SIOUX CITY | The Woodbury County Emergency Services Department director on Tuesday said the failure to add three paramedics in January will leave rural county residents without sufficient service and "would be setting the county back 35 years."

Director Gary Brown made that assertion as the Woodbury County Board of Supervisors, who hold the purse strings on all county spending, declined Brown's recommendation to add three jobs. Those paramedic jobs would have cost an estimated $97,555 for the first six months of 2018.

The supervisors defeated a motion to add the three jobs. Then on a 3-2 vote, they voted against adding one paramedic, something that would cost about $73,000 for a full year, with salary and benefits, Brown said.

He also framed the hiring request in the form of quality of life.

"If you don't have good EMS...who would want to live in our communities?" Brown asked.

Brown three weeks ago brought his proposal, noting the "necessity" for it, due to big changes ahead for a Sioux City-based ambulance agency.

Citing financial difficulties, the 35-year-old Siouxland Paramedics in August informed Sioux City officials that it would cease providing 911 services to Sioux City and North Sioux City by year's end. Sioux City Fire Rescue, a department of the city of Sioux City, will run a new emergency medical services division that will respond to 911 ambulance calls beginning Jan. 1.

Brown said with Sioux City Fire Rescue personnel taking on the new role in January, the trickle-down effect is that the changes "will not allow them to respond to rural paramedic assists."

Early in 2017, Brown sought to add two paramedics as part of setting the fiscal year 2017-18 budget, but that hiring was not approved. After another defeat on Tuesday, Brown is now seeking to decide if he should try to add more in the 2018-19 fiscal year. That proposal could be aired in early 2018 during budget-setting discussions.

If the Woodbury County supervisors agree to fund the changes for a full allotment into the 2018-19 fiscal year, the cost will be $195,110 annually.

Supervisors Rocky De Witt, Matthew Ung and Jeremy Taylor said they had qualms about being able to afford the new paramedics personnel, particularly in the middle of a fiscal year.

"We can't fund everything that comes down the pike," De Witt said.

De Witt added that he understands rural residents want good paramedic services, but "the fact remains that we can't be everywhere every time."

Brown proposed three jobs to be added by Jan. 1: two full-time operations officers/paramedics and a paramedic who would work three-fourths time.

He said those additions would allow the county to provide 24-7 paramedic service. Currently, there is no staffing in the late evenings and early morning overnights.

"EMS, it is time to look at it as an essential service, like fire and police," Brown said.

Note: An earlier version of this story incorrectly said the supervisors in a second vote approved hiring one paramedic.

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