Fayette County EMS – Minutes Matter
To the Editor:
Fayette County no longer has a hospital. It does however have Fayette County Emergency Medical Services (FCEMS). But is that enough to provide emergency care for county residents? There are FCEMS stations in La Grange, Schulenburg, Fayetteville, Flatonia and Round Top. In September, 2024, the Fayette County Record reported that the Texas EMS Alliance had named FCEMS as the EMSAgency of the Year based on its “demonstrated teamwork, innovation and a commitment to pursuing excellence to improve the delivery of emergency medical services.”
The Record published FCEMS Director Josh Vandever’s 2024 “Year-End Report” in its Dec. 31 issue. Mr. Vandever reported that FCEMS transfers “the majority of our patients to Columbus Community Hospital and Seton-Smithville. With most of our critically ill and injured patients still being taken to Austin either by ground or air ambulance.” He stated that there was “about a 20% average increase to our time on task due to the extended transports” of patients to hospitals. He also noted that since the closing of St. Mark’s Hospital, FCEMS “had worked to engage with our elected local, state and federal officials to pursue every potential opportunity to resurrect a hospital within our community. We continue to work, with the support of leaders within our community, to rebuild the healthcare infrastructure that once existed.”
In January of 2024, the County EMS Director told the Record that he estimated that, as a of result the closure of St. Mark’s Hospital in October 2023, labor and equipment costs could increase the EMS Department budget by about $1.15 million annually. The 2023 EMS budget was $3.671 million. The 2024 budget was $4.356 million. The 2025 EMS budget, approved by the Fayette County Commissioners last September, is $4.7 million (about 13% of the total County budget.)
By comparison, the 2025 Colorado County EMS budget is $3.6 million and the 2025 Lavaca County EMS budget is $3.3 million. Colorado County has two hospitals (Columbus and Eagle Lake). Lavaca County has one hospital (a hospital district.) The Jackson County (Edna) Hospital District provides that county with EMS services with seven MICU (mobile ICU) vehicles and a staff of 23 full-time employees and 10 part-time employees.
Rural EMS departments have the same challenges as rural hospitals and physicians, including staffing shortages due to “burnout,” declining insurance reimbursements, rising equipment costs and increases in salary and benefits to attract and keep qualified personnel. Personnel costs are usually the largest component of budgets of most organizations. About 86% of the FCEMS budget is for pay and benefits of EMTs and paramedics. FCEMS has about 40 EMTs and paramedics. Starting annual pay for Advanced EMTs is $60,000 and $70,000 for Paramedics.
In February 2023, the EMS Director told the FCR that because there was no local hospital ER for people to go to and EMS had to transfer more patients to area and city hospitals, EMS vehicles would wear out sooner. He noted that “in recent years, FCEMS has replaced roughly one ambulance every year but that the County may need to increase the pace to three replacements every two years” and that “the last ambulance the County priced was $330,000.” FCEMS has 5 MICU vehicles. It appears that the last EMS vehicle was budgeted for in 2022 and budget increases will be needed to replace EMS vehicles.
St. Mark’s Medical Center, a non-profit, converted to a Rural Emergency Hospital (emergency and outpatient services only) in February 2023 but couldn’t make monthly payments for the $12 million debt it owed on the building facility and closed in October, 2023. The building and land was auctioned off by the U.S. Department of Housing and Urban Development (the note holder) last summer and the debt was “written off.” (FCR 9-12-24) Whether Fayette County will ever have a hospital again remains to be seen. It would be good to have an ER centrally located in the County that was staffed and equipped as well or better than FCEMS vehicles. The question of whether even excellent rural emergency service departments can be substituted for a rural hospital emergency room with trauma, emergency cardiac and high-risk pregnancy services is a question best answered by experts.
The need for rural EMS services is significant and increasing. According to a 2024 National Highway & Traffic Safety Administration report, an estimated 20% of the U.S. population lives in rural areas but rural deaths accounted for 41% of all traffic fatalities in 2022. Women living in rural areas are more likely to die from pregnancy or childbirth-related causes, and infant mortality is also higher. Older and low income people may be less able to travel or less likely to seek medical care until a condition becomes an emergency. EMS services are their only lifeline. Rural EMS in Texas has also become a more pressing issue as the rise in urban housing prices has pushed more people into rural counties where homes are more affordable and the number of older residents who have more medical needs and emergencies has grown.
One of the priorities of the Texas Organization of Rural and Community Hospitals for the 2025 session of the Texas Legislature is to assist efforts by counties to seek appropriations for rural EMS. In 2019, the Texas Legislature put a cap on property tax increases. Cities and counties cannot raise property taxes beyond that 3.5% cap without taking the issue to local voters. As rural Texas counties see the need to pay for better EMS services, that cap is a factor.
Texas Farm Bureau notes that since bill filing began on Nov. 12 for the 2025 legislative session, lawmakers in the Texas House and Senate have submitted over 1,000 bills. The session begins Jan. 14, 2025. The last day lawmakers can file proposed laws is March 14. I did not see on web pages for State Senator Lois Kolkhorst and State Representative Stan Kitzman that they intend to introduce or sponsor any legislation to address rural health care or rural emergency medical services. There appears to be no proposed legislation that would directly address funding for rural EMS.
By choosing to live in a rural area, people should not have to accept that the risk of dying from an accident or serious medical event is just going to be significantly greater. Fayette County is not a poor county. It can afford necessary emergency medical services. Is a very good EMS department all that is needed?
Fayette County has many dedicated, qualified and competent folks to look at this. They probably are doing so. Residents should be involved. If the County will not get another hospital, local electedleaders, medical professionals and taxpayers should make sure that FCEMS has the resources that it needs to provide appropriate emergency services. I don’t know anything about running an EMS Department or providing rural medical services, but having had a near fatal heart attack, I can tell you that minutes matter – a lot. Overstretched EMS services and insufficient accessibility to hospital ERs can have very bad consequences.
Russell Friemel Ft. Worth & Ellinger