Author: Matt Zavadsky

We’re excited to share that the Ready, Next LIVE Operations Tour, held October 13-17, 2025 on the East Coast, was a tremendous success! Thank you to the active participation of our members and the generous support of our sponsors. The tour delivered insightful discussions, valuable education, and meaningful connections that continue to strengthen our industry.

Watch a short video of the MEDIC site visit here.

Watch a short video of the Richmond Ambulance Authority visit here.

Some pics from the event:

Nice to see more communities moving toward basing their ambulance fees on the cost of service delivery.

This is something we encourage to help with EMS system sustainability. Medicare and Medicaid patients are essentially unimpacted by changes in fees, and the reality is that collections from self-pay patients are very low (our soon to be released December 2025 EMS Financial Index will show a 7.3% self-pay gross collection rate for public providers). Self-Pay patients can be shielded from large out of pocket expenses through compassionate care billing practices.

Here’s a link to a recent PWW Advisory Group webinar on this topic: 𝐖𝐡𝐚𝐭 𝐀𝐫𝐞 𝐘𝐨𝐮 𝐖𝐨𝐫𝐭𝐡? 𝐄𝐬𝐭𝐚𝐛𝐥𝐢𝐬𝐡𝐢𝐧𝐠 𝐚𝐧 𝐀𝐩𝐩𝐫𝐨𝐩𝐫𝐢𝐚𝐭𝐞 (𝐚𝐧𝐝 𝐂𝐨𝐦𝐩𝐥𝐢𝐚𝐧𝐭) 𝐅𝐞𝐞 𝐒𝐜𝐡𝐞𝐝𝐮𝐥𝐞: https://info.emsmc.com/webinar-what-are-you-worth

Feel free to contact us if you would like to learn how to model the impact that fee schedule changes could have on your EMS system.

𝐊𝐞𝐲 𝐐𝐮𝐨𝐭𝐞𝐬 𝐟𝐫𝐨𝐦 𝐭𝐡𝐞 𝐑𝐞𝐩𝐨𝐫𝐭:
“The city plans to raise ambulance rates from $735 or $1,065 to $2,324 for advanced life support calls, and $620 to $1,162 for basic life support calls.”

“The new rate is based upon the “true cost” of the service as determined by a third-party auditor, a rate the city already uses to get additional federal reimbursement for Medicare and Medicaid clients.”

“Dubuque’s current ambulance rates are comparable to charges levied by other cities in Iowa, but cities in other states, particularly Illinois and Wisconsin, have already moved to charging ambulance users the full cost of the service, rather than falling back on property taxes.”

“These communities have also shifted the burden of paying for fire departments away from the community at large and onto the person who uses the service.”

“For that self-pay group, the city offers a hardship waiver both for residents and non-residents, which Scheller said would be extended to people charged for other Fire Department services.”
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𝐂𝐢𝐭𝐲 𝐨𝐟 𝐃𝐮𝐛𝐮𝐪𝐮𝐞 𝐬𝐞𝐞𝐤𝐬 𝐭𝐨 𝐫𝐚𝐢𝐬𝐞 𝐚𝐦𝐛𝐮𝐥𝐚𝐧𝐜𝐞 𝐟𝐞𝐞𝐬, 𝐜𝐡𝐚𝐫𝐠𝐞 𝐟𝐨𝐫 𝐬𝐨𝐦𝐞 𝐅𝐢𝐫𝐞 𝐃𝐞𝐩𝐚𝐫𝐭𝐦𝐞𝐧𝐭 𝐬𝐞𝐫𝐯𝐢𝐜𝐞𝐬
BY CHRIS GRAY
Nov 29, 2025

https://www.telegraphherald.com/news/tri-state/article_3e7caa05-8fb1-453b-8545-f3cb943dbbbd.html

City of Dubuque leaders seek to sharply increase ambulance fees and begin charging for a menu of Fire Department services, including dousing vehicle fires.

The new user fees and increased ambulance rates would allow the city to recruit and hire five new firefighter-paramedics as early as April.

The Dubuque City Council will consider a proposal for the new fees and added positions at its Monday, Dec. 1, meeting.

The city plans to raise ambulance rates from $735 or $1,065 to $2,324 for advanced life support calls, and $620 to $1,162 for basic life support calls.

“We are looking to charge the full cost of our service to all pieces of our payment mix,” said Fire Chief Amy Scheller, explaining the new ambulance rates.

Current rates have been billed based on what major insurers were willing to pay for the ambulance services and then spread out across other insurers and residents who self-pay.

The new rate is based upon the “true cost” of the service as determined by a third-party auditor, a rate the city already uses to get additional federal reimbursement for Medicare and Medicaid clients.

Dubuque’s current ambulance rates are comparable to charges levied by other cities in Iowa, but cities in other states, particularly Illinois and Wisconsin, have already moved to charging ambulance users the full cost of the service, rather than falling back on property taxes.

“It’s not just an Illinois model, it’s across the country,” Scheller said. “Fire departments will look at the user to cover the cost of the service.”

These communities have also shifted the burden of paying for fire departments away from the community at large and onto the person who uses the service. Some communities charge for house fires, but Scheller’s recommendation declined to add a fee for this service.

New Dubuque Fire Department charges have not been set, but a third-party fire cost recovery recommended $520 per auto crash, $605 per vehicle fire, $700 for hazardous material cleanups and $400 for rescues.

The new ambulance rates are expected to net an additional $1 million per year, and the new fire charges would bring in about $120,000. A renegotiation of an auditing contract reaped $78,000 in savings, leaving about $1.2 million to hire five new firefighters. The cost estimate for a new firefighter is $108,000, with a starting salary of about $70,000.

City Manager Mike Van Milligen has the authority to raise ambulance rates, but he would need authorization from the City Council to create five new firefighter positions as well as impose the new Fire Department cost recovery fees.

Mayor Brad Cavanagh said he was still working out his position but noted that ambulance rates had not been raised for 10 years, and an increase was overdue to cover the rising costs of the service. He also said there should be some balance between property taxes and user fees.

“We all have a desire to add these firefighters,” Cavanagh said. “This is a conversation about how we do it.”

Outgoing Council Member Ric Jones, a retired firefighter, said he is glad Scheller came forward with a concrete proposal to bring the city closer to its hiring goals for the Fire Department. He thought insurance companies would pick up many of the increased fees and new charges, but he drew the line at charging to extinguish vehicle fires.

“I’m not sure I agree with charging for putting out fires. I think that’s a basic tax-supported service,” Jones said.

But both incoming council members — who will be sworn in in January — rejected the plan and one sitting council member, Danny Sprank, said he was opposed to shifting so much of the burden for paying for the Fire Department to citizens who need its services.

“I don’t agree with that much of an increase,” he said. “That’s a pretty big jump — $2,300 to $2,400, that’s not exactly affordable for those who need it.”

He also thought auto insurers would balk at paying for the Fire Department to respond to crashes and put out fires.

“Citizens already pay taxes for our Fire Department,” he said. “I don’t think additional fees for a service that is out of your control is fair for our citizens.”

Council Member-elect Chris Staver agreed: “That seems like a bad idea. That seems like a way to promote people not to call the Fire Department. I think that’s what our taxes are for. They need to find it in the budget.”

Staver said he understood that ambulance fees might be overdue for an increase but opposed the sharp rise.

Council Member-elect Tyson Leyendecker said money for the Fire Department should come from a reprioritization of spending rather than heaping new fees on citizens.

“It’s double taxation, right?” he said. “I would think there’s a better solution than that.”

The new ambulance rates would primarily affect patrons who self-pay for the service, who are either uninsured or underinsured with a high deductible to pay before their insurance kicks in for the coverage.

The city might recover more money from insurance companies, but it cannot balance-bill the patient and seek more money than the insurer agreed to pay. People with insurance from Medicare or Medicaid would not see a bill, and the department already has a method to extract the actual cost of services from the federal government.

For that self-pay group, the city offers a hardship waiver both for residents and non-residents, which Scheller said would be extended to people charged for other Fire Department services.

The waiver works on a sliding scale. Households below 150% of the federal poverty level get a complete waiver, while those up to 300% of the poverty level can receive a reduction. The higher figure works out to $47,000 for a single person or $96,000 for a family of four.

Under the current fee schedule, the hardship waiver has rarely been used; Scheller said the department is currently processing one application, which would be the first sought and granted since 2022.

Scheller is also supporting a federal grant proposal that would help the city staff up to nine more firefighters over three years, helping to make good on a top council priority of increasing minimum staffing on all fire rigs to three firefighters, up from two firefighters currently.

The grant would have a 25% local match for the first two years and a 65% match for the third year, allowing the local government to ramp up budgeting for the added cost of the new employees so it would be sustainable when the grant ends, Scheller said.

Clarkston (WA) Looks Ahead After EMS Levy Fails at the Ballot Box

Sanders Kennedy

November 6, 2025

https://klewtv.com/news/local/clarkston-looks-ahead-after-ems-levy-fails-at-the-ballot-box

Clarkston, WA – Clarkston voters on Tuesday rejected a proposed emergency medical services levy that city officials say is crucial to keeping the community’s ambulance program running past next year.

The measure needed 60% voter approval to pass but received just 42% “yes” votes, according to preliminary election results.

The proposal would have increased the city’s EMS levy rate from $1.50 per $1,000 of assessed property value in 2025 to $2.64 in 2026 — roughly a 76% jump.

With the levy failing to pass, the EMS service could end in 2026.

“The current tax dollars will cover the department through the end of the year,” said Fire Chief Darren White. “And there is reserve set aside in the EMS budget that could possibly be carried over into 2026.”

White said the department is already preparing for budget discussions and next steps.

“We are in the process of budgeting for 2026,” he said. “We’re meeting Monday night at a normal council meeting, and we do plan to have at least a workshop or something to discuss future plans for what services we’ll be providing.”

If funding does not improve, up to six of the department’s 13 full-time employees could lose their jobs, White said.

“That would come through talks with city council,” he added. “The ultimate decision on the future relies on them.”

Despite the setback, White remains hopeful voters will reconsider next year.

Austin-Travis County EMS faces $6.2 million cut in newly revised proposed city budget

Daniel Perreault

November 8, 2025

https://www.kvue.com/article/news/local/austin-ems-faces-cut-newly-revised-proposed-city-budget/269-048536d7-c8c8-4c58-880c-601b7fce84d9

AUSTIN, Texas — The city of Austin has released an updated budget proposal, after having to rework the budget for the current fiscal year after voters rejected Prop Q at the ballot box earlier this week.

Prop Q would’ve raised property taxes by about 20% compared to the last fiscal year, and the newly proposed budget is already meeting opposition from some Austinites.

After voters rejected Prop Q, the city now has to balance a budget without more than $109 million in property tax revenue.

To meet that shortfall, they are taking an axe to the budget, cutting $5.2 million from Parks and Recreation, $3.7 million from the Municipal Court, $38 million from social services contracts and $1 million from Austin Fire Department.

“This initial budget does not meet the moment,” said Matt Mackowiak, co-chair of Save Austin Now, the organization that led the opposition to Prop Q. “It does not honor and respect the message voters were sending.”

One of the most significant slashes is a more than $6 million cut to Austin-Travis County Emergency Medical Services (ATCEMS).

James Monks, president of the Austin EMS Association, said he was shocked and disappointed by the proposed budget.

“We’re solving a lot of problems for the city, and it just kind of makes us feel a little bit unappreciated, honestly,” Monks said.

It is already a struggle for the department, Monk said, because they have only been able to secure small budget increases over the past few years, even though they are increasing the amount of money they bring into the general fund.

“I feel like the city always wants to demand that we run lean, but they don’t, and I think that’s a problem,” Monks said. “I hope that they can address that by reopening the budget next time.”

Monks said if the cuts stay as is, they’ll have fewer medics on the streets, which means slower ambulance response times to calls.

“We’ve tried different mechanisms to try to shift, shuffle things around, but this is getting to the point where that’s not working,” Monks said. “It’s actually just making people who are already here have to work harder.”

Earlier this year, the city launched a pilot program to help determine which calls do not require an ambulance staffed with two paramedics. Instead, one paramedic would respond in an SUV equipped with the same equipment as an ambulance, taking some ambulances out of service. This would help the department save money on gas, maintenance and overtime as they worry about going over the budget.

“We’ve been dealing with rolling brownouts for years now. We finally got to a point with our staffing where we were hoping that maybe we weren’t going to have to be brownout trucks anymore, and then we got hit with the budget crisis,” Monks.

They tried to find funding through the council and other avenues, but Monks said they were told none was available. He says these cuts would exacerbate the issue.

“The medics that are here, they’re going to have to work harder, they’re going to have to do more work, and we’re already kind of stretched thin,” Monks said. “People are already facing burnout, they’re already overworked, they’re already tired, and now this is just another blow to that.”

Mackowiak said he knows the city is in a tough spot with the budget, but he will fight any cuts to public safety.

“The message voters delivered on Tuesday night with Prop Q going down handily was not to cut public safety,” Mackowiak said. “If the first thing you want to do, after Prop Q, is to cut public safety, city leaders have another thing coming.”

Mackowiak said if public safety isn’t adequate in a city, almost nothing else matters.

“When you’re in a crisis or someone you care about is in a crisis, you expect EMS to be there, and those response times are absolutely critical,” Mackowiak said. “If a response time is 5 minutes or 10 minutes, that may not sound like much of a difference, but it’s the difference between life or death and a critical incident.”

Mackowiak called on city council members to fully fund public safety and said if they don’t, “all political options are on the table.”

“The charter election [is] in May, which will be occurring in our city, and half of our city council is on the ballot in November,” Mackowiak said. “Those are things we’re keeping a very close eye on.”

“City Hall will hear from our activists all across the city, across all demographics, across all parties starting on Monday,” he added.

In the new proposed budget, the Homelessness Strategy Office would get a roughly $3.7 million increase.

“Other states invest in homeless services. The state of Texas doesn’t do that,” Councilmember Ryan Alter said on Tuesday. “So it’s up to us to deliver those services because we’re on our own.”

City leaders are expected to move ahead with a 3.5% property tax increase next year, the highest rate they can implement without voter approval. The proposed new budget includes $5.25 million in additional property tax revenue.

Alter acknowledged that city leaders are now facing tough choices as they must find a way to account for the missing revenue the tax rate increase would have generated.

“We are going to try to minimize the damage, but it is going to hurt real people,” Alter said.

There is a $7.1 million increase in General Fund expenditures in the proposed new budget, including:

• $50,150 to provide employees who earned less than $53,000 per year in FY 2025 with a wage increase of $2,120 per year in FY 2026, in lieu of the 4% civilian wage increase.
• $5 million in ongoing funding for Austin Homeless Strategies and Operations to continue emergency shelter operations at the Marshaling Yard. An additional $3 million in one-time funding would be provided through the Housing Trust Fund in order to ensure total funding of $8 million in FY 2026.
• $2 million, including 20 new positions, for Austin Parks and Recreation to address parkland and grounds maintenance needs.

When the system SNAPs: How food and policy uncertainty will reshape EMS

“The next evolution of EMS leadership will not be measured by how many calls we answer, but by how many crises we prevent.”

November 05, 2025

Shannon L. Gollnick, DBA, NRP, FP-C

Matt Zavadsky, MS-HSA, EMT

PWW Advisory Group (PWWAG)

https://www.ems1.com/community-awareness/when-the-system-snaps-how-food-and-policy-uncertainty-will-reshape-ems

The Supplemental Nutrition Assistance Program (SNAP) is the cornerstone of America’s fight against hunger, serving over 41 million people every month. Administered by the U.S. Department of Agriculture, SNAP provides electronic benefits that help low-income households purchase food; a safety net that stabilizes families, communities and, indirectly, our healthcare system itself.

When this safety net is weakened, or worse, fails, the ripples are felt far beyond the grocery aisles.

They show up on 911 screens, in the patterns of repeat calls, and in the strained hands of the EMS clinicians who respond.

The impact of SNAP uncertainty

On Nov. 1, 2025, a federal funding lapse delayed SNAP benefits for the 41 million Americans who rely on this benefit. States have been left scrambling, contingency plans are uncertain, and families are being urged to stretch what remains on their Electronic Benefit Transfer (EBT) cards. For those living paycheck to paycheck, that uncertainty is destabilizing, but for EMS, it is predictive.

When people lose access to food, utilities or housing support, their health and stability erode in quiet ways that eventually become loud emergencies. Delays or reductions of SNAP don’t just affect the poor — they reshape local acute care and emergency response demands. The pandemic-era of SNAP had measurably reduced food insecurity. When those benefits expired, Health Affairs reported an 8.4% increase in food insecurity nationwide. That is not an abstract data point — it’s a stress test for the social systems that surround us, including EMS.

“ SNAP, like healthcare itself, is a social contract. When that contract wavers, it exposes the fragility of our social infrastructure, and the degree to which EMS has become both responder and witness to the nation’s inequity.”

The social determinants behind the sirens

Emergency medicine often deals with the symptoms of social distress. Behind many of our calls lies a social determinant: food, housing, transportation, education, medication or safety. In other words, what we often document as “chief complaints” are really the downstream effects of social challenges.

EMS professionals now find themselves again at the front line of public health, population health and social care all at once. Our ambulances increasingly serve as mobile observation posts for community well-being. The end of SNAP benefits and the uncertainty surrounding their renewal have underscored this realty: clinical emergencies are rarely isolated medical events — they are the social ledger of community health.

This recognition should not burden EMS — it should empower it. The growing intersection between health and policy means that emergency services must evolve into more adaptive, data-driven systems, capable of responding to — and not just transporting — social need.

While SNAP faces uncertainty, the much discussed “One Big Beautiful Bill Act” (OBBBA) proposed to redefine how healthcare and social policy interest. While its legislative fate remains uncertain, the intent is clear: to consolidate and modernize the funding streams that address the social determinants of health — from nutrition and housing to behavioral health and care access.

For EMS, this represents a profound transition. For decades, reimbursement has been tied almost exclusively to transport. The OBBBA and similar policy changes aim to incentivize outcomes over outputs and recognize that preventing crises and connecting people to social supports is as valuable a service as the lights-and-siren response.

This shift has the potential to reshape the financial and operational DNA of EMS. Systems that demonstrate community impact, integrate with public health and collect meaningful SDOH data will be best positioned to thrive in this new environment. Agencies that remain narrowly focused on transport alone may find themselves increasingly marginalized.

MORE: How ‘One big beautiful bill’ could break EMS

Redefining our role

EMS has always been adaptive. From wartime roots to today’s mobile integrated health (MIH) models, the profession has evolved with each new social reality. The current SNAP uncertainty is another inflection point. The lines between healthcare delivery, social care and emergency response are blurring faster than ever — that creates both risk and opportunity.

The opportunity is clear: evidence demonstrates that EMS can lead the integration of social determinants of health (SDOH) into emergency care. By tracking food insecurity, housing instability and other social factors in our electronic patient care records, we can offer real-time insights into community rends that hospitals, policymakers, and public health department may not see.

Preparing for the next iteration of EMS

The convergence of SNAP instability and transformative healthcare legislation is more than a political story; it is a leadership challenge. EMS leaders must start preparing for systems that are rewarded not based on process measures, like response times, but on measurable community outcomes.

To thrive in this new era, EMS must:

1. Embrace data as a social diagnostic tool. Aggregate and analyze SDOH indicators from field documentation to identify emerging vulnerabilities
2. Build partnerships beyond healthcare. Engage local food banks, social services and community health networks as part of coordinated care pathways
3. Invest in workforce stability. Recognize that some EMTs and paramedics face the same social vulnerabilities as their patients; addressing those needs strengthens organizational resilience
4. Prepare for reimbursement reform. Anticipate how the OBBBA and related initiatives will align payments with prevention, integration and social impact

The road ahead

The uncertainty surrounding SNAP is more than a budget hiccup — it’s a mirror reflecting the fragility of America’s safety nets. Peering into that reflection, EMS can see its future roles more clearly. The profession that once defined itself by rapid response must now define itself by relevance — by its ability to understand, measure and mitigate the social conditions that generate emergencies in the first place.

In the months and years ahead, as food assistance, healthcare and social policy become more interconnected, EMS will no longer be just an emergency service. It will be a social stabilizer, a public health partner and a community intelligence system.

The next evolution of EMS leadership will not be measured by how many calls we answer, but by how many crises we prevent.

We LOVE this idea!  A great way to serve the community, especially with local animal shelters in many communities reporting they are over capacity!

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OKC Animal Welfare, OKCFD partner to reunite lost pets

Oklahoma City fire stations 25 and 30 are now equipped to scan stray animals for microchips, aiming to reunite lost pets with their owners and reduce shelter intake.

11/3/25

https://www.okc.gov/News-articles/OKC-Animal-Welfare-OKCFD-partner-to-reunite-lost-pets

Oklahoma City Animal Welfare is partnering with the Oklahoma City Fire Department to make it easier for families to reunite with their lost pets without the pet ever entering the shelter. Beginning in November, two Oklahoma City fire stations will be equipped with microchip scanners, providing the community with more flexible options to help a found pet return home.

Residents who find a stray pet can take it to one of the participating stations, where firefighters will scan the animal for a microchip. If a chip is found, the finder will receive the microchip number and instructions on how to look up the owner’s information, allowing them to quickly and directly reconnect the pet with its family.

Participating Fire Stations:

Station 25: 2701 SW 59th St.

Station 30: 4343 S. Lake Hefner Dr.

“It’s always better for a lost pet to go directly back home rather than spend time in the shelter,” said Ronnie Schlabs, Superintendent of the Oklahoma City Animal Welfare. “By working with the Fire Department, we’re making it easier for neighbors to help neighbors and giving families more opportunities to be reunited quickly. This partnership saves time, reduces stress on the animals, and ultimately saves lives. We are grateful to the Oklahoma City Fire Department for their support and commitment in helping make this program possible.”

The program provides a convenient alternative to shelter intake and extends microchip scanning hours beyond the traditional operating times of veterinary clinics and the OKC Animal Shelter. This not only speeds up the process of reuniting pets with their owners but also helps reduce overcrowding at the shelter, conserve city resources and limit the stress that animals experience when separated from their families.

Pets cannot be left at the fire stations, as they are not equipped to house or care for animals. If a finder is unable to hold onto the pet or needs further assistance, they may contact OKC Animal Welfare dispatch at (405) 297-2255.

Here’s an excellent example of the inclusion on EMS in Iowa’s RHT Program Grant Application.

Rural Health Transformation (RHT)

https://hhs.iowa.gov/initiatives/rural-health-transformation-rht

https://hhs.iowa.gov/media/17491/download?inline

Initiative 5: EMS Community Care Mobile

EMS Community Care Mobile: An initiative that invests in new telehealth technology for high-risk transport of moms and their new babies to higher levels of care throughout the state and a mobile integrated healthcare program that brings prenatal, postpartum, post-surgery discharge, chronic disease management, and other types of care to rural residents in their homes or to easily accessible sites in their communities.

Description: Iowa will implement a robust strategy to transform prehospital care through three coordinated sub-initiatives: (1) EMS System Development and Sustainability Assessment, (2) Mobile Integrated Health Care, and (3) High-risk OB and Neonatal Transport Project. Together, these efforts will strengthen the EMS workforce, integrate telehealth and home-based care, and reduce unnecessary ED visits and hospital transports.

In 2024, over 320,000 Iowans interacted with the EMS system, with approximately 35% residing in rural areas. These initiatives will structurally transform rural health care delivery with a large projected impact on rural. This initiative primarily addresses EMS (C.2), remote care services (F.1), and improvements to population health clinical infrastructure (B.1), while also containing components of data infrastructure improvements (F.2), data collection for dually eligible individuals (E.2), rural provider strategic partnerships (C.1), and talent recruitment (D.1).

Iowa will conduct a statewide EMS system assessment to inform the development of a district-based hub-and-spoke model for prehospital care. The assessment, beginning early in the first budget year to maximize the immediate impact of this work, will include coverage mapping, call volume analysis, workforce distribution, and financial modeling. Predictive analytics and scenario testing will identify opportunities to optimize deployment, improve coordination, and ensure each district can support efficient operations. While implementation of the hub-and-spoke EMS model is outside the scope of this funding, the assessment will guide future system design, workforce strategies, payer engagement (including Medicaid and MCO reimbursement), and technology investments.

The assessment will be paired with data infrastructure system upgrades, quality improvement dashboards, and annual evaluations.

A reassessment in Year 4 will measure progress toward sustainability and system efficiency goals.

Iowa will also establish Mobile Integrated Health (MIH) demonstration projects to deliver care

directly to rural Iowans through home visits and community-based services. This community-based care initiative will outfit ambulances and existing vehicles with the technology needed for telehealth and direct care provision (remote care services, F.1), particularly in chronic disease prevention and management. MIH teams will provide post-discharge follow-up, chronic disease and cancer management, acute care, and preventive services.

The services provided use expanded scopes of practice for EMS clinicians to improve the population health clinical infrastructure (B.1) in rural Iowa by focusing on technological innovation, primary care, and

chronic disease prevention and management. MIH is an evidence-based strategy to reduce ED utilization and hospital readmissions by addressing health concerns before they escalate [70].

Services provided will be entered within the Iowa HIE (data infrastructure, F.2).

At least one MIH project will serve a three-county rural area, fostering regional collaboration and rural provider strategic partnerships (C.1). Services will include treatment-in-place, resource navigation, and chronic disease management for conditions such as diabetes, COPD, and heart failure. MIH teams will also integrate prenatal and postpartum care, using telehealth to close maternal health gaps in rural areas. These services are supported by strong evidence and have been shown to reduce costs and improve outcomes [71], though they are not currently reimbursable in Iowa. Data from these projects will support efforts to establish treat-in-place services as a reimbursable benefit (remote care, F.1).

Iowa will use this opportunity to further advance the goals of the Rural Health Transformation Program by collecting data on individuals receiving services from MIH units to determine how many beneficiaries are dually eligible (E.2). This data, following analysis by Iowa’s Health Economist, will help Iowa develop future strategies to improve care for this population. This project also supports a path for non-physician health care in rural areas and provides enhanced training for EMS clinicians (talent recruitment, D.1).

Iowa will fund demonstration projects to enhance maternal and neonatal transport capacity.

Existing ambulances and helicopters will be upgraded with OB-specific equipment, monitoring devices, and telehealth connectivity (remote care, F.1) to enable specialist-guided care during transport. EMS clinicians will receive advanced training (talent recruitment, D.1), including high-fidelity simulation, to manage complex deliveries and neonatal emergencies. This intervention, often referred to as tele-transport, has been shown through early trials to improve outcomes for critical neonatal cases [72].

These transport projects will integrate with the Hometown Connections network as part of rural provider strategic partnerships (C.1), ensuring timely access to perinatal hubs while preserving continuity of care by returning patients to local facilities when appropriate. This approach maximizes existing EMS assets, avoids the cost of new fleet purchases, and supports a scalable, cost-effective system for improving maternal and neonatal outcomes. Main Strategic Goals of the EMS Community Care Mobile:

Innovative care: High-risk OB and Neonatal Transport involve coordinated care and flexible care arrangements. High-risk OB and Neonatal Transport and Mobile Integrated Health projects make EMS providers a larger part of the care team and allow them to practice at the top of their licenses.

Make rural America healthy again: Support rural health innovations through new care access points with mobile integrated health care units serving patients in their homes or at other community sites. Implement evidence-based, outcomes-driven interventions to improve chronic disease prevention and management through MIH units.

Sustainable access: Help rural hospital OB units remain operational by providing access to High-Risk OB and Neonatal transport when needed. Offer tele-health through Mobile Integrated Health units within High-risk OB and Neonatal transport vehicles.

Workforce Development: Expand training for EMS clinicians, creating career pathways and improving retention.

Stakeholder Engagement: As described above, the RHTP core planning team and external engagement sessions also contributed toward this initiative and will continue to meet quarterly throughout the duration of this funding opportunity. Iowa is well-equipped to deploy RHTP with rural stakeholders through an existing network of contractors and local EMS providers.

Metrics and Evaluation Plan: The EMS initiative is designed to modernize and expand emergency medical services in rural areas through a combination of internal capacity-building, demonstration program deployment, and expanded service delivery. The selected performance metrics reflect this phased approach, beginning with foundational administrative and planning activities and progressing toward infrastructure readiness and measurable service impact. Early in the program, the time required to hire internal EMS staff and release RFPs for sub-projects will be tracked to demonstrate administrative readiness and the ability to launch key components of the initiative. As demonstration programs are awarded and implemented, the percentage of EMS programs that are fully equipped and staffed will be monitored, capturing progress in vehicle procurement, equipment installation, and workforce deployment. Once operational, the initiative will report the number of community visits and non-emergency transports conducted per month (at the county level), reflecting the volume and reach of expanded EMS services. To ensure equitable access, the geographic distribution of EMS services will also be tracked (at the county level) relative to rural population coverage, helping to demonstrate alignment with the initiative’s access for rural residents. These metrics are selected for their feasibility, alignment with the initiative’s objectives, and ability to show both early implementation progress and long term service delivery outcomes. The Milestones are given in the implementation section above.

Sustainability Plan: Iowa’s sustainability plan ensures that the investments made in the EMS

Community Care Mobile create a long-lasting, self-sustaining prehospital care system for the State. Investments in telehealth equipment and project-specific upgrades to existing emergency transport vehicles are one-time costs.

The Iowa EMS Program will work collaboratively with Iowa Medicaid to add Mobile Integrated Health treat-in-place services as reimbursable benefits. Iowa HHS will also partner with birthing hospitals, health systems, and insurers to co-fund OB capable transport teams as part of maternal health quality initiatives. Costs can be integrated into regional perinatal quality collaboratives to share expense burdens. Iowa will implement a robust evaluation component to explore improvements in population-level health and rural health outcomes throughout the grant award period and demonstrate cost savings from this initiative.

‘Tip of the Hat’ to Chief Jason Stroud and the team at Virginia Beach EMS on implementing an evidence-based process change for EMS responses, limiting the use of lights and siren (HOT) responses to only potentially time-sensitive EMS calls. In 2022, 50 EMS agencies partnered with the National EMS Quality Alliance (NEMSQA) on the Lights and Siren Collaborative bringing together a 50 EMS organizations, subject-matter experts, and EMS agencies from across the US to prevent ambulance crashes by reducing the use of lights and siren (L&S) while driving. After the recent news update about Wake County, NC EMS implementing similar changes, Brian Maloney, the Operations Director for Plum EMS in Pennsylvania, shared that for the first three quarters of this calendar year, their average the use of lights/siren responding to calls is 3.4% of the time and 2.9% during transport to the hospital, without compromising patient care!

Virginia Beach EMS will limit use of lights, sirens on responses outside of Priority 1 classification

About 25% of incidents fall under the Priority 1 designation, officials said, meaning 75% of incidents would no longer require lights or sirens.

October 31, 2025

https://www.13newsnow.com/article/news/local/mycity/virginia-beach/virginia-beach-ems-will-limit-use-of-lights-sirens-on-responses-outside-of-priority-1-classification/291-99b5908c-8efb-4c68-8271-1a6dc3ee0973

VIRGINIA BEACH, Va. — This week, an operational change went into effect for Virginia Beach EMS in which first responders will limit the utilization of lights and sirens for calls under their Priority 2 designation.

The change, confirmed by Chief Jason Stroud, is amid a nationwide shift by localities to rethink whether those signals should be deployed for every single instance that requires an EMS response.

“If we’re looking at a five-mile response, the use of red lights and sirens, at most, saves us two minutes according to our driving policy. So we know for 93% of our patient population, there is no impact to patient outcome,” he told 13News Now.

According to Stroud, other localities have made similar changes, including Wake County in the Raleigh area of North Carolina.

Stroud emphasized that lights and sirens will still be utilized for critical responses and high-priority calls, or incidents designated by dispatch under Priority 1 classification.

“Breathing difficulty, reports of someone unresponsive, someone actively having a seizure or traumatic accident. Those types of things get scored at a higher acuity level, they are a Priority 1, and we’ll still use red lights or sirens for those calls,” he says.

However, over a twelve-month sample size spanning from October 1, 2024 to October 1, 2025, 25% of 911 calls were designated under Priority 1. All calls dispatched outside of that will be subject to the operational change.

“What we do know nationally is that ambulances responding with lights and sirens are twice as likely to be involved in a crash. Lights and sirens-related ambulance crashes, the injury rate is ten times higher. So over the last couple of years, as data became collected and readily available, this conversation and consensus is, the increased risk isn’t necessary for the majority of our patients or outcomes,” he said.

Kudos to the  Northern Lake County Mobile Integrated Healthcare Partners, a coalition of Fire Protection Districts in Northern Illinois, spearheaded by Erick Christensen of the Wauconda Fire Protection District for releasing their first 2024 – 2025 Annual Impact Report: Mobile Integrated Healthcare – Community Paramedicine.
 
The results are striking: 85% of enrolled patients avoided hospital or ER admissions within 30 days, and over 71% did not require EMS or 911 services even after program completion.
 
This is the type of data-driven information payers are looking for to help make value decisions to reimburse EMS agencies for MIH/CP services.
 
It is worth noting that the report shares data not only on acute care and inpatient utilization, but also outcomes for patient experience!

Lake County MIH Program Achieves 85% Reduction in ER Visits During First Year

https://www.healthcall.com/lake-county-mih-program-85-percent-er-reduction/

The Northern Lake County Mobile Integrated Healthcare (NLCMIH) – Community Paramedicine program, initially launched in Wauconda, Illinois, has completed its first full year, and the results are compelling. Designed to support patients with complex health needs such as diabetes, congestive heart failure, COPD, and frequent falls, the program has already demonstrated substantial improvements in patient outcomes and system-wide efficiency.

Thanks to this ability to embed standardized data collection within a flexible framework, HealthCall’s recent state-level partnerships have empowered participating MIH-CP agencies with tools for better care delivery, reimbursement, and data-driven decision-making, allowing them to quickly and sustainably scale their operational frameworks.

A Focus on High Utilizers Leads to Major Impact
From August 2024 to August 2025, the program received 166 referrals, ultimately enrolling 53 patients. These individuals were primarily “high utilizers”—patients who frequently accessed 911 and emergency services. By providing proactive, scheduled in-home visits and addressing both medical conditions and non-medical social needs (like food insecurity, transportation, and housing challenges), the program helped reduce unnecessary emergency department visits.

The results are striking: 85% of enrolled patients avoided hospital or ER admissions within 30 days, and over 71% did not require EMS or 911 services even after program completion. This success not only improves the quality of life for patients but also frees up emergency departments for those in immediate need.

Financial Savings and System Efficiency
The Wauconda Fire Protection District and its partners have realized substantial savings. An ambulance transport costs, on average, $2,465 in gross charges, but reimbursement averages just $900—leaving a deficit of over $1,500 per call. By comparison, the MIH model costs around $202 per patient visit, making it a far more efficient and sustainable approach.

In practical terms, this means fewer costly ambulance rides and ER visits, and more targeted, appropriate care delivered where it is needed most.

Patient Satisfaction at Its Highest
Early feedback shows the program is not only effective but also deeply valued. In patient surveys conducted in 2025, every respondent reported being “very satisfied” with the care received, particularly highlighting the quality of care, social service assistance, and reduction in 911 use.

Looking Ahead: New Legislation Expands Opportunities
Perhaps most exciting is the upcoming Illinois Public Act 103-1024, which takes effect on January 1, 2026. This groundbreaking legislation will require state-regulated health insurance plans to cover Mobile Integrated Healthcare services.

Key provisions include:

• Coverage for patients who have visited the ER three or more times in four months, or those identified by providers as likely to benefit from MIH.
• Recognition of MIH services, such as chronic disease monitoring, hospital discharge follow-ups, medication compliance support, vaccinations, and more.
• Standardization of reimbursement, ensuring long-term financial sustainability for programs across Illinois.

For communities like Wauconda, this means expanded access to MIH, more stable funding, and the ability to scale services to reach even more patients in need.

A Model for Community Health
In its first year, NLCMIH has proven that community paramedicine works. By focusing on proactive, patient-centered care, the program reduces costs, improves outcomes, and strengthens the healthcare system as a whole. With the backing of Illinois’ new legislation, programs like Wauconda’s will continue to grow—delivering smarter, more compassionate care where it matters most.

The Vision and Leadership Behind the Program
The success of the Northern Lake County MIH–Community Paramedicine program would not have been possible without the dedication and vision of its champion, Lieutenant Erik Christensen of the Wauconda Fire Protection District.

As one of the program’s earliest advocates, he played a pivotal role in launching MIH, building the program’s foundation, and assembling the team that now delivers this innovative model of care. Beyond Wauconda, he has worked tirelessly to promote the value of MIH to other departments in Illinois, helping to broaden its reach and impact.

Known for his humility and patient-first mindset, Lt. Christensen brings both professional expertise and personal passion to the role.

“EMS and pre-hospital care have always been a passion of mine, and the Wauconda Fire Protection District is always looking for ways to expand community service and outreach. Mobile Integrated Healthcare – Community Paramedicine was a natural fit for our mission and values, and we are excited to have been a part of the creation of this regional program. Wauconda Fire Protection District and its regional partners are what make this program so strong, and our partnerships are invaluable.”

Lieutenant Christensen has been with the department for 13 years, including eight years as Medical Officer. His leadership continues to drive the program forward, ensuring it not only delivers measurable outcomes but also embodies the compassionate, community-centered care at the heart of MIH.

Download the complete annual report here.

Another well-respected EMS system flipping of the RLS switch for most EMS responses.
 
This is a growing national trend, using evidence-based research to tailor responses based on medical director approved, quality assured and scientifically driven emergency medical dispatch (EMD) processes.

Over 15 national and international EMS and Fire associations have published two joint position statements designed to reduce lights and siren responses, and use EMS performance measures more relevant to EMS quality than response time:
 
Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services Responses
Joint Position Statement on EMS Performance Measures Beyond Response Times
 
The latter of which has a list of potential EMS system performance measure beyond response times.
 
These Joint Position Statements used a litany of published peer reviewed studies on topics such as correlation of patient outcomes based on response time and number of paramedics in and EMS system.
 
A summary of those research studies can be downloaded here.
 
The Academy of International Mobile Healthcare Integration hosted a webinar on this topic in July 2021 and you can view a recording of the webinar and download the handout here.

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Wake County ambulances to silence sirens, turn off lights for most 911 calls

Wake County EMS is set to transform its emergency response by reducing the use of sirens and lights for most 911 calls, prioritizing safety and reducing accidents. The change aims to curb confusion on roads and improve safety.

10/28/2025

https://www.wral.com/news/local/wake-county-ems-ambulance-siren-lights-policy-change-october-2025

Emergencies in Wake County are about to look and sound different. Wake EMS announced Monday that ambulances will silence sirens and turn off emergency lights for the majority of 911 calls.

Ambulances would still use lights and sirens for the most serious calls, including shootings, stabbings, and car crashes.

EMS leaders say the reason is safety. The lights and sirens can confuse drivers on the roads who don’t know what to do, and can lead to more crashes.

“Red lights and sirens use is one of the most dangerous things we do as emergency responders,” Wake EMS director Jon Studnek told the Wake County Board of Commissioners during their regular meeting on Monday. “We know that EMTs, firefighters, paramedics, and police officers have a five time increase in being involved in a fatal motor vehicle collision when compared to the general public.”

According to data from Wake EMS, ambulances with lights and sirens on have been involved in 21 crashes in Wake County this year alone, resulting in the loss of two ambulances. No one was seriously injured in those crashes.

The plan will require a top-to-bottom overhaul of how Wake EMS responds to emergencies. Studnek said he has already been coordinating with other emergency departments and will begin training Wake, Raleigh, and Cary dispatchers on the new system soon. The new light and siren plan itself will be rolled out in phases, starting in December and ending in March.

Wake County is far from the first county to consider this change. Studnek pointed to dozens of other municipalities around the country, including Charlotte, where he said red light and siren crashes have dropped 33%.

“Out of a hundred calls, only 10 to 15 times does a patient need immediate, life-saving intervention,” Studnek said. “Red lights and sirens should be thought of as a clinical intervention that we use on those patients that we suspect of having need for a time-critical intervention.”

The change will mean slower response times to some 911 calls. Studnek noted that using lights and sirens does save, on average, two to three minutes per response.

“We should reserve those red lights and sirens for when we think that 2-3 minute savings will have a clinical impact,” Studnek said.

During the presentation, that change worried County Commissioner Shinica Thomas, who asked what this could do to Wake EMS’s average response times.

Studnek did not have an immediate answer, but promised to reach out to other departments and check.