The District’s ability to maintain its current level of service has become more challenging as demand for EMS has increased. In the past, the District has been careful to limit levy increases and has relied on a combination of efficiency, cost control, and alternative funding sources to support operations. Before pursuing a levy override, the District explored multiple other funding options. These included efforts to establish impact fees, seeking legislative changes at the state level to recognize EMS as an essential service, and pursuing grant funding year after year. While grants have helped the District purchase vehicles and equipment in the past, they are competitive, limited, and not a reliable source of ongoing operational funding. In addition, the availability of EMS-related grants has continued to decline over time. As service demand continues to grow and costs rise, the levy override is being considered as a way to sustainably support emergency medical services and maintain public safety.

The District’s building purchase is being funded with one-time federal ARPA dollars provided through the County. These funds are restricted to specific capital purposes and cannot be used to pay for paramedics, salaries, benefits, or day-to-day operations. The District is grateful to the County for prioritizing this facility need and allocating ARPA funding to support it. Using one-time funds for the building helps reduce the overall tax impact on District residents. The levy discussion focuses on the ongoing operational costs of staffing ambulances and responding to emergencies, which must be supported through the District’s operating budget.

Call demand has increased over time, but more notably, the number of calls requiring response from outside agencies has risen significantly in the most recent year. This reflects growing strain on available staffed units rather than a lack of effort or efficiency. Capacity and staffing challenges are not new. The District has been managing these issues for many years, but they have become more pronounced as demand has continued to grow. Existing facilities also limit the District’s ability to expand. The primary operational space is a 20-year-old single-wide trailer provided by the City of Fruitland. Ambulances are staged in Fruitland Fire bays at City Hall, which is also used for meetings and training. Over time, the District has made incremental improvements, including constructing a small equipment and medication storage area with limited administrative space. However, current facilities do not allow for additional staff or expanded operations. There is no remaining space to accommodate growth under the existing conditions.

Calls requiring outside agencies occur when all Payette County Paramedics units are already committed to other emergency calls and no local ambulances are available to respond. In these situations, another EMS provider must respond from outside the district, which can result in longer response times. These incidents are commonly referred to as mutual aid calls. The use of outside agencies does not reflect idle time or inefficiency. It occurs because crews are actively responding to other emergencies at the same time and cannot leave a patient once care has begun. This reflects the limits of available staffed units, not a lack of effort or readiness by District personnel.

In the most recent year of data (2024–2025), there were 493 calls (11.4%) that required outside agencies to respond. This represents a noticeable increase compared to prior years. For example, in 2023-2024, there were 281 mutual aid calls.

Overall call volume has increased gradually. However, the sharper increase in calls requiring outside agencies suggests that staffing availability has not kept pace with when and how calls are occurring.

EMS response depends on having staffed ambulances available at the moment calls come in. When units are already committed to other emergencies or when multiple calls occur at the same time, additional calls must be handled by outside agencies if they are available. This can result in longer response times. These situations reflect limits on operational capacity rather than a lack of effort or efficiency. Emergency crews cannot be in multiple places at once. Calls are prioritized by dispatch based on medical need, and crews respond first to the most critical emergencies. Once a crew makes patient contact, they are legally and medically required to remain with that patient until care is complete or the patient is transferred. Each ambulance must be staffed with at least two certified ambulance rated providers. Both providers will provide patient care on scene as a team. During transport one will drive and the other will continue patient care. From dispatch through patient care and required documentation, the average call takes approximately two hours to complete. When new calls occur during that time, they add to the overall demand rather than replacing the time already committed.

Personnel costs make up the largest share of EMS operating expenses. Providing 24/7, readiness and professional emergency medical coverage requires trained paramedics and EMTs, along with required benefits, retirement contributions, payroll taxes, and other overhead.

Base wages are only one part of the total cost of staffing emergency medical services. When benefits, retirement contributions, payroll taxes, insurance, and other required employment costs are included, the total annual cost of a full-time paramedic is significantly higher than hourly pay alone. The District has consistently operated within the levy increases allowed under state law and has not exceeded the statutory limit in prior years. Despite this restraint, the District’s average wages remain below those of nearby EMS agencies. On average, District wages are approximately $6 per hour lower than comparable positions in the surrounding area, making recruitment and retention increasingly challenging.

Part-time staffing can provide some flexibility in filling schedule gaps, but it cannot replace the consistent, fully staffed coverage required to respond reliably when multiple emergencies occur at the same time. Part-time employees still carry real costs and are not a substitute for stable, 24/7 professional staffing. The District has actively recruited PRN staff for several years and currently employs four PRN Paramedics and three PRN EMTs. While this helps supplement coverage, part-time staff often seek full-time positions elsewhere when those opportunities arise. When that happens, the District loses the significant investment made in onboarding and training. The nature of EMS work has also changed. Today’s paramedics and EMTs are not simply ambulance drivers. They are trained medical professionals providing advanced care in mobile intensive care units, responding to increasingly complex and high-acuity emergencies.