As emergency medical services (EMS) providers in Lafayette County face challenges maintaining appropriate staffing levels and response times, heightened inter-agency collaboration could help stabilize provision of these services, a new Wisconsin Policy Forum report finds.

Greater coordination at a countywide level also could help to ensure more uniform response times and improved quality of care, particularly for more critical situations requiring advanced life support. However, it likely would come at a higher cost to residents. We also find that the need for some stakeholders to rebuild trust —and for others, the willingness to consider change — will be key for any movement toward countywide EMS sustainability.

“Long-range planning and forward thinking now,” the report finds, “could be the difference between a measured, planned approach to service provision or more costly, crisis-oriented responses.”

Many of the same challenges facing other Wisconsin EMS agencies are affecting those in Lafayette County. Call volumes are increasing, and recruiting and retaining staff has become more difficult, particularly when it comes to maintaining sufficient rosters of volunteer responders.

In Lafayette County and elsewhere, this can have life-and-death consequences. In recent years, the communities examined in this report faced multiple instances in which an EMS agency was unable to assemble a crew to respond to a 911 call due to a lack of available volunteers and needed to rely on a neighboring jurisdiction instead.

Some areas in ambulance desert

Lafayette County, a largely rural county in southwestern Wisconsin, is served by a patchwork of small EMS agencies based within, and just outside of, the county. EMS agencies located within Lafayette County include Argyle, Belmont, Blanchardville, Shullsburg, and Lafayette County EMS, based in Darlington. Providers based outside the county, but serving portions of it, include Green County EMS, Hazel Green, Mineral Point, and Southwest Health.

These providers use a variety of staffing models. Of the five agencies based inside the county, three use a paid-on-call — or volunteer — model in which staff are paid at an hourly rate or receive a stipend per call to which they respond. One agency is fully staffed by volunteers who receive no payments. Only one, Lafayette County EMS, uses at least some full-time staff; Blanchardville added two part-time staffers in late 2024 in response to staffing challenges under the volunteer model.

All five of these agencies are capable of providing basic life support (BLS), which typically consists of first aid services for individuals with relatively minor needs, such as broken limbs. None are licensed by the state as advanced life support (ALS) service providers, although some have paramedics or advanced EMTs on their staff or volunteer rosters and can offer those services when personnel are available. Often, EMS responders from outside of the county must be called for emergencies requiring ALS capabilities, such as urgent treatment for heart attacks and strokes.

Response times vary significantly across the county. However, in many cases the total response time can be 25 minutes or more, meaning many Lafayette County residents may live in an ambulance desert under the current model.

Complicating factors

EMS agencies in Lafayette County experience a number of common challenges that would benefit from greater cooperation and collaboration. These include staff recruitment and retention, lengthy ALS response times in some areas, and anticipated population growth — much of which will be senior citizens — that will create higher call volumes.

However, the report finds one “complicating factor is the lack of enthusiasm — and in some cases opposition — to formal collaboration we have detected among many agency and municipal leaders.”

Our report outlines a spectrum of collaboration opportunities that could help address these agencies’ operating challenges. Small-scale opportunities include: adopting standardized dispatch protocols across agencies, joint training sessions, joint supply and equipment purchasing, sharing backup ambulances, cross-credentialing staff, shared scheduling software, or shared use of volunteers from other local government departments. Intermediate opportunities include adopting coverage agreements between agencies, shared use of medical staff, or hiring an EMS coordinator who would be shared between agencies.

Countywide options examined

Many Wisconsin communities are considering or pursuing regional consolidation of fire and EMS services, involving two or more municipalities, towns, or county governments. However, our research finds that in Lafayette County, the scattered geographic dispersal of ambulance bases and population centers does not easily support such a model.

Should agencies wish to consider it, our report also offers options that would involve countywide collaboration. These could include shared use of a single paramedic fly vehicle — an SUV or truck with paramedic equipment that can quickly get to a scene — housed in Darlington and staffed by the county, or shared use of two or three paramedic fly vehicles.

We also model what a potential countywide EMS service might look like in Lafayette County, using Oneida County and Marquette County as examples. Such a step would help to address staffing shortages while improving EMS response times and standards of care. At the same time, it also would increase countywide EMS operating expenditures substantially and also would eventually require the possible construction of a new EMS station.