Colorado ambulance services are on the verge of collapse, government report finds
Snow was still on the ground one afternoon in late March last year when Hinsdale County’s only full-time paramedic, Buffy Witt, got a call about a car accident on Highway 149.
At first, she thought it was just a routine call, but when she got to the scene, her heart sank. The car pinned against a tree next to the road belonged to her 20-year-old son, Logan. He was trapped inside with a shattered femur, six broken ribs, a fractured vertebrae and a collapsed lung.
Witt immediately went into first-responder mode and focused on saving her son’s life.
“I told myself, put on your sheet of armor and just do it,” she said. “My son told me that he was getting right with dying because he knew he couldn't get out of the car.”
Logan Witt survived after being flown to the nearest trauma center equipped to treat him, which was almost 150 miles away in Grand Junction. The experience was so traumatic that Witt stopped going on calls altogether. But there weren’t any other paramedics in Hinsdale County at the time to take her place, so less than two months later, Witt responded to the scene of another car accident. That time, the driver, a longtime friend of hers, died.
“That feeling of responsibility in a rural community, where you know the people that you respond to - it's just such a heavy weight,” Witt said. “The burnout rate is magnified here because of the staffing issues, the personal connection and the responsibility to the community.”
On top of being a paramedic, Witt is also Hinsdale County’s director of emergency medical services. She manages the department and goes on calls for a salary of less than $60,000 per year. Like in many rural areas, any other first responders that back her up are volunteers. In fact, more than one in 10 ambulance agencies in Colorado have all-volunteer staff.
For Witt, the job is worth the challenges because she serves the community where she was born and raised. But ambulance services across Colorado, especially those in rural areas, are facing the same existential problems: a lack of funding, workforce shortages and declining volunteerism. A draft report sent to Gov. Jared Polis last week from the state’s EMS Sustainability Task Force found that many of the state’s emergency medical services are unsustainable, with some at risk of disappearing altogether.
The 20-member task force was launched last year to address the problems over a five-year period and is made up of state lawmakers and EMS professionals. Many first responders, however, including some serving on the task force, say more urgent action has to be taken.
“We can't wait,” Lisa Ward, a professional EMT on the task force, told KUNC. “We're already losing EMS services in Colorado. It's not sustainable to have a volunteer and all-volunteer base when you can't pay them, you can't offer them health benefits, the mental and physical exhaustion that it takes to do the job wears on people.”
Fewer and fewer people are willing and able to dedicate time to volunteering as a first responder. Those that do often have to juggle other jobs to pay the bills, which means they’re only able to volunteer periodically and are at higher risk of burnout. At the same time, many small agencies don’t have the budgets to pay for full-time ambulance staff.
The problems partially stem from inconsistencies between state and local oversight of ambulance services. For example, first responders like paramedics and EMTs are currently licensed by the state while their emergency vehicles and the agencies that manage them are licensed on the county level. Colorado is the only state in the U.S. without centralized oversight of its EMS system. The state also has no uniform system in place for communicating or sharing data and information between local agencies.
“One county does one thing and another county does another thing. If you want to transfer a patient from one county to another county, you have to figure out what that looks like, how that's done and who responds,” Ward said. “Right now it's kind of a patchwork of county to county regulation.”
The patchwork system has resulted in varying access to emergency medical services across the state. Even the requirements for life-saving equipment on an ambulance can change from county to county because there are no statewide standards. Lawmakers passed legislation last year, Senate Bill 225, which will consolidate ambulance licensing at the state level starting in January.
Colorado ambulance services are funded in a variety of ways as well. Some are private businesses, nonprofits or function through hospital systems. Others are funded by property tax revenue alongside other local services like schools, libraries and water districts. That means local residents have to agree to higher taxes to increase funding for their emergency medical services.
Many local ambulance agencies also rely on grants from the Colorado Department of Public Health and Environment, but the lack of statewide standards blocks access to other funding sources like federal grants.
“When you have consistency and you have standards, you make a case for reimbursement models and funding models to say, ‘Hey, look, there's no difference in any of these agencies. It's not a rural agency versus an urban agency.' It creates consistency in licensing standards, education standards and equipment standards,” Ward said.
Ward also noted that ambulances in Colorado are only reimbursed if they transport a patient to a hospital. They do not get paid for calls where they only treat a person on the scene. Under state law, ambulances are considered transportation services, not medical services.
“When any one of us individuals has an emergency, we just pick up the phone in the 21st century in America and dial 911, and we anticipate that the expert on the other end of the phone is going to realize and figure out which type of emergency service to send to us within minutes,” EMS Sustainability Task Force Chairman and State Sen. Mark Baisley said. “It works pretty well for a fire because fire is considered an essential service, which is a term that has a meaning to it: that the local municipality shall provide fire response. Not so with emergency management services.”
Baisley added that there needs to be more public awareness of the issue and how Colorado EMS systems function. But he also agrees with Lisa Ward that funding needs to be the first priority, and he’s working with the task force on legislation that he plans to introduce during next year’s legislative session. He believes tourists need to cover some of those EMS costs.
“I intend to rethink the entire manner of how this is funded,” Baisley said. “Obviously, it's always going to be through taxation. But since our tourism industry creates a lot of the cost and demands a lot of our responsiveness and appropriate care, then we will look at that.”
The population of many rural mountain communities balloons in the summer months due to tourism. Those tourists often have to use local emergency medical services, which adds even more strain to those systems.
In Hinsdale County, the population increases from about 800 people year-round to about 6,000 people over the summer months when tourists descend on the area to hike, climb, fish and hunt among the peaks of the San Juan Mountains. Buffy Witt is doing what she can on the local level to keep emergency medical services available there while holding on to hope that the state can get its EMS oversight on the right track.
“I’m just trying to keep the wheels rolling and keep the duct tape and the fingers plugged in the holes,” Witt said. “There is hope that change is on the horizon, and this personally gives me motivation to be a part of that change.”
She’s launching a local training course in partnership with neighboring counties so that volunteers don’t have to travel to become first responders. She’s also put in place a stipend program to provide some compensation to volunteers, which is funded by the San Juan Solstice 50 Mile Run, an annual Hinsdale County marathon that typically attracts about 300 runners.
Updated August 14, 2023 at 4:03 p.m.: A previous version listed Buffy Witt's salary as about $50,000 per year. That was corrected to under $60,000.
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