Siouxland Paramedics

An ambulance leaves Siouxland Paramedics for a medical call in early 2016. An agreement finalized Monday has outlined payment received by Sioux City when Sioux City Fire Rescue's EMS Division provides paramedic assistance to the Dakota Valley Fire District, which encompasses North Sioux City, Dakota Dunes, Big Sioux Township and Wynstone.

Editor's note: The Journal today countinues the countdown of the Top 10 Stories of 2017 in Siouxland, as chosen by Journal editors. The No. 1 story will be revealed on Dec. 30, and the Journal's annual Newsmaker of the Year will be named on Dec. 31.

SIOUX CITY | The announcement sent shock waves throughout the region, with the full extent yet to be felt. 

In August, longtime nonprofit ambulance service Siouxland Paramedics Inc. informed local cities it would no longer provide emergency medical services after the year's end. Leadership said such service was unsustainable in the face of rising numbers of uninsured patients, declining reimbursements from Medicaid and Medicare and increased personnel costs. 

The 35-year-old nonprofit has long been the ambulance service provider in Sioux City and North Sioux City, where it responds to 911 calls. It also provides vital paramedic assistance to the volunteer fire and rescue departments in under-served areas across the tri-state region. 

After Siouxland Paramedics gave its minimum 90-day notice required under the contract to end the service, cities had to scramble to find a replacement. 

The upheaval in the way ambulances are dispatched to 911 calls is The Journal's No. 9 story of 2017. 

Sioux City has opted to form its own EMS division within Sioux City Fire Rescue. The division will employ 27 people and run at an estimated subsidy of $600,000 in the first six months, although organizers admit the full cost is yet unknown. The city will cover the start-up costs -- unforeseen when it created its fiscal 2018 budget earlier this year -- with fund balances through June 30 and will then discuss how to cover the ongoing expense in future fiscal years during its budget hearings in February. 

All ambulances used by Siouxland Paramedics, except one, will revert to the city by 8 a.m. Jan. 1, when the city will take over ambulance operations as of 8 a.m. Jan. 1. 

The Dakota Valley Fire District -- which encompasses North Sioux City, Dakota Dunes, Big Sioux Township and Wynstone -- is moving ahead with plans to form an agreement with Sioux City to use its paramedics. Some residents of the southeast South Dakota district still favor Dakota Valley staffing its own paramedic service.

Meanwhile, rural areas and small cities surrounding Sioux City could have few to no options to fill the need for the paramedic assists they previously received from SPI. When rural ambulances loaded critical patients, Siouxland Paramedics would frequently meet them partway to Sioux City so a paramedic could climb aboard and administer higher-level care. 

Discussions are underway in Woodbury County, where the county staffs a lone paramedic on weekdays but has no coverage on nights and weekends. Emergency Services Director Gary Brown wants to see enough paramedics staffed for 24/7 response throughout the county, and cities and townships will meet with the Woodbury County Board of Supervisors Jan. 8 to discuss funding options. 

Other areas, such as the Akron Fire District -- which covers 365 square miles in sparsely populated western Plymouth County, Iowa, and eastern Union County, South Dakota -- have few to no options to find an alternate paramedic service. 

Siouxland Paramedics is not completely dissolving, as a downsized version of the nonprofit will continue providing non-emergency transfers, such as those between hospitals and nursing homes. Such a service offers better reimbursements. 

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