For more than a century, many small and even medium-sized cities, villages, and towns in Wisconsin have used volunteers to staff their fire departments and emergency medical services (EMS) agencies. Because of the infrequency of calls for service – particularly in rural areas of the state – this model has served these communities well and become a source of community solidarity and pride. The model also has been cost efficient, as volunteer responders typically are paid on an hourly basis and only when called in to respond and do not receive fringe benefits.
Unfortunately, as we have reported in several recent studies, cracks in the volunteer model have become evident, and volunteer staffing models have become exceedingly difficult to sustain in many localities. The difficulties typically stem from an inability to recruit new responders to take the place of aging volunteers, and particularly to find volunteer staff who are available to respond during daytime hours, when call volumes are highest. Rising call volumes caused by aging populations or new development also are forcing many departments to turn away from volunteers and consider replacing them with full-time staff, albeit at a much higher cost.
Leaders in Lafayette County have been facing these challenges for some time, yet exactly how to respond and whether to do so collectively or individually are unanswered questions. The matter first came to a head in 2020, when the Rural Medical Ambulance Service, an EMS agency that covered a central region of the county including seven towns and the city of Darlington, was forced to close its doors. Lafayette County government moved to fill the gap and began operating Lafayette County EMS (LCEMS) in 2021 to cover the former service area.
While LCEMS leaders originally intended to employ a paid-on-call (POC) staffing model, they were unable to adequately recruit volunteers and pivoted to a combination full-time/POC model prior to initiating operations. This new, more expensive model was partly funded with a countywide property tax levy. Tensions quickly rose, given that parts of the county not covered by LCEMS were levying property taxes to support their own EMS coverage. Ultimately, a settlement was reached that included the creation of an EMS Advisory Subcommittee to support EMS services countywide as well as an agreement that the county would return $5 per capita of its EMS levy to municipalities for use toward their respective EMS needs.
Lafayette County contracted with the Wisconsin Policy Forum in 2024 to analyze the state of EMS service provision in Lafayette County and outline a range of options to improve or better-coordinate services. Through a careful review of agency staffing models, call volumes, response times, and operating budgets, our analysis finds that several agencies are struggling to staff ambulances, while appropriate response times for high acuity calls are not necessarily guaranteed. We find, further, that enhanced collaboration and countywide coordination of EMS may offer an effective path to achieving countywide service improvements, although any such improvements will come at a higher cost.
In the pages that follow, we outline the EMS landscape across Lafayette County, offer snapshots of each EMS provider’s operations, and lay out a range of options to enhance service coordination and quality. While not offering a single recommended solution, our goal is to provide Lafayette County leaders and citizens with new insights on the challenges facing EMS providers in the county and how they might be collaboratively addressed.