Towns, Ryan Brothers hold meeting to discuss EMS

By Kim McDarison

Representatives from several Jefferson County towns, including three which contract EMS services through the City of Fort Atkinson, met with representatives of Ryan Brothers Ambulance Service Tuesday to discuss changes in EMS services that could affect their communities. 

The meeting, which was held at the Koshkonong Town Hall, was offered as a round table discussion, Koshkonong Town Board of Supervisors Chairman Bill Burlingame said. The intent of the meeting was to help officials and residents living within the towns gain a better understanding of how services might be affected if a City of Fort Atkinson Public Safety Referendum, which will come before the city’s voters in April, is approved. 

Ryan Brothers Ambulance Service owner Erin Ryan and Ryan Brothers Service Director for the City of Fort Atkinson 911 Operations Cody Letson presented information and answered questions posed by officials from the towns of Koshkonong, Sumner, Jefferson and Lake Mills. 

Included within the Fort Atkinson Fire Department service territory are five towns, in part or in full, including Koshkonong, Sumner, Oakland, Hebron, and Jefferson, which contract with the City of Fort Atkinson for 911 service. 

Addressing attendees at the meeting, Letson said: “Obviously our contract is with the City of Fort Atkinson, however we service most of your guys’ communities as well through subcontracts with them.” 

Contract non-renewal 

Letson said in past years, he, the chief of the Fort Atkinson Fire Department and the Fort Atkinson city manager met regularly, about once every other month.  

“Everything was very standard for us; we had different issues here and there, go over stuff, and then about September last year, they called us up, Erin and I, and notified us that in about two days they would be canceling our contract,” Letson said, adding that Ryan Brothers was essentially told that the city council would be voting to “non-renew our contract.” 

Letson said that Ryan Brothers has a rolling three-year contract with the city. 

Further, Letson said, city officials told Ryan Brothers that “the timeframe for us to present anything at that meeting had already elapsed as well, so essentially, they told us that we had no say; we could make a public comment and that was about it.”  

Letson said he and Ryan went to the meeting and made public comments. 

“We were not allowed to present any information about anything during the meeting. They subsequently voted at that time to non-renew our contract and then essentially kept us out of the process. We were never approached with any kind of issues, with any kinds of concerns about whether we needed more … resources or anything. Obviously we are a contracted service, so if they needed any additional, or thought they needed any additional services … we were not notified of any of that information, and really, it’s been relatively quiet from the City of Fort Atkinson towards us. They have never asked us to weigh in on anything. This is the first time since our meeting with any municipality personnel to discuss it, to give our side of the view, or anything like that,” Letson said.  

Said Ryan: “The frustrating thing here is the City of Fort Atkinson and the fire chief in Fort Atkinson have been speaking on Ryan Brothers’ behalf, giving them (community) information about us that is not accurate and not true, and we don’t have a platform to be able to say: ‘that’s not correct. This isn’t right, that’s false,’ and so that’s a very stressful situation.” 

Ryan thanked the towns for organizing the informational meeting, saying: “we really appreciate it, because that opens up the doors, and it sounds like we’re both in the dark of what’s going on, and that shouldn’t be the way it goes.”

Without inclusion of Ryan Brothers within the planning process, Letson said, the city cannot benefit from the company’s 20 years of experience and data collection. 

“We’ve been here longer than most of the people who are making the decisions,” he said, adding: “We were never asked to share it (data), never asked to weigh in on solutions.”  

Ryan said that while he and Letson did not have all the answers, they could answer questions for the town representatives, provide some data and a company perspective. 

Questions

After the presentation, Burlingame invited attendees to ask questions. 

Burlingame asked: How do 911 service calls work? What is the process? 

Letson responded, saying that the typical 911 call begins with a caller needing help. They place a 911 call and a GPS system can usually find the location. Calls automatically go to the nearest dispatch center. For calls coming out of the city of Fort Atkinson, the dispatch center is the Fort Atkinson Police Department. Calls originating in the rural areas, such as the towns, are dispatched through the Jefferson County dispatch center. 

At the dispatch center, an operator receiving the call determines which resources the emergency requires and a page to the corresponding units assigned within that territory is sent out. 

“So for this area, it would be us, and then we respond,” Letson said. 

Burlingame asked: Do you get the call first? 

Letson said, yes, adding: “Every ambulance call, we get the first call in our territory.” 

Burlington asked: What area does the territory cover?  

Said Letson: “It would cover the city of Fort Atkinson and a large proportion, I believe we are just over 99%, of Koshkonong, and varying degrees of the other municipalities … we cover the southern area of the Town of Jefferson, and then the northern area closer to Jefferson. The city is covered by Jefferson EMS.” 

Burlingame asked: What happens if there’s a second call? 

Letson said Ryan Brothers has a primary ambulance called unit 736, which is dedicated to the community. 

“Our contract reads that we’re to provide one dedicated A-EMT to the ambulance. About 10 years ago, we made a decision to start staffing that as a paramedic-level ambulance at no cost to the city because we felt that it was important to give the highest level of care that Ryan Brothers was able to do, so we staffed it with a paramedic,” Letson noted, adding that when a first call is received that rig will go out.

If Ryan Brothers receives a second call, he said, the company’s backup unit, 735, will go out. 

According to Letson, the contract with the city specifies that the backup unit, which is on call, must be staffed at EMT-level. Twenty years ago, he said, the company made a decision to staff the backup unit full-time and with a paramedic. The upgrades were made at no additional cost to the city. 

“That secondary rig also services Fort Atkinson Hospital, so let’s say somebody from Fort Atkinson has to go to the hospital because they are having a heart attack and they needed to have emergency surgery, Fort Hospital is not able to perform that, so they would call us, (and) our secondary ambulance would transport that person to a cardiac lab say in Madison,” Letson said. 

Letson said the backup unit on average responds to about two to three calls a day for the Fort Atkinson Hospital. Still, he said, about half of the ambulance’s time is spent responding to a second 911 call.  

“If we kept going down the line, a third call, as of 2018, a third call now goes to the fire department. They asked to have their own ambulance to do calls here in the community as a third-out ambulance. Prior to that, we had mutual aid agreements with neighboring communities. So we would provide backup calls for Whitewater, for Jefferson, or Milton, and vice-versa. So if we got to that third page, historically, one of those communities would send their ambulance to help us out. That also happens on multi-vehicle accidents, so a single incident with maybe multiple patients. 

“And typically … I would say we probably requested an outside unit into our territory about 25 to 30 times in a given year. We would probably provide (an ambulance) to outside communities probably about twice that much in mutual aid because we also — being the only paramedic unit on this lower half of the county — we also provide them with intercepts to give them a higher level of care,” Letson stated.  

Burlingame asked: If you’ve got two ambulances, why not three? 

Said Letson: “Essentially that’s what caused us to be surprised about this because basically our contract spells out what the city wants. We were never approached to bring a third ambulance.”

Sometime around 2018 or 2019, Letson recalled, the fire department began discussing the possibility of having a third ambulance. Ryan Brothers approached the fire department, he said, and suggested the idea of bringing a third rig as a backup unit, offering the city two backup units. 

“At that time, we were prohibited from doing so. They said that if we were to do that it would make their ambulance unnecessary,” Letson said. 

Burlingame asked: After going out on calls, what is the procedure for you to come back in? How do you let somebody know that you are available? 

Said Letson: “What usually happens, our primary ambulance typically stays in the Fort Atkinson community unless we have a real serious call — one that needs to say go to Mercy or another hospital nearby — but for the most part, we have relatively short transports, so as soon as our ambulance, our primary ambulance, is clear … either they look at the patient when we get there and it’s something that they can treat on-scene, or if ultimately the patient requests transport to the hospital, as soon as we’re finished with that, we notify the dispatch centers via radio … and then they immediately put us back in service. We are clear to take the next call.”  

Burlingame asked: What timetable is that? 

Letson responded, saying: “So the average call for us, obviously it depends on how far out we’re driving, so the biggest factor is drive time. Typically, our crews strive to have an on-scene time, which is the time that they arrive at the house to the time they start transport, of 15 minutes. And I would say that most of our transports are about 5 to 10 minutes one way, so I would say a total call is about 35 to 40 minutes.” 

Town of Koshkonong board member Kim Cheney asked: Are they sending calls to their ambulance first?

“They are not,” Letson said. “I’ve never had an incidence with that.” 

Letson said all of the agencies involved have maintained the proper order of paging. As per the protocol, Ryan Brothers’ primary ambulance 736 is sent out first, followed by 735. If a call for a third ambulance comes in, the ambulance at the Fort Atkinson Fire Department is dispatched. 

Burlingame asked: Are you saying you make 90 to 95% of all 911 calls? 

Letson said: “yes.” 

Sharing statistics from 2020, which Letson said was the most recent year available with full data, the fire department’s ambulance was dispatched through 911 to 50 EMS calls, that, he said, “typically used to be serviced by mutual aid, and I would say a fair number of those 50 calls, our ambulance still responded and ultimately ended up transporting a patient.”

In 2020, Letson said, Ryan Brothers responded to 1,250 911-dispatched EMS calls.  

Said Ryan: “The other thing to keep in mind is that we have 20 years worth of data where we are pretty efficient, and we get paged and we do what we need to do, and we get back in service. 

“The unique thing about having the Fort hospital so close, we are able to get back into service very quickly. If we had to go to Madison all the time, or if we had to go to Oconomowoc, or Janesville, that would be very tough to do for one rig. So going back to how many times we’ve provided mutual aid as well as how many times we’ve needed it, it’s well within the parameters of — this happens with any community — you are always going to run out of resources as some point. If you have a car accident with 10 cars, no service has that many ambulances, so there’s a lot of times where these car accidents bring in other communities just because there’s multiple, multiple patients.” 

Ryan continued: “So that number of 50, again, that’s not a bad number. I think it’s grown a little bit. I think the fire chief wants to be responding to things maybe they don’t always need to. And so that’s kind of another thing to look at. If they send a fire truck and an ambulance, that’s, in their mind, two calls. For us, that’s one call. 

“And so now we start looking at some of their numbers, and they’ve asked, and wanted, and insisted on being called for certain things, which, again, over the last couple years started to ratchet their numbers up, but that’s on their request.”  

Burlingame asked: How many times do you get on scene and an engine arrives? 

Said Letson: “There’s two ways that an engine will automatically get dispatched with us from the fire department. It’s anytime there’s a car accident, and again, that’s at their request — it could be a minor fender-bender, it could be a catastrophic accident. So they, about four or five years ago, they made that request to us that they get called for every single accident. Our crews used to make the determination whether they were needed or not. So now they come on every one of those calls and then it’s also the same … anytime there’s a cardiac arrest.”

With cardiac arrest patients, he said, there are some cases when having an engine arrive is beneficial because it comes with extra manpower. On other occasions, he said, the situation brings an unfortunate outcome and an elevated level of care and extra manpower are not required.  

Another scenario when an engine with manpower is needed is when a two-man ambulance crew needs help lifting a patient. 

“If we have like a large patient that we can’t, with two members, get out of the house, we would request that an engine shows up and they help us remove the patient from the house,” Letson said. 

Letson said a situation where an ambulance crew might need assistance lifting a patient occurs about five times a week.  

Town of Jefferson Clerk Tina Barnes said she understood some similar policies of dispatching ambulances and engines together are used in Jefferson. 

“They’ve told us that if their ambulance rolls then their truck rolls and that they are doing it almost 100% of the time just because extra bodies are needed,” Barnes said. 

“A lot of communities do have policies like that where they’ll send an engine automatically. Obviously that puts a huge strain on the fire department,” Letson said.  

Several in the room noted that the practice also brings a “double charge.” 

Town of Koshkonong board member Walt Christensen asked: “You said they (Fort Atkinson City Council) originally made this change in service or decided not to renew the contract again because of issues. Do you have any idea what the issues were?” 

Said Letson: “What the fire chief has said in his meetings with the city council is that they don’t have a specific issue with Ryan Brothers. Really, this is to try and address issues within their fire department and their ability to respond on calls. The chief has told us before that he has no concerns about the service that we provide and our response times, our level of care, everything like that, can’t be improved on, so EMS-wise, I think this is really just based off of them having a need for the fire department.”  

Christensen asked several questions about Koshkonong’s contract for EMS service. Letson responding by saying that the town’s contract was with the city of Fort Atkinson and not directly with Ryan Brothers. 

Said Christensen: “So it was always all the towns contracted with the city and then you work with the city in your own capacity.”

Letson said that was true.  

Christensen asked if that structure could change if the town made a different decision. 

“Yes. You guys would be in charge of your own contracts,” Letson said. 

Ryan said he was confident that the contract in place with the city runs until the end of 2023. 

Burlingame said he thought it ended in 2022. 

“Well, that’s what the city thinks,” Ryan said.  

Burlingame asked if any attorneys had been asked to weigh in on the contract. 

Ryan said they had. 

“And nobody knows the outcome?” Burlingame asked.  

“Not yet,” Letson said. 

“It’s ongoing,” Ryan agreed, adding that a letter from his attorney had been sent to the city’s attorney and was also shared, by his choice, Ryan said, with the town chairs. 

Said Letson: “The big thing for us, we want this process to be very transparent. If at the end of the day, they compare us to them, and they think that that’s a better deal, better price, I think I’m all for it. It’s the fact that they are not letting us speak up that I have an issue with.”  

Barnes asked about services Ryan Brothers is providing in other territories like Madison. 

Ryan noted that the larger company which operates from Madison is an inter-facility operation. Fort Atkinson is the company’s 911 division. 

Town of Lake Mills Board of Supervisors Chairman Thomas Buechel, participating through Zoom, asked for such statistics as cost per person for EMS services and call volume.  

Letson said that he believed Ryan Brothers was providing through its contract with Fort Atkinson “about the cheapest rate in the state of Wisconsin.” 

Within the territory the company serves, Letson said, there are about 18,000 people. The contract with the city last year was for $110,000. 

“That roughly comes out to about $6.50 a person,” he said. 

“Our contract has been unchanged since it started 20 years ago. The only adjustment is a CPI  (Consumer Price Index) increase every year. 

“As far as percentage of townships, the calls are really directly tied to the population of the township and also, for us, we don’t cover 100% of the townships, we cover portions of them,” Letson said, adding that in the town of Jefferson, Jefferson EMS covers about 80% of the township and Ryan Brothers covers about 20%. 

“Call volumes can fluctuate pretty dramatically from township to township,” he said. 

In 2020, Letson said, the five towns covered by Ryan Brothers made up about 25% of the company’s total 911 call volume.  

Looking more specifically at towns, he said, Koshkonong brings about 10% of the call volume and the other towns contribute about 3% each. 

Several meeting participants offered numbers related to per person costs within their towns for EMS services. 

Dave Larsuel, service director with the town of Lake Mills EMS and Barnes said in the towns of Lake Mills and Jefferson, they were paying $15 per person. 

Ryan said he believed Koshkonong was paying just under $12 per person. 

Letson said in 2020, Jefferson County completed a feasibility study, looking at countywide costs for EMS. 

“The average cost for a fire/EMS combination was typically around $90 per capita. If it was EMS stand-alone it was in the $50 range,” he said. 

Letson continued: “What typically happens to a lot of communities, when they don’t have representation for decisions like this, they end up paying a price. So like the township down in Milton, where I’m from, basically, to start funding services, the townships got served with 2 and 3 and 400% increases in costs and they don’t really have any recourse because they have no representation. 

“Ultimately now, what Milton looks like they’re going to do is, their townships luckily had Edgerton as a choice, and Edgerton was willing to give them an option of representation. So now you are going to see what looks like the City of Milton, the town of Milton, town of Lima, all those communities, are going to contract to Edgerton Fire Department where they have some representation and have some control over their costs and services.”  

“What Fort is kind of doing, just what Janesville was doing, telling the townships here’s what you are going to pay, you don’t have a say,” said Town of Sumner Board of Supervisors Chairman John Dohner. 

Burlingame asked: If the city comes back with something that the townships can’t accept, what is your cost? How would that picture look? 

Said Ryan: “We’d be interested in continuing talking about that. I know I’ve talked to Dave from Lake Mills and I told him about this and he had mentioned there’s three townships that might be interested in looking at some other options. That’s why we asked if it was ok if they joined in. As things change — these things are changing in Cambridge. I know we service part of Oakland and Cambridge services part of Oakland — so the dominos are changing here and as townships get less and less representation and choice, if you guys can band together and potentially make that territory bigger, so there are more communities that would be able to utilize a Ryan Brothers in a different township, that makes the pricing different. 

“Like today, three other townships joined in. Let’s listen and see what we can do, because there is some time left here, and again, if we really are contracted through 2023, we have more time than you think.” 

Ryan continued: “The referendum’s the big thing. I would really like to ask you guys to really pressure the city of Fort Atkinson and ask them for secure numbers. What’s your budgeting numbers? This levy information is very confusing. How much do they really need for the levy? I know you guys don’t get a vote in that because you most likely don’t live there, but that’s very confusing. And you guys are a part of a contract with them. It would be great for you guys to get that information.” 

Said Burlingame: “I would like to have this same type of meeting with the city. We’re hearing one thing. Let’s hear something from the city.” 

“Let’s have everyone at the table,” Ryan said.  

A story about the City of Fort Atkinson Public Safety Referendum is here: https://fortatkinsononline.com/city-approves-public-safety-referendum-question-for-april-election-ballot/.

An earlier story about Ryan Brothers Ambulance Service is here: https://fortatkinsononline.com/ryan-brothers-shares-its-record-of-service-concerns-with-911-plans/.

An earlier story about the Fort Atkinson Fire Department is here: https://fortatkinsononline.com/an-issue-of-sustainability-fort-firefighters-talk-about-call-volume-staffing/.