire chiefs and deputy chiefs in the county from nine to one—a hypothetical possibility if county consolidation moves forward—would lead to significant administrative change. Decreasing the number of fire chiefs would allow for the creation of other positions, he said, such as an EMS supervisor and a training officer.

“We have a lot of fire chiefs, but we don’t have a single full-time training officer in the entire county,” he said. “One of the biggest issues we’ve identified is a lack of consistency in how we respond to major events.”

And a reduction in the number of leaders could divert more funds toward firefighters and paramedics, McLaughlin said.

Reducing overlap of fire stations and equipment could also lead to cost savings. “We have a lot of engines in this county,” McLaughlin said. “Probably more than we could put firefighters on.”

During public comment, paramedic Tom McLean said he saw the merger plan as benefiting both employees and the community, and that he knew there was support among firefighters and EMS workers in moving forward. McLean retired as Ketchum fire captain in 2018 after 30 years of service with the department. He currently serves as president of the Ketchum Sun Valley Volunteer Association.

Countywide consolidation

Consolidation of fire departments is a nationwide trend that has been growing over the past 40 years, McLaughlin said at the Jan. 11 meeting.

In May 2023, Blaine County hired a consultant to study full consolidation of the valley’s nine fire agencies and the Blaine County Ambulance District.

The Blaine County Ambulance District is a separate taxing district governed by the Blaine County Board of Commissioners. It funds ambulance services that cover the entire county through contracts with Ketchum, Wood River Fire & Rescue, Sun Valley and the Carey Rural Fire Protection District.

Ketchum and Wood River Fire & Rescue first announced their plan to consolidate in August 2023, according to previous Express reporting. McLaughlin and Bateman said in August that they began merger talks long before the county initiated its effort.

Ketchum Mayor Neil Bradshaw on Thursday said he appreciated other county leaders who were in the room or attending the meeting virtually, including Hailey Fire Department Chief Mike Baledge, Hailey Mayor Martha Burke, Hailey City Administrator Lisa Horowitz and Blaine County Commissioners Angenie McCleary and Muffy Davis. Other leaders were observing the process, he said, and participating in county meetings.

“This is one small potential step in that progress, but we will always continue to participate on a countywide basis on what is best for residents, businesses and our respective communities,” Bradshaw said.

Hailey Mayor Martha Burke said Hailey was “very interested in consolidation” and represented a major and growing population center.

“We recognize that you are taking the first step that we will be following for success closely, which I expect you to have,” Burke said. “But I’m not ready to sign this JPA today. I’m just not ready.”

The next step in the county’s consolidation study will be for its consultant to analyze and present data collected over the past six months from all county agencies.

“We will continue to work with the county and hopefully this will help as a stepping stone to wherever we end up with the county’s program, and the recommendation made by their current consultant,” McLaughlin said.

Hiring a new chief

McLaughlin said the top priorities under the JPA between Ketchum and Wood River Fire & Rescue would include assembling the fire authority’s governing board, beginning the search for a new fire chief and approving a budget.

Blaine County currently funds more than 50% of each fire department’s total budget through ambulance contracts for each. It requires budget requests to be submitted in May.

Riley suggested having a new board in place by February or the beginning of March.

The JPA would need to be approved by both the Ketchum City Council and Wood River Fire & Rescue commissioners before the merger begins.

Ketchum Councilman Spencer Cordovano said he would prefer to hire a local as chief of the new fire authority, if everyone can “avoid politics and put on their big boy pants.” McLaughlin said a local hire should not be off the table, but that he recommended keeping the position “as neutral as possible.”

Hamilton agreed with the merits of a broad search effort, and noted how hard it is right now to fill positions in the Wood River Valley.

“The board may not find people willing to come,” agreed McLaughlin. “Everyone looks at the price of housing and they go somewhere else.”

Bradshaw said he preferred a local hire, but “We owe it to the taxpayers to get the best possible candidate.”

County leaders express support, want to see more participation

Blaine County Commissioner Angenie McCleary said she was excited to see the progress being made by Ketchum and Wood River Fire & Rescue, but she continues to be a strong advocate for countywide consolidation. “I really hope this effort is concurrent with that, and not divergent,” she said. “The more inclusive the better.”

She said failures to consolidate in the past—efforts which date back 20 to 30 years—were partly caused by a struggle among various agencies to “get over cultural differences.”

McCleary also stressed that consolidation was not only about efficiency but also providing better and more effective service to the community. She added that there may not necessarily be additional money available from the county for a new ambulance contract in excess of current funding amounts.

Commissioner Muffy Davis also said wider collaboration between agencies is important, as was making sure the ambulance district stays involved in this JPA process.

Bradshaw said the ambulance district partnership is “critical to this potential entity, and we take that very seriously.”

Councilwoman Amanda Breen expressed support for the merger while “keeping the door open for everyone else.”

Hamilton said she wanted to see the ambulance district included every step of the way.

“I would love for this to be a countywide consolidation, and I think that’s what a lot of people want,” Hamilton said. “I want this to set us up to do that.”