Emergency Medical Services departments are staples of our rural communities. However, many rural volunteer EMS departments are struggling with recruiting new members and retaining current members. I recently held four rural volunteer EMS summits across the 17th Senate District to answer the question, “What can the state do to encourage volunteers and help with recruitment and retention of rural volunteer EMS?” Rural voices and opinions are often overshadowed in Madison. For this reason, I wanted to hear directly from my rural EMS volunteers. We had great turnout for these discussions.

Nearly 70 EMS volunteers, representing almost 30 different departments, attended. They provided me with productive and informative feedback. I heard about the burden of the National Registry of Emergency Medical Technicians exam, received input on initial training and refresher requirements, learned about the burdensome process of applying for the Funding Assistance Program and discussed the challenges that rural departments face finding people to fully staff their ambulances. I am currently in the process of drafting legislation to address what I heard.

One of the themes that I heard echoed over and over was the difficulty of the NREMT exam. Since 2011, this exam has been required for initial EMS licensure in Wisconsin. I heard that the test is difficult, expensive and doesn’t always test for relevant information. A participant at the Darlington summit lamented that one of the questions was: “What should the tire pressure be on an ambulance in the mountains of Colorado?” Questions like this have no relevance to rural Wisconsin.

I also heard about several individuals who would be great Emergency Medical Technicians but they have test anxiety. These volunteers can save your life, but they don’t perform well on standardized tests. We need to fix this. Many departments told me they would have two, three or even eight more members if the NREMT exam was not a required part of the initial licensure process. For this reason, I will be introducing legislation to make the test optional for new volunteers. Individual departments will be able to decide whether the NREMT test is required.

In order to maintain our high standards and safety for our communities, I will work with the Wisconsin Technical College System to ensure consistency among the training courses and exams across WTCS institutions statewide. I will also be working with them to increase flexibility for class offerings and make-up classes. Initial training to become an EMT now requires 180 hours. While most volunteers were comfortable with the current requirements, they do not want the number of hours increased in the future and they asked for more access to consistent training.

We also discussed the FAP, which distributes state funding to transporting ambulance services through a population-based formula. Departments use FAP to pay for training courses and equipment. However, every year each department must collect in-person population verification signatures from the clerks in each municipality the department serves. Rural departments cover a lot of territory and some have to collect a dozen or more paper signatures each year. I will introduce legislation to streamline and reform the signature collection and population verification process for this important program.

Throughout each summit, the need for more volunteers was at the top of everyone’s mind, especially related to the ambulance staffing requirements. I am examining the current ambulance staffing requirements and will push for ways to ensure that each department has the staff to respond to calls at all hours of the day. Unfortunately, I heard many departments say that they “hope and pray” the pager doesn’t go off during the work day because they don’t have enough people to staff an ambulance while many of their volunteers are working.

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However, several departments are working directly with local businesses to allow employees to respond to calls during the day. Many businesses and several school districts across the 17th Senate District already do this. There are teachers at the Argyle and Potosi School Districts who serve with full support from their school.

In addition to the highlights, we also discussed:

  • Increasing collaboration between EMS departments, WTCS, and high schools.
  • Tax credits and their general inability to motivate behavior.
  • Increasing the Medicaid reimbursement rate for ambulance transports.
  • Clarification of previous legislation related to rural EMS departments and volunteers.
  • EMS as an essential service.
  • Concerns about alignment of the Wisconsin scope of practice standards with the national standards, which could reduce the role of − and alienate − rural volunteer departments.

Throughout the summits, I was impressed by the passion that our volunteer EMS personnel have for their communities and for helping others. I will continue to fight for our rural communities and will provide further updates as my EMS legislation makes its way through the legislative process.

For more information and to connect with me, visit my website http://legis.wisconsin.gov/senate/17/marklein and subscribe to my weekly E-Update by sending an email to Sen.Marklein@legis.wisconsin.gov. Do not hesitate to call 800-978-8008 if you have input, ideas or need assistance with any state-related matters.

Republican Howard Marklein, Spring Green, represents the 17th state Senate District.

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Tomah Journal editor

Steve Rundio is editor of the Tomah Journal. Contact him at 608-374-7785.

(2) comments


As an educator and advocate for EMS volunteers nationwide I appreciate the support & concern for the difficulties encountered by rural EMS. However , the idea that the National Registry Exam is the issue is frankly ridiculous, The information you received is wildly inaccurate , and I can guarantee you that questions about tire pressure in any state are not and never have been on the test. It is a NATIONAL test. I teach in a very poor, rural area where the high school graduation rate is less than 70%. We have a first time pass rate of over 90% on both the skills & didactic testing . It’s not rocket science. The public deserves to know that a standard is being met and the vast majority of the country uses NR certification as a requirement for licensure. Please continue to advocate for volunteers but it is critically important that you obtain accurate information so that planning focuses on reality, not misinformation.


I agree with these comments wholeheartedly. In general, the information in the article is anecdotal not evidence-based or data-driven. Support is desperately needed for EMS across the country. EMS needs to be recognized as an essential service to improve municipality funding alongside our protective service counterparts- Law Enforcement and Fire Depts. EMS agencies fill the role of so many community needs without a source of adequate financial support/reimbursement at the local, state and federal levels. I strongly advocate for the recognition that the EMS profession is transitioning from a primarily volunteer- staffed service to a professional career. Time demands, educational requirements and level of responsibility far exceeds what today's average volunteer is often able to manage .

No matter the call volume of an agency, every EMS responder is held to the same professional standard of care, every Service Director is held responsible to DHS Ch. 110.48, WARDS/NEMSIS reporting and Medicare regulations. These duties do not include maintenance of EMS licensure through continuing education, CPR renewal, fleet management, budgeting, scheduling etc..

Law enforcement officers would not be considered for a position if they did not prove competency in firearms, tactics or thorough knowledge in the law. Nurses are not employed without demonstrating the ability to effectively assess a patient, knowledge in pathophysiology, accurately measure and administer medication or thoroughly document nursing care provided. Attorneys are not hired without proving competency on bar exams. Relaxing standards in any of the professions would be unacceptable.

Local, state and federal officials should recognize the need for funding EMS appropriately. EMS picks up the pieces for a host of gaps in healthcare and community resources when considering that 911 is called when someone has no other resource to turn to. I am happy to be a part of a solution and encourage contacting me directly at 2651captain@gmail.com. Thank you

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