STORY AND PHOTO BY KAREN BOSSICK

Patrick McIntyre says Blaine County residents have a pretty good thing going. And he wants to keep it that way.

As EMS coordinator for the Blaine County Ambulance District, McIntyre oversees a system he describes as "very robust and busy"--one that dispatches an ambulance to your driveway in an average of six minutes and 45 seconds after a 911 call.

That beats the national gold standard of eight minutes, even factoring in backcountry rescues that can take 30 minutes or more.

But sustaining that excellence comes at a cost—a cost that is rising faster than current revenues can cover.

On May 19, Blaine County voters will decide whether to approve a two-year temporary levy that would add $6.72 per $100,000 of taxable assessed property value to fund emergency medical services across the county. For a home assessed at $800,000, that works out to roughly $54 per year.

Early voting begins today—Monday, April 27.

Many residents, McIntyre acknowledges, don't fully understand how ambulance service in Blaine County is structured.

The county is not served by a single fire department with ambulances. Instead, the Blaine County Ambulance District owns ten ambulances and leases them to partnership agencies--three to Ketchum Fire, four to BC South in Hailey and Bellevue and three to Carey Rural Fire.

The district is governed by the three county commissioners — Angenie McCleary, Muffy Davis and Lindsay Mollineaux — with medical oversight provided by Dr. Malie Kopplin as director and Katie Ferris as associate director.

The district provides approximately $1.8 million annually to each of its two largest partners, Ketchum Fire and BC South. All told, the district distributes roughly $4 million per year across its partner agencies.

Seventy-five percent of that revenue comes from property taxes. The remaining 25 percent comes from insurance reimbursements—billing Medicare, Medicaid and private insurers when patients are transported to St. Luke's Wood River or airlifted out.

"We take everybody regardless of ability to pay,” McIntyre said. “We don't go to a car crash and ask, 'Do you have an insurance card or I'm not taking you.' We take everybody."

The last ambulance levy in Blaine County passed in 2008. For nearly a decade afterward, call volumes stayed relatively flat, hovering between 600 and 800 calls per year.

Then came COVID, and with it a wave of newcomers.

Since 2021, EMS calls for service have increased 40 percent. The county now handles approximately 2,500 medical calls per year and the number keeps climbing.

"Our calls are vastly different from a city system," McIntyre said, noting that Blaine County's typical patient is what he calls an aging athlete. “Where urban EMS systems might respond to an 84-year-old having chest pain at home, here it is often an 84-year-old who wrecked on the bike trail.

"That's how you live to be 110," he added. "But I would assume our calls per capita are probably higher than the national average because we have an older demographic."

Meanwhile, the district's operating costs are rising at about 8 percent per year, while revenues are increasing only about 4 percent. The math, McIntyre said, leads to a fiscal cliff.

"In 2027 we would start to dip into reserves to the tune of several hundred thousand dollars," he said. "And if we did not find additional funding by 2028, those reserves would be depleted. Then we're operating in the red, which we cannot do."

Running out of money means running fewer ambulances.

Currently, six personnel on duty at Ketchum Fire can staff all three ambulances simultaneously. Drop to four people, and only two ambulances roll, leaving the third uncovered if three calls come in at once.

That scenario is no longer hypothetical. In March, during what McIntyre called the slack season, he was on his way to BC South when four simultaneous calls came in.

"If we're stacking calls to this magnitude right now," he said, "we can't go backwards in staffing, period."

When ambulances are occupied and a fourth call comes in, auto aid kicks in meaning BC South responds to a Ketchum call or Ketchum heads south to cover Hailey. Given the highway’s volume of traffic and bottlenecks, that stretches response times well beyond the golden window.

"There's this golden window of ten minutes," McIntyre explained. "If someone suffers a cardiac arrest and somebody's on scene in six minutes, that might be a survivable event. Beyond ten minutes, the likelihood of surviving dramatically decreases."

Reduced staffing would push that average response time up. And a survivable event, he said, might not be.

The proposed levy is deliberately structured as a temporary measure.

"We don't have the answers right now," McIntyre said. "We don't know what's going to happen in two years."

The 6 percent increase was chosen carefully. Some local governance officials suggested requesting 10 or 12 percent. The district pulled back, concerned that a larger ask would fail at the ballot box, particularly in the south county.

"We're not going to do an enormous levy and say, 'Hey, we're building up a cash reserve,' " McIntyre said. "In this environment, people would say, 'We're not going to give you a slush fund. What do you need to get by?' And this is what we need."

The two-year window also provides breathing room for ongoing efforts to find additional revenue. McIntyre is pursuing reimbursement through Idaho's GEMT (Ground Emergency Medical Transportation) program. The program provides supplemental reimbursement for the true cost of transporting patients, covering the gap between low Medicaid reimbursement rates and actual expenses.

He is also applying for grants and talking with St. Luke's about greater financial integration--a partnership that exists in Magic Valley but not in the Wood River Valley.

"I'm reaching through every couch cushion to find every nickel I can find," McIntyre said.

McIntyre said that Ketchum Fire and BC South’s attempt to move forward with a joint powers agreement could also create unified command across both departments and potentially improve efficiencies.

"This two to three-year period for the levy gives us time to look at the picture and say, ‘Our call volume is mellowing out.’ "Or, if they go forward with new subdivisions down by the blinking light, ‘No, we're still climbing.’ "

McIntyre grew up in the Treasure Valley, often recreating in Sun Valley. He now coordinates Blaine County’s EMS from his home outside Las Vegas where he and his wife landed after retirement priced them out of their hometown.

He has watched Blaine County change. And, like many, he feels the bittersweet pull of a place he loves being discovered by the rest of the world.

Idaho is currently the No. 1 inbound moving destination in the United States with more  than 72,000 people moving into the state during the past year, pushing the population over the two million mark.

"The well-kept secret of Idaho ain't a secret no more," he said. "I hate to say it, but I can't stop what's coming."

What he hopes to do, however, is make sure that when a 911 call goes out on a July afternoon with three simultaneous emergencies--at Dollar Mountain, at the hospital, at a trailhead--there are enough crews and enough ambulances to answer all of them.

"We have a pretty good thing going right now," McIntyre said. "We want to keep it that way."

WANT TO KNOW MORE?

Go to https://www.blainecountyid.gov/1303/Ambulance-District.