A plan being developed for ambulance service in the county could mean that 70 percent of the rural population of Yellowstone County would be within ten minutes of an ambulance. To develop some kind of service for the county is being viewed by most emergency service providers in the county as critical because the services provided in the past are rapidly deteriorating.

A plan, county officials and area fire districts are proposing, would be funded, in large part, by a designated property tax levy which would have to be put before voters for approval. The soonest that a countywide ambulance service could be operational is sometime in 2019, according to director of emergency services for Yellowstone County, Brad Shoemaker. Shoemaker is working on a plan to establish the service as cost effectively as possible, and as soon as possible. He laid out the details of a plan for County Commissioners during discussion on Tuesday and for members of the Rural Fire Council, later that evening at the Shepherd Fire Station. If the mill levy request should fail, County Commissioner John Ostlund said, the time is going to come - probably about mid-2019 - that someone is going to call for an ambulance and they will be told "that service is not provided in your area." In fact, he added, "we are almost at that point now." For the rural county areas, "it is a fairly non-existent service," said Ostlund, "but a lot of people believe we have a contract with AMR." There have already been incidents in which responses to ambulance calls have taken over an hour, while dispatch operators have searched in vain for an available provider. A rapidly escalating demand for ambulance service is overwhelming all of the ambulance services in the county. Because of an increase in demand, AMR, an ambulance service business in Billings, is no longer able to respond to calls outside of the city as they have in the past. Services provided by volunteers of rural area fire districts are feeling the same increase in demand, while experiencing a dramatic reduction in volunteers. "It is our obligation," said Ostlund, "to inform the public about the situation, because they think we already have some kind of county service." The voters, he said, must know that "it is a choice they have to make." "If they want to have some kind of service you are going to have to pay for it." Shoemaker said that in order to meet the deadlines for the State Department of Revenue, the soonest that they can have a mail ballot election and still have "meaningful public input" is November 7, 2017. In order to have the most accurate figures possible, the county will do a RFQ (request for qualifications) for a company to help determine costs. Deputy County Attorney Kevin Gillen said, "There are entities that can do that. It would be similar to the process we used for the jail." If the levy passes, the commissioners will do another RFQ and a RFP (request for proposal). The service being envisioned would have two bases of operation - one in the vicinity of Shepherd/ Worden/ Huntley, and another in the Laurel area, and both would be operational and staffed 24- seven. Saying he has no interest in the county forming a new agency and employing some additional 30 people to be managed by his department, Shoemaker said the most practical approach would be to contract with a private sector provider. Gillen said that that was without doubt the best approach not just for economic efficiency but for issues of liability. Brian Hanson with AMR was present at both meetings, and when commissioners asked if his company would be interested in bidding, he said they would. Shoemaker said there are options that could be pursued in the details of how the service would function. The bases of operation could be rented or built. They would require little more than a large residence with a double car garage with high doors, and space for attendants to sleep and eat. The contractor could be responsible for having their own facilities or the county could own them. Revenue generated by the ambulance service is expected to be less than $250,000 annually. Shoemaker noted that it is a fact of ambulance service operations that seldom do more than 40 percent of patients pay for their services. Also playing a role in its financial structure will be issues pertaining to Medicare and Medicaid payments. A mail ballot election would be the preferred approach and being able to do it in conjunction with another election would save money, said County Elections Officer Brett Rutherford. He said it would involve between 17,000 and 20,000 voters, and a good estimate of cost is usually $1 per voter. The City of Laurel is interested in being part of the service, said Shoemaker. Laurel provides ambulance service also using volunteers through their fire service.

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