County Commissioner Rick Bailey knows immediately when one of his Johnson County constituents has suffered a health issue. That’s usually when calls and texts come in from residents wanting to know more about ambulance service for those who live outside the city limits of Cleburne or Burleson.

“I get complaints about accidents or heart attacks, saying, ‘Hey, why did it take so long?’ » Bailey said.

His county, about 15 miles south of Fort Worth, is in amid an unprecedented boom. More retirees in Dallas and Fort Worth are taking advantage of their homes and moving, or younger, active adults, unfazed by longer commutes, are opting for a more affordable lifestyle, choosing from hundreds of new houses built there.

Over the past three years, Johnson County has welcomed 25,000 more people and by 2030, 60,000 more are expected to move here, Bailey said. Currently, the county, which at 734 square miles is slightly larger than the size of Houston, has proposed 17 municipal utility districtsthe first signal from developers that they wish to raise funds to finance new infrastructure for the construction of new housing.

Factoring in highway expansion and road congestion, counties like Johnson will experience an increase in traffic accidents that will require a more immediate medical response than smaller cities, with their combined services. fire and emergency, can offer.

In 2023, more than 152,000 accidents occurred in rural areas of the state.

“Our growth has exploded, and with so many vehicles on the road, the roads were not designed for this much traffic or this many delays,” Bailey said. “It’s only going to increase.”

In addition to the need for additional ambulances, Johnson County is short on health care options. The county has only one hospital — Texas Health Harris Methodist Hospital Cleburne — within its boundaries that can admit patients overnight, Bailey said. This summer, tThe hospital also closed its maternity warddue to a decrease in the number of deliveries there. Now, residents here can expect that in the event of a medical emergency, they will be transported to hospitals in neighboring Tarrant and Dallas counties, which can take between 40 minutes and an hour, depending on the type of care needed. In these situations, county officials know they need to have multiple ambulances on hand in case one is used to transport a patient miles away.

“I got a call for a woman who was in her second trimester,” Bailey recalls. “She said, ‘What are we going to do?’ I depended on the hospital here.

To help bolster ambulance service outside of Johnson County’s largest city fire departments, commissioners this year approved a $1.5 million contract with Grand Prairie-based CareFlite, which adds five full-time and another part-time ambulances to cover unincorporated areas. To save money, the county paid the contract in full, up front. That’s a lot for a county that has a total general budget of about $102 million, Bailey said.

Johnson County Commissioner Rick Bailey poses at his Cleburne office on Nov. 8, 2024. Credit: Shelby Tauber for The Texas Tribune In 2019, Gov. Greg Abbott signed into law a measure that puts a cap on property tax increases. Cities and counties cannot raise property taxes beyond this 3.5% cap without putting the issue before local voters. Bailey said the need for better EMS service, something counties are not required to provide, makes working within that cap more difficult, especially as rural hospitals close or reduce beds due to a widespread shortage of health workers.

“As the population increases, so does the need for ambulances,” he said.

The urgent need for EMS across the state

Complaints from counties about how to pay for emergency medical services are nothing new, says Rick Thompson, program director for the Texas Association of County Judges and Commissioners. As demand for EMS services increases, the old model of volunteer firefighters for small towns concentrated in one or two areas of a sprawling county is forcing counties to consider hiring paid county staff and purchasing ambulances or contract with private ambulance companies.

“It’s a huge problem,” Thompson said. “I’ve been working with counties for 25 years and when I’ve traveled the state, this has always been an issue.”

But it’s becoming more urgent as rising housing prices have pushed more people to metro-adjacent counties where housing is more affordable and the number of elderly residents with more medical and emergency needs increase. The coronavirus pandemic has also made workers more mobile and less location dependent, able to work anywhere there is internet access.

This summer, a survey was sent to 236 of the state’s 254 counties about their EMS services. Of the 81 counties that responded to the survey, about 48% reported having open EMS positions and about half reported having no volunteer staff, Thompson said. Additionally, approximately 55% reported EMS round trip times of one hour, 38% reported round trips of two hours, and 26% reported round trips of three hours. The counties closest trauma center was within 5 miles to 200 miles.

And while counties aren’t required to provide ambulance service, they do so to avoid disappearing completely and becoming ghost regions.

Last month, Grayson County D.A. ask the question directly to the state attorney general’s office after EMS contractors informed the county they would not provide ambulance service to planned housing developments under construction in unincorporated areas.

Does the county have a legal obligation to provide fire and ambulance services to residents living in unincorporated areas?

“There is a problem on the horizon in which Grayson County residents living in higher density developments will not have emergency services,” Grayson County’s request to the Attorney General states.

Calls for comment were not immediately returned by Grayson County officials.

About 40 minutes northwest of Lubbock, Lamb County Judge James “Mike” DeLoach remembers how rural ambulance service was a “load and go” operation, where residents were placed in the beds of pickup trucks and traveled dozens of kilometers to the nearest location. hospital.

Texas Health Harris Methodist Hospital in Cleburne on November 8, 2024. According to Johnson County Commissioner Rick Bailey, some services such as the maternity ward have closed at the hospital, forcing patients to travel 30 miles or more to ‘to Fort Worth to get the care they need. Credit: Shelby Tauber for The Texas Tribune Today, DeLoach, a paramedic for 38 years, says the job is more sophisticated, with competition for qualified emergency personnel reaching a critical stage. Although his county isn’t experiencing the growth spurt that Johnson County is experiencing, Lubbock’s growth has translated into more health care workers working there, where salaries are higher. And the need for emergency medical transportation increases as its residents age.

“We’re not necessarily seeing an influx of people,” DeLoach said. “But we are seeing an aging population that has a greater need for EMS.”

Texas is aging at a rapid rate. According to Texas Health and Human Services, the state has third largest population of people 50 and older. That population is expected to grow 82% to 16.4 million by 2050, and a large portion of those over 50 are choosing to live where it’s more affordable: in rural and metro-adjacent counties.

Among those aging are volunteers who now fill EMS positions in small-town fire departments. Current volunteers retire and find their replacements it’s getting harder and harder because the rising cost of living discourages people from working for free. Counties that pay for EMTs or paramedics often lose them after a few years to larger counties that can pay them more.

DeLoach said it’s difficult to recruit EMTs and paramedics to his county when they can work in Lubbock and make $57,000.

Then there is the overall operational cost associated with a private ambulance service having to travel long distances to hospitals. Even when there is a local hospital, not all hospitals in a rural county can treat every injury or illness in their emergency rooms. That means taking patients to more specialized care elsewhere.

The cost increases due to both the specialized training and the equipment needed on board.

“It’s increasing because in theory there are more requirements. They must have all kinds of equipment. It’s very expensive,” Fannin County Judge Newt Cunningham said.

More dedicated public funding

When the Texas Legislature convenes in January, county leaders like Bailey and DeLoach will ask lawmakers for a better, dedicated way to fund emergency medical care that would help counties raise property taxes.

They have their eyes on an effective remedy obtained by rural law enforcement. A year ago, a new amount of 330 million dollars grant program was approved for rural policing purposes. Counties would like to see such a grant program to help fund rural ambulance services.

“Counties are working with the state to find core funding to support rural EMS,” said Thompson, of the County Judges and Commissioners Association. “No one wants to be that person on the side of the road and no one comes.”

And as Thompson points out, the days of pancake breakfasts and other fundraisers to help pay for volunteer ambulance services are over.

“You can’t have enough bake sales to afford a $400,000 ambulance and then equip it and run it,” Thompson said. “It’s not realistic.”

This article was originally published in The Texas Tribune has https://www.texastribune.org/2024/11/11/texas-counties-ems-ambulance/.

The Texas Tribune is a nonpartisan, member-supported newsroom that informs and engages Texans on state politics and policy. Learn more at texastribune.org.

“Growing, Aging Population Forces Texas Counties to Seek Public EMS Funding” was first published by The Texas Tribune, a nonpartisan, nonprofit media organization that informs – and engages with – Texans about public policy, politics, government and issues across the country. of the state.

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