Growing and aging population forces Texas counties to seek state EMS funding

“Growing and aging population forces Texas counties to seek state EMS funding” was originally published by The Texas Tribune, a nonprofit, nonpartisan media organization that informs and engages Texans about public policy, politics, government and statewide issues.

County Commissioner Rick Bailey immediately recognizes that one of his Johnson County constituents is experiencing a health issue. These are often calls and messages from residents wanting to learn more about ambulance service for those living outside Cleburne or Burleson city limits.

“When there’s an accident or a heart attack, you’re like, ‘Hey, what took you so long?'” Bailey said. “I get complaints,” he said.

County located approximately 25 miles south of Fort Worth In the midst of an unprecedented explosion. More Dallas and Fort Worth retirees are either cashing out of their homes and moving elsewhere, or younger, working adults unimpressed by longer commutes are opting for a more affordable lifestyle by choosing from the hundreds of new homes being built there.

Johnson County added 25,000 people in the last three years, and another 60,000 people are expected to move here by 2030, Bailey said. Currently, 17 proposals have been submitted for the county, which at 734 square miles is slightly larger than the size of Houston. municipal services districtsThis is the first signal from developers that they want to raise funds to cover new infrastructure costs for new housing construction.

Due to highway expansions and increased capacity of roads, counties like Johnson will see an increase in traffic accidents requiring more immediate medical attention than in smaller towns where combined fire and emergency services can provide.

more than once in 2023 152,000 accidents It happened in rural areas across the state.

“We had an explosion of growth and with so many vehicles on the roads, the roads were not designed for this much traffic or this much delay,” Bailey said. “It’s only going to increase.”

In addition to the need for more ambulances, there is also a lack of healthcare options in Johnson County. There is only one hospital within the county’s borders (Texas Health Harris Methodist Hospital Cleburne) that can accept patients at night, Bailey said. this summerThe hospital also closed the obstetrics departmentdue to the decrease in the number of deliveries there. Now, when a medical emergency occurs, residents here can expect to be transported to hospitals in neighboring Tarrant and Dallas counties, which can take anywhere from 40 minutes to an hour, depending on the type of care needed. In such cases, county officials know they need to have more than one ambulance on hand in case one is used to transport a patient many miles.

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

To help bolster ambulance service outside the fire departments of Johnson County’s largest cities, commissioners this year approved a $1.5 million contract with Grand Prairie-based CareFlite; This contract added five full-time ambulances and one more part-time ambulance to cover unincorporated areas. To save money, the district paid for the entire contract upfront. That’s a lot for a county with a total general fund budget of about $102 million, Bailey said.

In 2019, Gov. Greg Abbott enacted a measure that brought cap on property tax increases. Cities and counties cannot raise property taxes above this 3.5% limit without taking the issue to local voters. The need for better EMS service, which counties are not required to provide, makes it difficult to work within that limit, especially as rural hospitals close or reduce beds due to widespread healthcare workforce shortages, Bailey said.

“As the population increases, the need for ambulances will also increase,” he said.

Emergency EMS needs statewide

Rick Thompson, program director for the Texas Association of District Judges and Commissioners, says complaints from counties about how to pay for emergency medical services are not new. As demand for EMS service increases, the old model of volunteer fire departments for small towns concentrated in one or two areas of a sprawling county is forcing counties to hire paid county staff and purchase ambulances or contract with private ambulance companies.

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

But the situation has become more pressing as rising housing prices push more people into metro-adjacent counties where homes are more affordable, and as the number of older residents with more medical needs and emergencies increases. The coronavirus pandemic has also made workers more mobile and less location-dependent, allowing them to work wherever there is internet access.

This summer, a survey about EMS services was sent to 236 of the state’s 254 counties. Of the 81 counties that completed the survey, about 48 percent reported having open EMS positions, and about half said they had zero volunteer staff, Thompson said. Additionally, approximately 55% reported their EMS round trip was one hour, 38% reported their round trip was two hours, and 26% reported their round trip was three hours. The nearest trauma center for counties ranged from less than 5 miles to 200 miles away.

Although districts are not required to provide ambulance services, they do so to avoid disappearing completely and becoming a ghost zone.

Last month, the Grayson County district attorney ask the question before the state attorney general’s office after EMS contractors notified the county that they would not provide ambulance service to housing projects planned to be built in unincorporated areas.

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

“There is a problem on the horizon where Grayson County residents living in higher density subdivisions will not have access to emergency services,” Grayson County’s request to the attorney general said.

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

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

Today, DeLoach, who has been a paramedic for the past 38 years, says the job is more complex as the competition for trained emergency personnel has reached a critical point. Although his county did not see the growth spurt that Johnson County experienced, Lubbock’s growth led to more medical personnel working in the area, where wages were higher. And as residents age, the need for emergency medical transport increases.

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

Texas is aging fast. According to Texas Health and Human Services, the state Third largest population aged 50 and over. This population is expected to increase by 82% to 16.4 million by 2050, and most of the over-50 demographic chooses to live in rural and metro-adjacent counties where it is more affordable.

Among those aging out are volunteers working in emergency service positions at small-town fire departments. Current volunteers are retiring and finding replacements it’s getting harder and harder The increase in the cost of living discourages people from working for free. Counties that pay EMTs or paramedics often lose them after a few years to larger counties that can pay more.

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

There is also the overall operating cost of the private ambulance service having to travel long distances to hospitals. Not every hospital in a rural area, even a local hospital, can treat every injury or illness in the emergency room. This means moving patients to more specialized care elsewhere.

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

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

More private government funding

When the Texas Legislature meets in January, state leaders like Bailey and DeLoach will ask lawmakers for a better, more specific way to fund emergency medical care that would help states raise property taxes.

Their eyes are set on a successful remedy secured by rural law enforcement. A year ago, a new $330 million grant program Approved for rural policing needs. Counties would like to see such a grant program to help pay for rural ambulance services.

“Counties are working with the state to find essential funding to support rural EMS,” said Thompson of the county judge and commissioners association. “No one wants to be that person on the side of the road and no one comes.”

Other fundraising days to help pay for pancake breakfasts and volunteer ambulance services are over, Thompson noted.

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

This article was first published on: Texas Tribune -most https://www.texastribune.org/2024/11/11/texas-counties-ems-ambulance/.

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