POLK COUNTY -- Polk County Fire District No. 1 officials said an anticipated budget shortfall, a dwindling number of volunteers and other problems have put the future of the district's ambulance service in question.
District Board President Evan "Butch" Evans said difficult decisions will have to be made to maintain the service at its current level for next year, and that the staff is looking to the community for direction.
A public workshop starts at 7 p.m. Tuesday, Jan. 20, at the Central Fire Station to gather input on what citizens want and need in emergency services.
"This is their service, so it has to work for them," Evans said. "If we have to make any cuts, what we're hoping is the public will tell us how to go about it."
Officials haven't settled on a course of action or implemented any cuts, but Evans said they have been looking at two basic options: scaling back services or levying taxes to raise revenues.
Fire Chief Mark Prince said scaling back would mean longer response times and responding to fewer public assistance calls, such as helping somebody who's fallen out of bed.
Cutbacks might also mean moving from providing critical care for patients beyond first aid, including treatment for cardiac arrest, trauma care and drug administration, to offering only Basic Life Support services on rescue vehicles, such as a defibrillator.
"I don't feel comfortable making those types of cuts," Evans said. But, "if people want Advanced Life Support 365, 24/7, there is a price tag for all this...we'll have to prioritize where the money goes."
An operational tax levy could be incorporated to keep services at their current level.
"We'll be happy to carry out whatever they tell us," he said.
It costs the district roughly $500,000 to $550,000 to operate its ambulance service per year, Prince said. This fiscal year, it faces a shortfall of about $120,000.
The deficit stems primarily from two factors. In 2002-03, the district was only able to collect 75 percent of what it billed for its services.
In addition, a Medicare/Medicaid fee restructuring plan, which reduces the amount of reimbursements received for providing ambulance transportation to clients.
The insurance typically covers part of the cost for ambulance service, about $400 of an $800 bill. Under the plan, that portion is reduced by 20 percent to $320, forcing the district to absorb the balance.
Evans said the district has suffered a 40 percent hit in the first year of the plan, with more cuts expected in 2004. Compounding the problem is the high percentage of Medicare/Medicaid subscribers in the area, which grows as the population ages.
"Next year, about 65 percent of our ridership will be covered by Medicare and that ensures a big impact," he said.
Another issue has been the decrease in volunteer firefighters and medics. Evans said the demand has grown for professional providers of emergency services, which results in fewer volunteers because of the 75 hours of additional training needed to stay current with state and federal standards.
"Our ambulance service used to be made up of mainly volunteers who agreed to be first aid trained," he said.
"But then it became EMTs, then paramedics and now instead of being something you volunteer for, most people are doing this as a vocation...all the requirements prevent the volunteers from staying current because they're so stringent."
"There are too many things competing for their time," Evans also said.
There are two qualified paramedics that cover the region 24 hours a day, seven days a week, a provision that has driven personnel costs beyond the district's ability to pay for the service.
The district Fire-Med program, which lets subscribers pay a $50 flat fee for annual ambulance coverage, was used as a way to help supplement lost revenue, but current enrollment is only half of what's needed to turn a profit.
"We were able to break even, but it didn't solve our problems," Prince said.
Evans said he hopes the public can help direct the district in maintaining a service that will fit their needs.
"We think we know what the public wants, but that's usually different from what they want," he said. "We want to be in a position that will let us do what they want."