The Boulder Ambulance Service is poised to get a new ambulance and other equipment, paid for with grants the service was recently awarded. But the service is struggling to recruit volunteers—and while city officials have applauded its grant-writing efforts, they have also sparred with Ambulance Service leaders over their engagement in helping to steer the department toward a sustainable future.
In public meetings, city and department staff meetings, interviews, and emails provided to The Monitor, Ambulance Service and city leaders agreed that a lack of volunteers threatens to cripple the service, and that new grant-funded equipment could help with recruitment. But they disagreed over who should craft a plan to revitalize the service—and over how involved Ambulance Service leadership has been, or should be, in working with elected officials to move forward.
The all-volunteer Boulder Ambulance Service is a city department that provides emergency medical services (EMS) to Boulder and adjacent areas. The department operates as an enterprise fund within the city's annual budget, meaning that it generates revenue primarily through fees it charges for calls it responds to, rather than direct through tax revenue. Department leaders say that only four volunteers are regularly available for calls and others bolster the service, but that at least 10–14 regular volunteers are needed to provide adequate staffing. With the current staffing level, many calls are handled instead by Eagle Ambulance in Montana City, meaning a longer wait for patients and less revenue for the Boulder Ambulance Service.
City officials met with department leaders and volunteers on Nov. 9 to lay the groundwork for a revamped Ambulance Service, and to address tensions between the city and the department that boiled over during a public meeting three weeks earlier.
At a City Council meeting on Oct. 18, city leaders, including Mayor Rusty Giulio and City Council President Drew Dawson, lauded Ambulance Service Director Michele St. George, Deputy Director Molly Carey and volunteer EMT and grant writer Steve Carey for a grant the service received for a new ambulance equipped with a power-cot and power-load, which will allow first responders to more easily load patients into the ambulance.
"Congratulations on getting a substantial contract for a new ambulance, that's very exciting," Dawson said at the meeting.
St. George added that "Steven did all the work, so he deserves all the pats on the back."
In a phone interview on Nov. 8, Steve Carey said that the service "applied for a $175,000 ambulance, $21,000 Stryker power-cot, $23,000 Stryker power-load and a Zoll X series [12-lead defibrillator and vital-sign monitor]. We got all of the grant but the Zoll."
The equipment provided by the grant, offered through the Montana Department of Transportation, will be supplied to the department by the MDT, he said, though it's unclear when the city will receive the equipment, and the city must sell one of its two aging ambulances to comply with the terms of the grant.
"The biggest advantage to all this is the four-wheel drive [in the new ambulance]. Right now we're only running two-wheel drive ... but as people move further out into the rural parts," it's vital to have four-wheel drive, he said. "I don't take credit for it. Ellen [Harne, the city clerk] and Michele, and Molly too, got me most of the info that I needed."
The city of Boulder originally contributed $52,000 in match money for the equipment grant, Harne said at the Oct. 18 meeting. But Ambulance Service and city leaders learned later that the grant required only a 10% match, not the 20% match initially stated by the service.
"We allocated more money in match for this than what was required. There was a minor snafu in your favor, so there was actually additional money in the budget," Dawson told Ambulance Service leaders and volunteers at the meeting.
Harne said that the Ambulance Service used $22,000 of $52,000 in matching funds for the MDT equipment grant, leaving an unexpected $30,000 remaining. The service also had $8,000 in grant money earmarked for training, in addition to the $30,000.
And Steve Carey reminded the City Council toward the end of the Ambulance Service discussion that the service was also awarded a $20,000 grant from Town Pump, earmarked for a power-load for one of the city's existing ambulances that will become the service's backup ambulance once the new one arrives.
But city leaders, and Dawson in particular, took issue with what Dawson and Giulio described as a repeated failure on behalf of St. George and Molly Carey, the Ambulance Service leaders, to devise a plan not only for the expenditure of the excess matching funds, but also for how to revitalize the service in years to come.
"So, what are we going to do for a plan? What are we going to do for a strategy moving forward that is going to have a first-rate, high-quality emergency medical services in Boulder that we can sustain, that would have ongoing education, that we can use the new ambulance to help provide that EMS service, and use whatever money we didn't use for the new vehicle to help do that? And how can we as the council help do that? How can we make this work together as a team?" Dawson asked St. George at the meeting.
St. George replied, "You tell me—" before Dawson interrupted.
"No, no, no—I've heard that, I've heard that, I've heard that, I've heard that—and I'm tired, because I've heard that since I took over here—'You tell me,'" Dawson said. "No, I don't run the Ambulance Service. You two run the Ambulance Service. We pay you a bit, it's not much, but we pay you two to run the Ambulance Service."
Over the course of 30 minutes, Dawson, Giulio, St. George, Molly Carey and Steve Carey sparred over whether or not St. George and Molly Carey had attended budget meetings to determine how the department would expend funds, and over who, ultimately, was responsible for steering the department down a viable path.
"I think what Drew's trying to say is, we had asked you guys to come to budget meetings at a number of different times," Giulio said. "And all it is is out of respect for us and you both, just let us know that you can't make it or whatever. We want to help."
At one point in the meeting, Molly Carey threatened to resign because of what she said was "discouraging" treatment from Dawson toward the service.
"I will respectfully resign my position and I have no problem doing that," she said, arguing that she or St. George had been present at every budget meeting that Dawson or Giulio requested they attend.
"Molly, just a minute ... all we're trying to do is, the last budget meeting we had to try to finalize it, we didn't get anybody to show up and we didn't get a response, so all we're saying is, can you help us out? That's all it is," Giulio replied. "So when Drew's saying, what can we do to help, that's what we're asking—what can we do to help and get everybody on the same page."
Dawson added: "What we asked for at the budget meeting that we feel hasn't been delivered, and it might be for a variety of reasons, is a written plan for the utilization for the money—how we're going to use it to build this service. And that's what we asked for at the budget meetings to be delivered, and that's why we're a bit frustrated."
In official city communications provided to The Monitor, Dawson and Giulio formally requested that St. George and Carey attend certain budget-planning and City Council meetings, including the Oct. 18 meeting, and provide written plans for the department's future and the expenditure of funds. In the Oct. 18 meeting, and in a later interview, St. George and Carey maintained that one or both of them attended every meeting in question, which Dawson seemed to acknowledge later in the City Council meeting.
Regarding a written plan, St. George said in a Nov. 8 interview that "I didn't get him a plan. I put it on the back burner and didn't get him a plan. I told him that in the meeting and I apologized to him in the meeting."
Molly Carey did not resign, but Steve Carey, in an email to city leaders later that night, did resign as volunteer grant writer for the service, though he remains a volunteer in the Ambulance Service and in the Boulder-Bull Mountain Rural Volunteer Fire Department.
In emails shared with The Monitor, Dawson apologized after the meeting to the Ambulance Service as a whole and to St. George and Molly Carey individually, and he replied to Steve Carey's resignation email with an individual apology.
"Although I usually pride myself on maintaining a reasonably even temperament, at this meeting I made a very serious mistake. I launched into a serious outburst against members of our very dedicated Ambulance Service," Dawson wrote in a later emailed statement to The Monitor. "After many years of public service, I should know that productive discussions result from calm, candid, private conversations, not such crazy eruptions. I apologize to the ambulance crew members for any negative comments to or about them, and to my constituents for my unprofessional behavior."
In an Oct. 22 interview, Dawson said that "their dilemma certainly is real and their frustration is real, in terms of not having enough volunteers to staff the service. Collectively as a community … we need to figure out what level of emergency medical services we want in our community, and what level of emergency medical services we are willing to support, either financially or by volunteering services for it."
Despite the apologies, Ambulance Service leaders remained frustrated and hurt.
"I'm very hurt by the things Drew implied and said and did," St. George said in the Nov. 8 interview. "He was very hurtful and it was something that should've been handled as a personnel issue and not out in the public."
St. George said in the interview that "Drew is mistaken on the budget meetings. Every budget meeting that we were requested to be at, we were at. Drew's mistaken," though she acknowledged she did not provide a written plan to the city, citing the volunteer nature of her and Molly Carey's positions.
"What Drew doesn't seem to remember is we all have full-time jobs and full-time families. We're busy but we're still trying to help. It'd be real easy to throw up our hands and let St. Pete's and Eagle [Ambulance] get every one of these calls," St. George said. "People need to remember that we have all this other stuff going on, too. Molly and I went on a call on my husband's birthday."
More local EMS volunteers, she said, "need to step up or we are going to lose this," and she argued that "we need better leadership than what was shown at the council meeting."
On Nov. 9, Dawson, Giulio, Harne, St. George, Molly Carey, Steve Carey, City Councilman Bear Taylor and other Boulder Ambulance Service volunteers assembled at Boulder's Ambulance Barn to discuss how to work together better, and how to recruit more volunteers to the Boulder Ambulance Service.
Dawson opened the meeting with an apology.
"I apologize, well, to everyone, but particularly to Michele and Molly, who were at the meeting, for what seemed like a personal attack," he said. "What I’d like to do tonight is mostly listen and … eventually engage in a set of expectations for how we’d work together between the city and the ambulance crew."
Over the course of about an hour, a room full of city and department officials batted around ideas including pitching EMT training to high-school seniors, marketing volunteer positions to stay-at-home parents, encouraging businesses to promote EMT training and volunteerism, and recruiting people qualified only as ambulance drivers to drive and free up EMTs and other first responders to provide medical assistance on calls.
Molly Carey said that the struggle to recruit volunteers stretched back at least 11 years, and that "it's always been a struggle."
City leaders and Ambulance Service directors agreed that some or all of the department's $8,000 in funds earmarked for training could go toward offsetting the cost of new recruits' EMT training in courses that the department is working to schedule with a targeted start date in January, but specifics of how much of applicants' costs would be covered was not settled.
Dawson suggested that determining and publicizing a job descriptions of sorts, specifically detailing volunteer expectations and training reimbursement perks, could incentivize people to volunteer for the service.
Above all, Giulio and Dawson hammered on what they said was a need for greater communication.
"Improving communications seems to improve things, almost all the time," Dawson said. "What would be good is if you guys came up with a plan for the $8,000, how you think it could be best used for the service."