Bayfield County Board Meeting-SPECIAL 2:00 PM, July 15, 2026

1 Bayfield County Clerk Lynn M. Divine, County Clerk Jeran Delaine Deputy Clerk Erin Tibbits Clerk II Ph: 715.373.6100 ● Fx: 715.373.6153 ● Email: Lynn.Divine@bayfieldcounty.wi.gov ● 117 E. Fifth Street, PO Box 878, Washburn, WI 54891 BAYFIELD COUNTY BOARD OF SUPERVISORS Jan Lee, Chair, Fred Strand, Vice-Chair Steve Sandstrom, Jamie Tucker, Larry Fickbohm, Charly Ray, Dennis Pocernich, Jeffrey Olsen, Sue Rosa, Marty Milanowski, Jackie Roguski, James Crandall, Jeff Holte RE: July 15, 2026 Special Bayfield County Board of Supervisors’ Meeting Dear Supervisors: Please be advised that a special meeting of the Bayfield County Board of Supervisors will be held on Wednesday, July 15 at 2:00 PM. This meeting will be held in-person in the Bayfield County Board Room at 117 E 5th St Washburn, WI. Supervisors and the public will be able to participate in the meeting in- person or remotely via voice either by using the internet link or phone number below. _______________________________________________________________________________ Microsoft Teams meeting Join: https://teams.microsoft.com/meet/213718485264560?p=jzBZH1lFtHolyNpVO3 Meeting ID: 213 718 485 264 560 Passcode: Mb2UE6TX Need help? | System reference Dial in by phone +1 715-318-2087,,876206258# United States, Eau Claire Find a local number Phone conference ID: 876 206 258# For organizers: Meeting options | Reset dial-in PIN ________________________________________________________________________________ _____ __________________________________________________________________________ Please contact Bayfield County at 715-373-6181 or 715-373-6100. If you have access questions prior to the meeting. During the meeting if you have connection issues, please email mark.abeles- allison@bayfieldcounty.wi.gov. 1. Call to Order 2. Roll Call 3. Pledge of Allegiance 4. Introduction: Meagan Quaderer, Emergency Management, and Kelly Westlund, Deputy County Administrator Any person wishing to attend who, because of a disability, requires special accommodations, should contact the County Clerk’s office at 715-373-6100, at least 24 hours before the scheduled meeting time, so appropriate arrangements can be made. 2 5. Countywide Emergency Medical Service Overview and Evaluation Process: James Small, Rural EMS Outreach Program Manager, Wisconsin Office of Rural Health 6. Proposal Presentations: Each will deliver a 20-minute presentation with 10 minutes Q & A a) Ashland Fire Department b) Bayfield County c) Essentia Health d) North Memorial Health 7. Impact Statements a) Bayfield County Medical Director, Dr. Jonathan Shultz b) County Dispatch c) Red Cliff 8. Public Comment: Limited to 3 minutes per person, 15 minutes maximum. The County Board welcomes and encourages public comments but will not respond to questions or provide feedback during the public comment period. A topic raised during public comment may be added to a future Board or Committee agenda for additional discussion. The County encourages written comments. Any written comments received by noon on July 15 will be provided to County Board Supervisors at the meeting. Please send written comments to lynn.divine@bayfieldcounty.wi.gov and kelly.westlund@bayfieldcounty.wi.gov. 9. The Board may entertain a motion to convene in closed session pursuant to Wis. Stat. § 19.85(1)(e), which permits a closed session for deliberating or negotiating the investing of public funds or conducting other specified public business whenever competitive reasons require a closed session. The Board may reconvene in open session and take action as appropriate. a) Discussion regarding EMS proposals 10. Discussion and Possible Action regarding EMS Proposal Recommendation 11. Future County EMS-related Meeting Dates: a) In-person Public Meeting – Wednesday, July 22 at 6 p.m., Northern Great Lakes Visitor Center b) Virtual Public Meeting – Thursday, July 23 at 6 p.m. (details to come) 12. Next County Board Meeting – Tuesday, July 28 at 6 p.m., Bayfield County Board room 13. Adjourn Sincerely, LYNN M. DIVINE Bayfield County Clerk LMD/ejt County Board Special Meeting Narrative – July 15, 2026 Please review all proposals in advance of the meeting and do an initial scoring for each using the scoring sheets included in the packet. At the meeting, all respondents will present their proposal and answer any questions that may remain. Item 4. County staff will provide general background on the EMS proposal review process to date, the purpose of the special session, and the intended next steps. Item 5. James Small of the Office of Rural Health will explain the proposal evaluation process and walk through the scoring tools provided. He will also serve as facilitator for questions and Board discussion and will be available as a subject-matter resource on EMS service models, current trends, and key considerations. James facilitated the last public meeting on this topic. James Small grew up on Washington Island and has spent his adult life working in public safety since becoming a first responder in 1993. He has nearly 10 years of experience as a Public Safety Director and has served two municipalities as Police Chief and Fire Chief. He is certified as a Paramedic, Law Enforcement Officer, and Fire Officer II. James works with organizations to develop strategies that improve street-level service delivery to residents. Item 6. The County received three proposals from service providers through the RFP process. In addition, County staff, in partnership with local EMS Agency Directors, developed countywide EMS safety-net options for consideration. Each option will be presented, followed by time for questions. Following each presentation, all Supervisors will then finalize their individual scoring sheets. All sheets will be collected after each presentation for tabulation. Item 7. Invited partners will share brief impact statements regarding current EMS coverage challenges in Bayfield County. Item 9. The Board may convene in closed session for deliberation regarding the EMS proposals. Score sheets will be collected and tabulated to help inform the Board’s discussion and next steps. Item 10. Following deliberation, supervisors are expected to identify an option to advance for public comment at two public sessions the following week. The selected option will then be included on the July 28 County Board agenda for discussion and possible action. Proposals included for review: Please note the price ranges listed for two of the proposals. For added context: • Ashland Fire Department offered estimates for 3 ($360k), 4 ($462k), or 7 days per week service ($1.5M). They anticipate billing revenue that would reduce expenses to Bayfield County, for potential net expense of $320k - $1.1M. • North Memorial has proposed two options, both of which are three-year terms: o Option 1 – 1 BLS ambulance, staffed 12 hrs/day o Option 2 – 1 BLS ambulance, staffed 24 hrs/day Bayfield County EMS Proposal Evaluation Packet Bayfield County EMS Proposal Evaluation Packet Scoring Tool for County Board Review Purpose This packet is designed to help County Board members review EMS proposals in a structured, transparent, and objective way. Each option should be scored independently using the same evaluation criteria and point values. The final scores are intended to support discussion and decision-making. Background Bayfield County is evaluating options to improve Emergency Medical Services across a large rural service area with long response distances, seasonal population increases, staffing shortages, increasing call volume, and limited availability of advanced medical care within the County. The RFP seeks a supplemental EMS “safety net” that improves system coverage, response capability, staffing resiliency, and operational readiness while preserving and supporting the existing volunteer ambulance agencies. Procurement and Evaluation Process Note Bayfield County’s Procurement Policy requires County purchasing to be conducted in a manner that preserves an open, fair, transparent, and competitive procurement process. For requests for proposals, the policy states that evaluation factors and their relative importance should be identified, proposals should be considered to the maximum extent practical, the County should use an evaluation matrix, and contracts should be awarded to a responsible firm with price and other factors considered. County Board members reviewing EMS proposals should use the scoring materials provided, apply the stated criteria consistently to all proposals, avoid considering outside factors not included in the RFP/evaluation materials, and disclose any actual or apparent conflict of interest. The scoring process is advisory and intended to support objective comparison of proposals; any final award or contract approval must follow the applicable County approval process. The RFP evaluation criteria are: Experience and Qualifications (20%), Operational Plan and Coverage Model (20%), Ability to Coordinate with Existing Volunteer Agencies (15%), Staffing and Workforce Stability (15%), Financial Proposal (15%), and Quality Assurance and Clinical Oversight (15%). Bayfield County EMS Proposal Evaluation Packet How to Use This Packet 1. Review each proposal and any supporting materials before scoring. 2. Score each option independently. Do not rank one proposal first and then force the others to fit around that score. 3. Use the full scoring range when justified. A proposal does not need to be perfect to score well, but high scores should be supported by clear evidence in the proposal. 4. Use the notes boxes to identify strengths, concerns, missing information, assumptions, and any follow-up questions. 5. After scoring all six criteria, total the points for each option out of 100. Use the summary table to compare scores across options. 6. Consider both total score and critical risks. A lower-cost proposal may not provide best value if service reliability, staffing, or coordination risks are high. Bayfield County EMS Proposal Evaluation Packet Proposals Included for Review Option Service Type Coverage Staffing Est. Cost Governance Brief Summary Ashland Fire Department ALS/BLS hybrid Flexible Mixed staffing $360K- $1.53M Contracted • Provides supplemental ambulance coverage • Offers flexible deployment with scalable coverage • Can operate at ALS or BLS levels • Integrated with regional partners Bayfield County Quick Response Vehicle Non-transport response 24/7 County EMT staff ~$1.16M County- operated • Establishes a County-run non-transport unit • Provides 24/7 EMT-level response • Supports existing EMS agencies and handles non-transport calls • County responsible for staffing and operations Bayfield County Transport Ambulance BLS ambulance 24/7 County EMT staff ~$1.2M County- operated • Establishes a County-run ambulance service • Provides one 24/7 transporting BLS ambulance • Deploys dynamically based on coverage gaps • County responsible for staffing, operations, and funding Essentia Health EMS ALS ambulance 24/7 Paramedic + EMT ~$990,000 Contracted • Provides one 24/7 ambulance staffed at the Advanced Life Support (ALS) level • Includes paramedic-level care and regional system support • Operates as a contracted service provider • Provides dispatch integration and supervisory oversight North Memorial Health Ambulance BLS ambulance 12-24 hr EMT-based $1.7M- $2.4M Contracted • Provides 12-hour or 24-hour ambulance coverage • Staffing primarily at Basic Life Support (BLS) level • Operates within a large regional EMS system • Includes centralized administration and support services Status Quo / Maintain Current System Existing system Variable Volunteer- based No new County cost Existing • No new service introduced • Current EMS agencies continue operations • No additional staffing or structural changes Bayfield County EMS Proposal Evaluation Packet Scoring Legend and Criteria Use the guidance below to maintain consistency across reviewers and proposals. For 20-point categories, the approximate ranges are Excellent 18-20, Strong 15-17, Moderate 10-14, and Weak/Unclear 0-9. For 15-point categories, the approximate ranges are Excellent 14-15, Strong 11-13, Moderate 8-10, and Weak/Unclear 0-7. Rating Approximate Score Range General Meaning Excellent 90-100% of available points Proposal is highly responsive, well documented, and strongly advances County goals with little apparent risk. Strong 75-89% of available points Proposal is responsive and credible, with only minor gaps, assumptions, or implementation concerns. Moderate 50-74% of available points Proposal addresses the criterion but has notable gaps, uncertainty, or only a limited improvement over current conditions. Weak / Unclear 0-49% of available points Proposal provides limited detail, weak alignment, high risk, or minimal evidence that the criterion will be met. Criterion Max Pts What to Consider Experience & Qualifications 20 Relevant EMS experience, licensure, rural/regional background, references, financial stability, and demonstrated ability to perform. Operational Plan & Coverage Model 20 Service model, hours/level of coverage, deployment/staging, response readiness, mutual aid, communications, and impact on reliability. Coordination with Existing Volunteer Agencies 15 Ability to supplement rather than replace local agencies; coordination with EMS, dispatch, Sheriff, Emergency Management, fire, hospitals, Tribal agencies, and local governments. Staffing & Workforce Stability 15 Adequacy of staffing levels and schedules, recruitment/retention, training, continuing education, background checks, and contingency plans. Financial Proposal 15 Clear pricing, service fees/rates, transport billing practices, assumptions, contract terms, County obligations, sustainability, and value. Quality Assurance & Clinical Oversight 15 Medical direction, clinical quality improvement, patient care review, safety programs, infection control, compliance, and reporting. Bayfield County EMS Proposal Evaluation Packet Score Sheet: Ashland Fire Department Service Type ALS/BLS hybrid Coverage Flexible Governance Contracted Staffing Model Mixed staffing Estimated Cost $360K-$1.53M Reviewer Brief Summary Provides supplemental ambulance coverage with a flexible, scalable deployment model that can operate at ALS or BLS levels and integrate with regional partners. Date Evaluation Criterion Max Score Notes / Evidence / Follow-Up Questions Experience & Qualifications Relevant EMS experience, licensure, rural/regional background, references, financial stability, and demonstrated ability to perform. 20 Operational Plan & Coverage Model Service model, hours/level of coverage, deployment/staging, response readiness, mutual aid, communications, and impact on reliability. 20 Coordination with Existing Volunteer Agencies Ability to supplement rather than replace local agencies; coordination with EMS, dispatch, Sheriff, Emergency Management, fire, hospitals, Tribal agencies, and local governments. 15 Staffing & Workforce Stability Adequacy of staffing levels and schedules, recruitment/retention, training, continuing education, background checks, and contingency plans. 15 Financial Proposal Clear pricing, service fees/rates, transport billing practices, assumptions, contract terms, County obligations, sustainability, and value. 15 Quality Assurance & Clinical Oversight Medical direction, clinical quality improvement, patient care review, safety programs, infection control, compliance, and reporting. 15 TOTAL SCORE 100 Overall comments: Bayfield County EMS Proposal Evaluation Packet Score Sheet: Bayfield County Quick Response Vehicle Service Type Non-transport response Coverage 24/7 Governance County-operated Staffing Model County EMT staff Estimated Cost ~$1.16M Reviewer Brief Summary Establishes a County-run non-transport EMT-level response unit to support existing agencies and handle non-transport calls where appropriate. Date Evaluation Criterion Max Score Notes / Evidence / Follow-Up Questions Experience & Qualifications Relevant EMS experience, licensure, rural/regional background, references, financial stability, and demonstrated ability to perform. 20 Operational Plan & Coverage Model Service model, hours/level of coverage, deployment/staging, response readiness, mutual aid, communications, and impact on reliability. 20 Coordination with Existing Volunteer Agencies Ability to supplement rather than replace local agencies; coordination with EMS, dispatch, Sheriff, Emergency Management, fire, hospitals, Tribal agencies, and local governments. 15 Staffing & Workforce Stability Adequacy of staffing levels and schedules, recruitment/retention, training, continuing education, background checks, and contingency plans. 15 Financial Proposal Clear pricing, service fees/rates, transport billing practices, assumptions, contract terms, County obligations, sustainability, and value. 15 Quality Assurance & Clinical Oversight Medical direction, clinical quality improvement, patient care review, safety programs, infection control, compliance, and reporting. 15 TOTAL SCORE 100 Overall comments: Bayfield County EMS Proposal Evaluation Packet Score Sheet: Bayfield County Transport Ambulance Service Type BLS ambulance Coverage 24/7 Governance County-operated Staffing Model County EMT staff Estimated Cost ~$1.2M Reviewer Brief Summary Establishes a County-run transporting ambulance service, dynamically deployed to coverage gaps with County responsibility for staffing, operations, and funding. Date Evaluation Criterion Max Score Notes / Evidence / Follow-Up Questions Experience & Qualifications Relevant EMS experience, licensure, rural/regional background, references, financial stability, and demonstrated ability to perform. 20 Operational Plan & Coverage Model Service model, hours/level of coverage, deployment/staging, response readiness, mutual aid, communications, and impact on reliability. 20 Coordination with Existing Volunteer Agencies Ability to supplement rather than replace local agencies; coordination with EMS, dispatch, Sheriff, Emergency Management, fire, hospitals, Tribal agencies, and local governments. 15 Staffing & Workforce Stability Adequacy of staffing levels and schedules, recruitment/retention, training, continuing education, background checks, and contingency plans. 15 Financial Proposal Clear pricing, service fees/rates, transport billing practices, assumptions, contract terms, County obligations, sustainability, and value. 15 Quality Assurance & Clinical Oversight Medical direction, clinical quality improvement, patient care review, safety programs, infection control, compliance, and reporting. 15 TOTAL SCORE 100 Overall comments: Bayfield County EMS Proposal Evaluation Packet Score Sheet: Essentia Health EMS Service Type ALS ambulance Coverage 24/7 Governance Contracted Staffing Model Paramedic + EMT Estimated Cost ~$990,000 Reviewer Brief Summary Provides one 24/7 ambulance staffed at the Advanced Life Support level, with paramedic - level care, regional system support, dispatch integration, and supervisory oversight. Date Evaluation Criterion Max Score Notes / Evidence / Follow-Up Questions Experience & Qualifications Relevant EMS experience, licensure, rural/regional background, references, financial stability, and demonstrated ability to perform. 20 Operational Plan & Coverage Model Service model, hours/level of coverage, deployment/staging, response readiness, mutual aid, communications, and impact on reliability. 20 Coordination with Existing Volunteer Agencies Ability to supplement rather than replace local agencies; coordination with EMS, dispatch, Sheriff, Emergency Management, fire, hospitals, Tribal agencies, and local governments. 15 Staffing & Workforce Stability Adequacy of staffing levels and schedules, recruitment/retention, training, continuing education, background checks, and contingency plans. 15 Financial Proposal Clear pricing, service fees/rates, transport billing practices, assumptions, contract terms, County obligations, sustainability, and value. 15 Quality Assurance & Clinical Oversight Medical direction, clinical quality improvement, patient care review, safety programs, infection control, compliance, and reporting. 15 TOTAL SCORE 100 Overall comments: Bayfield County EMS Proposal Evaluation Packet Score Sheet: North Memorial Health Ambulance Service Type BLS ambulance Coverage 12-24 hr Governance Contracted Staffing Model EMT-based Estimated Cost $1.7M-$2.4M Reviewer Brief Summary Provides 12-hour or 24-hour ambulance coverage, primarily at the Basic Life Support level, within a larger regional EMS system with centralized administration and support. Date Evaluation Criterion Max Score Notes / Evidence / Follow-Up Questions Experience & Qualifications Relevant EMS experience, licensure, rural/regional background, references, financial stability, and demonstrated ability to perform. 20 Operational Plan & Coverage Model Service model, hours/level of coverage, deployment/staging, response readiness, mutual aid, communications, and impact on reliability. 20 Coordination with Existing Volunteer Agencies Ability to supplement rather than replace local agencies; coordination with EMS, dispatch, Sheriff, Emergency Management, fire, hospitals, Tribal agencies, and local governments. 15 Staffing & Workforce Stability Adequacy of staffing levels and schedules, recruitment/retention, training, continuing education, background checks, and contingency plans. 15 Financial Proposal Clear pricing, service fees/rates, transport billing practices, assumptions, contract terms, County obligations, sustainability, and value. 15 Quality Assurance & Clinical Oversight Medical direction, clinical quality improvement, patient care review, safety programs, infection control, compliance, and reporting. 15 TOTAL SCORE 100 Overall comments: Bayfield County EMS Proposal Evaluation Packet Score Sheet: Maintain Current System / Status Quo Service Type Existing system Coverage Variable Governance Existing Staffing Model Volunteer-based Estimated Cost No new County cost Reviewer Brief Summary No new service is introduced. Current EMS agencies continue operations without additional staffing or structural changes. Date Evaluation Criterion Max Score Notes / Evidence / Follow-Up Questions Experience & Qualifications Relevant EMS experience, licensure, rural/regional background, references, financial stability, and demonstrated ability to perform. 20 Operational Plan & Coverage Model Service model, hours/level of coverage, deployment/staging, response readiness, mutual aid, communications, and impact on reliability. 20 Coordination with Existing Volunteer Agencies Ability to supplement rather than replace local agencies; coordination with EMS, dispatch, Sheriff, Emergency Management, fire, hospitals, Tribal agencies, and local governments. 15 Staffing & Workforce Stability Adequacy of staffing levels and schedules, recruitment/retention, training, continuing education, background checks, and contingency plans. 15 Financial Proposal Clear pricing, service fees/rates, transport billing practices, assumptions, contract terms, County obligations, sustainability, and value. 15 Quality Assurance & Clinical Oversight Medical direction, clinical quality improvement, patient care review, safety programs, infection control, compliance, and reporting. 15 TOTAL SCORE 100 Overall comments: Bayfield County EMS Proposal Evaluation Packet Overall Comparison Summary Use this table only after completing all individual score sheets. Transfer the total score for each criterion, add the overall score, and note the most important strengths or concerns. Proposal Exp. & Quals 20 points Ops. & Coverage 20 points Coordination 15 points Staffing 15 points Financial 15 points Quality 15 points Total 100 points Rank Key Notes Ashland Fire Department Bayfield County Quick Response Vehicle Bayfield County Transport Ambulance Essentia Health EMS North Memorial Health Ambulance Status Quo / Maintain Current System City of Ashland Fire Department – Stuart Matthias, Fire Chief 215 6th Street East, Ashland, WI 54806 – smatthia@coawi.org June 23, 2026 Bayfield County Emergency Management 117 E. Sixth Street P.O. Box 423 Washburn, WI 54891 Megan and Bryan; Please accept the attached proposal for supplemental emergency medical services for Bayfield County on behalf of the Ashland Fire Department. The Ashland Fire Department is a branch of the City of Ashland. The City of Ashland is in an excellent financial position and maintains an A+ bond rating. A financial summary is included in the attachments. I will be your primary contact as we work through the negotiation process. I look forward to working with you, Bayfield County citizens, the Bayfield County Board, and area service directors as we shape the next phase of emergency medical service delivery in Bayfield County. In order to facilitate immediate communications, please utilize my direct wireless number of 715-979-1141. Our station address and my email are in the heading above. Respectfully, Stuart Matthias Fire Chief Ashland Fire Department EMERGENCY MEDICAL SERVICES PROPOSAL FOR BAYFIELD COUNTY Stuart Matthias, Fire Chief, Ashland Fire Department smatthias@coawi.org 715-682-7052 Page 1 of 8 Introduction The Ashland Fire Department (AFD) is a comprehensive emergency response department based in Ashland, WI. AFD currently provides 911 EMS response at the paramedic level, paramedic intercepts with ambulance services throughout Ashland and Bayfield counties, emergent-only interfacility transfers at the critical care paramedic level, fire suppression, fire inspections, fire investigations, fire prevention, ice rescues, and hazardous materials response. AFD serves as a member of the State of Wisconsin Type II Hazardous Materials Response Team with responds throughout Ashland, Bayfield, Iron, and Price counties. AFD has a primary service area of 400.4 square miles which includes the City of Ashland, and the Towns of Eileen, Gingles, Sanborn, Pilsen, White River, and Marengo. AFD has a history of collaboration with Bayfield County EMS agencies and has proudly supported ambulance services throughout Bayfield County for decades. In 2025 AFD provided: • 60 - 911 EMS calls in the Towns of Eileen and Pilsen • 180 paramedic intercepts with Bayfield County ambulance services • 41 coverage calls when volunteer ambulance services were unavailable • 13 mutual aid responses to assist Bayfield County ambulance services during incidents requiring additional resources • EMS ad Hoc committee active engagement • Bayfield-Ashland County EMS Association membership and active participation Over the years, AFD has built and maintained strong working relationships with Bayfield County Emergency Management, Bayfield Sheriff’s Office, Bayfield County Fire Departments and Ambulance Services, Tamarack Medical Center-Ashland, Ashland Bayfield County Emergency Communication Center, Red Cliff Tribe, Bad River Tribe, and numerous County Committees and Town Boards. AFD has demonstrated its commitment to Bayfield County residents by responding to an increasing number of EMS coverage calls over the past five years. As EMS systems continue to evolve across the region, AFD is seeking opportunities to strengthen service delivery through strategic partnerships. This proposal is intended to enhance EMS coverage in Bayfield County while supporting long-term EMS system stability. History The Ashland Fire Department has served the Chequamegon Bay Area dating back to 1883. Throughout its history, AFD has evolved to meet the changing needs of the community. One of the most significant operational changes occurred in 1967 when the department began providing emergency medical services. In 1994, paramedic level service was added to meet the Page 2 of 8 demand for higher level of prehospital care. Paramedic intercepts have been provided to Bayfield County Ambulance services since 1995. Today AFD employs 21 full-time staff—all with fire, hazmat, rescue, and emergency medical service responsibilities. AFD also employs a part- time administrative assistant and two part-time EMTs. AFD provides fire and EMS service to the City of Ashland, and the townships of Eileen, Gingles, and Pilsen which together encompass 122.9 square miles of Ashland and Bayfield Counties. In addition, AFD also provides EMS only service to the townships of Marengo, White River, and Sanborn in Ashland County bringing our total service area to 400.4 square miles. AFD staff are familiar with Bayfield County’s community, roads, and culture and are prepared to provide high quality emergency medical service on day one. AFD is licensed with the State of Wisconsin to operate at the Paramedic level with a Critical Care Endorsement. Our experience spans generations while encompassing a mix of new providers all focused on serving our community. AFD has also maintained strong partnerships with regional technical colleges which provides hands-on clinical training opportunities for EMS students. These training programs have helped develop lasting relationships throughout the region. In fact, many current Bayfield County EMS providers completed portions of their clinical education alongside AFD personnel. These established relationships with local ambulance services will help ensure a seamless transition and continued collaboration. Collaborative EMS Support in Bayfield County AFD proposes a partnership with Bayfield County to provide dedicated 911 EMS coverage while supporting existing local ambulance services. This proposal is designed as a low-risk, high-value collaboration that strengthens the County’s emergency response network without replacing or undermining current volunteer services. Our goal is to supplement existing ambulance services, improve system reliability, and provide high-quality patient care while preserving the important role local services play within their communities. Key points of the proposal: • One dedicated Advanced Life Support (ALS) or Basic Life Support (BLS) ambulance The ambulance would typically be staffed with one Paramedic or Advanced EMT and one EMT, with occasional staffing by two EMTs when operationally appropriate. • Optional Part-time initial coverage, starting at 72–96 hours per week would allow for a more gradual transition to a full-time crew as well as a gradual transition to the costs associated with a full-time crew • Flexible staffing model: crews will include at least one experienced provider and will include a mix of full-time and part-time staff Page 3 of 8 • Coordination with local EMS: when AFD covers an ambulance territory, local EMS staff can focus on remaining shifts, improving efficiency and overall coverage for the County • State-of-the-art ambulance and equipment: A fully equipped and immediately available F550 4x4 ambulance with Stryker Power Load system, powered stair chair, cardiac monitor/defibrillator, and all necessary medications and supplies to begin operations • Electronic documentation and billing: AFD uses a robust electronic patient care reporting system that integrates with our billing company, ensuring efficient recordkeeping and revenue collection, while providing the Bayfield County EMS Director access for transparency Benefits to Bayfield County This partnership provides a win-win solution: • Strengthens County EMS coverage without disrupting current volunteer services • Supports local EMS personnel by reducing coverage gaps and enabling a more manageable schedule • Provides immediate, high-quality patient care using experienced, cross-trained crews familiar with the County • Leverages AFD’s fleet and operational expertise to ensure uninterrupted service, even during maintenance or staffing fluctuations. AFD maintains five ambulances so another ambulance can be used during maintenance and repairs. • Offers a scalable model: part-time coverage can expand to full-time as needs grow AFD’s approach ensures that Bayfield County residents receive prompt, professional emergency care while preserving and enhancing the capabilities of existing EMS services. Documentation & Billing AFD utilizes an electronic patient care reporting system, ImageTrend Elite, that is designed for efficient processing of claims to all types of insurance providers. AFD also uses ESO for more detailed data reports that are not available through Elite. Each ambulance is equipped with a cellular-enabled tablet and also provides wireless internet access for real-time patient care documentation so that each report can be completed remotely. The Bayfield County EMS Director will have access to all patient care reports once they are completed to ensure that quality patient care is being delivered. Our billing company or AFD can provide segregated billing information. Page 4 of 8 Currently 73% of our EMS calls result in billable revenue. Medicare and Medicaid rates are the largest factors in terms of how much revenue is collected. Medicare currently pays about $718 a call and Medicaid pays about $520 a call. Estimating two billable calls per day at a collection rate of $750 per call, a conservative estimate of billing revenue calculates to $547,500 a year. A percentage of the revenue collected will be retained by AFD to pay for the billing company’s service and to help cover administrative expenses. Revenue generated beyond the agreed upon administrative fees will be paid to Bayfield County. All amounts will be mutually agreed upon during negotiations of the governing agreement. AFD reviews EMS fees annually in consultation with our billing company to ensure fees appropriately reflect the services provided while remaining reasonable and consistent with regional market conditions. A detailed listing of our 2026 fee schedule is included in the attachments. Medical direction AFD’s medical direction is provided by Dr. Jonathan Shultz of Aspirus Medical Center in Duluth Minnesota. Dr. Shultz is an ER doctor who actively practices emergency medicine as well as providing medical oversight for multiple ambulance services in Ashland and Bayfield County. Dr. Shultz began his healthcare career as a paramedic and intimately understands EMS. Dr Shultz supports this proposal and has agreed to provide medical direction for our expanded efforts in Bayfield County. As part of AFD’s new agreement with Dr Shultz, time is allotted to review patient care reports to help us maintain the highest standards. Quality Improvement and Quality Control AFD is very proactive in quality improvement. Daily review is done by in house officers to ensure patient care as well as documentation maintains a high standard. The EMS service director provides oversight as well as routine QI checks. When necessary the medical director is consulted for additional guidance. The service director in conjunction with the trauma coordinator at Ashland Medical Center review a significant number of trauma calls to ensure we are providing the highest standard in trauma care. Findings from quality improvement reviews are used to guide future EMS training and continuing education, helping maintain a consistently high standard of patient care. AFD utilizes a Safety Committee consisting of both department officers and line staff to proactively address common safety issues and ensure the work environment at Ashland EMS is of the highest standard. AFD in conjunction with Ashland Medical Center train staff on best practices for infection control. This includes ensuring staff are up to date on with common vaccinations as well as providing testing for possible infection when necessary. Accepted body substance isolation Page 5 of 8 practices are utilized on all calls for service. All personal safety equipment is provided by the department and is readily available for all staff. AFD has had no Wisconsin EMS Licensing infractions or violations, no Federal healthcare regulation violations, no Medicare or Medicaid billing infractions or violations, no HIPAA violations or infractions, no OSHA violations, and no local ordinance violations. Ambulance Fleet, Communications, and Equipment The Ashland Fire Department maintains a fleet of five licensed Advanced Life Support ambulances to ensure reliable emergency medical service delivery and operational redundancy. All ambulance maintenance is overseen by a member of AFD and performed by experienced City of Ashland Fleet mechanics as well as local automotive shops. All maintenance intervals meet or exceed factory recommendations. AFD rotates front-line ambulances each month to ensure ambulances receive scheduled maintenance. The ambulance assigned to Bayfield County will also be rotated as needed so that routine maintenance can continue without affecting operations at any location. Unit Year Chassis Drive Med 3 2020 Ford F-450 Rear-Wheel Drive Med 4 2013 Chevrolet E-3500 Rear-Wheel Drive Med 5 2023 Ford E-450 Rear-Wheel Drive Med 7 2022 Ford F-550 Four-Wheel Drive Med 8 2018 Ford F-550 Four-Wheel Drive AFD maintains a fleet replacement program with ambulances typically replaced on a ten-year lifecycle. Med 4 is currently scheduled for replacement in August 2026 with a new Ford F-550 four-wheel-drive ambulance. This replacement will further enhance the department's ability to operate during severe weather and challenging road conditions common throughout northern Wisconsin. All ambulances are licensed and equipped at the Advanced Life Support level and utilize a standardized equipment configuration. Standardization allows personnel to operate efficiently regardless of vehicle assignment while ensuring consistent patient care throughout the fleet. Each ambulance is equipped with Physio-Control LIFEPAK 15 cardiac monitor/defibrillators, LUCAS mechanical CPR devices, Stryker powered cots, FERNO powered stair chairs, advanced airway equipment, medication administration equipment, and ALS patient care supplies and medications that are stored in a locked vault. Page 6 of 8 AFD maintains interoperable communication systems and technology capabilities to support emergency operations throughout the region. Each ambulance is equipped with WISCOM- compatible mobile radios, cellular-enabled iPads, cellular phones, GPS navigation, and electronic patient care reporting capabilities. All EMS personnel carry portable radios, ensuring continuous communications between responders, dispatch centers, hospitals, and partner agencies during emergency operations. AFD upgraded their base radio to an all band capable radio in May providing a level of redundant communication capabilities needed for emergency operations now and well into the future. Scope of Work Provided AFD remains committed to finding the EMS solution that works for Bayfield County while allowing AFD to sustainably grow to meet the demand for more service as our partnership grows. We plan on providing a dedicated ambulance and staff for Bayfield County’s needs. This ambulance crew will respond to 911 calls as well as non-emergent medical calls that are dispatched by our Emergency Communications Center. The AFD Chief in collaboration with Bayfield County will work to locate the ambulance in areas that are in the highest need for a supplemental ambulance or in areas where it is known that no ambulance crew is available. This cooperative scheduling will position the ambulance where it is needed most to help reduce response times. This ambulance can also be staged to service areas when the local ambulance is transporting a patient to a hospital. AFD will work with Bayfield County to determine locations suitable for overnight EMS operations as well as locations for daytime EMS staging sites that provide staff with suitable accommodations for report writing, online training, and community engagement. AFD staff that are cross-trained in fire and EMS will rotate through assignments in Bayfield County keeping staff engaged in daily operations while providing them a diverse work environment. As the ambulance schedule is developed, Bayfield County events such as Applefest, the American Birkebeiner, and the Bayfield County Fair can be incorporated into deployment planning. This flexibility allows local ambulance services to focus on either event coverage or 911 response while the AFD ambulance fills the remaining need. One additional AFD ambulance could be available for special events at an additional rate once all staffing needs have been met. The AFD ambulance, when on duty in Bayfield County, will be available for mutual aid calls or for backfilling local Bayfield County ambulance services that are providing mutual aid. The same is true for coverage calls, the AFD ambulance, when on duty, can provide EMS coverage or back fill for other services that are providing EMS coverage. Any mutual aid response or coverage response to Ashland County will be limited to disasters or multi-casualty incidents if allowed by the governing agreement. Page 7 of 8 The AFD ambulance will not be available for interfacility transfers under the scope of this proposal. Staffing Plan Over the past five years, the Fire Chief has demonstrated the ability to recruit and hire high- quality employees using both conventional and innovative recruitment methods. The department has successfully developed these employees into highly capable EMS providers through structured training and mentorship. Four to five full-time staff would need to be hired as well as two to three part time staff to facilitate a three to four day-a-week model of service. Fully staffing an ambulance 24/7/365 will require a minimum of seven full-time staff and six part-time staff as well as an EMS administrator/service provider. All prospective candidates are screened multiple times before in-person interviews occur with a panel of citizens and department staff. Candidates that are selected for hire receive medical and psychological screening to ensure physical and mental health of all employees upon hire. This extra level of screening helps ensure citizens that their first responders are competent and capable to do the job. New employees receive one-on-one onboarding during their first week and follow a scripted training program for the first three months as the new employee works as part of a three- person EMS crew. Each employee training program is tailored to their specific needs and progression to more responsibilities is not automatic, it must be demonstrated and documented repeatedly. Training continues throughout the first year and the complete training manual is available upon request. Costs & Implementation AFD’s staffing, equipment, and administrative infrastructure allow for rapid deployment and high operational readiness, minimizing risk to the County while maximizing service delivery. AFD is proposing to start service in a part-time capacity and increasing service to seven days a week over a span of 12-24 months • Part-time coverage (3 days/week): $359,622.56 for 2027 • Part-time coverage (4 days/week): $462,060.50 for 2027 • Full-time coverage (7 days/week): $1,525,671.47 for 2027 • All options include personnel wages and benefits, supplies, equipment, training, hiring, and capital depreciation • Additional staffing and recruitment plans are already in place, with qualified candidates selected and ready to onboard immediately Page 8 of 8 All costs listed are estimated based on projected expenses and will be finalized during negotiations of the terms of a service agreement. References Marty Milanowski, Chairman of the Town of Eileen. 715-746-2484. martyrm@cheqnet.net Receives fire and EMS services from AFD, participated in contract negotiations. Luis Salas, Chairperson of the Town of Sanborn. 715-292-4698. salasluis0150@gmail.com Receives EMS service from AFD, participated in contract negotiations. Stephen Walson, Chairman of the Town of Marengo. 715-292-0866. stephen_walston@cheqnet.net Receives EMS service from AFD, participated in contract negotiations. Gary M. Johanik, Chairperson of the Town of Pilsen. 715-746-2911. gajj@cheqnet.net Receives fire and EMS services from AFD, participated in contract negotiations. Patrick Colgrove, Chairperson of the Town of Gingles. 715-209-5592. patrickcolgrove@hotmail.com Receives fire and EMS service from AFD, participated in contract negotiations. Matt Lehto, Chairperson of the Town of White River. 715-292-2720. 14ledo81@gmail.com Receives EMS service from AFD. Summary AFD is uniquely positioned to enhance EMS coverage in Bayfield County. With our experienced staff, proven operational success, modern equipment, and long-standing commitment to the region, this partnership is a strategic, low-risk, and high-value solution. This proposal is focused on supporting local EMS, protecting residents, and strengthening regional emergency services. AFD’s proven track record demonstrates our ability to deliver reliable high-quality care, ensuring a safer Bayfield County for all. AFD is prepared to begin implementation immediately upon agreement and welcomes the opportunity to formalize this partnership. Onboarding of additional employees will begin in 2026 to ensure that the desire level of service will be available in 2027. ASHLAND FIRE DEPARTMENT 2026 FEE SCHEDULE AMBULANCE FEES: Resident Non-Resident Basic Life Support $1,350.00 $1,640.00 Advance Life Support 1 $1,450.00 $1,750.00 Advance Life Support 2 $1,860.00 $2,020.00 SCT Base Rate $1,970.00 $2,185.00 Mileage $23.00 $26.00 Oxygen N/A Bundled into baseN/A Bundled into base Spinal Immobilization $160.00 $165.00 4th Lift Assist or > per yr $180.00 $375.00 7th Life Assist or > per yr $375.00 Lift Assist at Nursing Facility $180.00 $375.00 Non-res Lift Assist or No Transport $375.00 Ambulance Transfer w/ no medical necessity $475.00 + mileage $595.00 + mileage BLS on Scene Care $400.00 $515.00 ALS on Scene Care $1,030.00 $1,400.00 Intravenous Access at a Medical Facility $185.00 **Fee increases includes billed supplies **Fee increases includes billed supplies Engines $510.00 per hour Aerial Apparatus $765.00 per hour Tanker $510.00 per hour Command Vehicle $200.00 per hour Ambulance $340.00 per hour Ambulance for Local Events $127.00 per hour/per ambulance Brush Truck $310.00 per hour Ice Angel $660.00 per hour Snowmobile/Rescue Trailer $175.00 per hour Haz Mat Trailer $525.00 per hour Extrication Equipment $195.00 per hour APPARATUS FEES: PRELIMINARY AS OF 6/22/2026 - UNAUDITED PRELIMINARY AS OF 6/22/2026 - UNAUDITED PRELIMINARY AS OF 6/22/2026 - UNAUDITED PRELIMINARY AS OF 6/22/2026 - UNAUDITED CITY OF ASHLAND 2027 BUDGET BAYFIELD COUNTY AMBULANCE Base 2027 DESCRIPTION ESTIMATES PERSONNEL COSTS 100 52300 111 SALARIES & WAGES 720,218.23$ 100 52300 112 OVERTIME WAGES 24,400.00$ 100 52300 113 UPGRADE & SHIFT DIFFERENTIAL 1,320.00$ 100 52300 125 WAGES-PART TIME 162,500.00$ 100 52300 131 LONGEVITY PAY 7,490.00$ 100 52300 132 HOLIDAY PAY 32,769.20$ 100 52300 133 RETIREMENT PAYOUT -$ 100 52300 136 CLOTHING 3,150.00$ 100 52300 151 SOCIAL SECURITY 14,000.00$ 100 52300 152 EMPLOYER RETIREMENT 150,703.50$ 100 52300 157 HSA CONTRIBUTION 17,400.00$ 100 52300 154 MED/DENT INSURANCE 176,657.20$ 100 52300 155 LIFE INSURANCE 784.00$ 100 52300 156 WORKER'S COMP INSURANCE 20,709.20$ 100 52300 159 OTHER EMPLOYEE CONT 3,680.00$ 100 52300 190 POST EMPLOYMENT HEALTH -$ 100 52300 191 RETIREE HSA DEDUCTIBLE -$ TOTAL PERSONNEL COSTS 1,335,781.33$ SERVICES 100 52300 213 BILLING COMPANY 43,800.00$ 100 52300 221 WATER/SEWER 4,360.00$ 100 52300 222 ELECTRICITY 8,720.00$ 100 52300 224 NATURAL GAS 4,013.60$ 100 52300 225 TELEPHONE & DATA 2,713.60$ 100 52300 290 SERVICE CONTRACTS 5,880.00$ TOTAL SERVICES: 69,487.20$ MATERIALS/SUPPLIES/MAINTENANCE 100 52300 311 POSTAGE 80.00$ 100 52300 313 PRINT/COPY 120.00$ 100 52300 319 OFFICE SUPPLIES 240.00$ 100 52300 322 SUBSCRIPTIONS 120.00$ 100 52300 324 MEMBERSHIP DUES 1,088.40$ 100 52300 337 CERTIFICATION - CONT ED 5,760.00$ 100 52300 339 TRAVEL/TRAINING-OTHER 3,480.00$ 100 52300 340 OPERATING SUPPLIES 28,560.00$ 100 52300 342 GAS & OIL 22,954.55$ 100 52300 344 JANITORIAL 800.00$ 100 52300 350 R&M - TRANSPORTATION 8,000.00$ 100 52300 352 R&M - EQUIP/MACHINERY/TOOL 2,000.00$ 100 52300 354 R&M-TEL/DATA COMM 400.00$ 100 52300 355 R&M-BUILDINGS -$ 100 52300 357 R&M-MAINTENANCE OTHER 200.00$ 100 52300 390 MISCELLANEOUS 600.00$ TOTAL MAT/SUPPLIES/MAINT: 74,402.95$ 3 Day/Week Service4 Day/Week Service Capital Costs 46,000.00$ TOTAL BC AMBULANCE COST 1,525,671.47$ 359,622.56$ 462,060.50$ EMS REVENUES PROJECTIONS 100 46230 PROJECTED BILLING REVENUE 547,500.00$ 117,000.00 $ 156,000.00$ Less Offsets back to AFD 114,750.00$ 76,800.00$ 90,600.00$ Total Revenues to BC 432,750.00$ 40,200.00$ 65,400.00$ NET EXPENSES FOR BAYFIELD COUNTY 1,092,921.47$ 319,422.56$ 396,660.50$ State of Wisconsin Department of Health Services DIVISION OF PUBLIC HEALTH 210 EAST WASHINGTON AVE. P.O. BOX 2659 MADISON WI 53701-2659 TELEPHONE: 608-266-1568 dhs.wisconsin.gov/EMS 5/15/2026 Ashland Fire Department 215 6th Street E Ashland, WI 54806 This is your Emergency Medical Services Provider license. Wis. Admin. Code § 110.46 states: A License issued by the department to an emergency medical service provider is valid as long as the provider remains in continuous compliance with EMS-related federal and state statutes, this, chapter, and the operational plan approved by the department, or until the provider notifies the department in writing that it intends to cease providing emergency medical services or the department suspends or revokes the license. License Number 6000349 State of Wisconsin Valid Through 06/30/2029 DEPARTMENT OF HEALTH SERVICES License Paramedic with Critical Care Endorsement 911 Transporting Service, ALS Intercept Service, Critical Care (Ground) Service, Interfacility Transport Service The EMS Service Provider listed below has complied with the provisions of the Wisconsin statutes and is hereby authorized to engage in this activity. Ashland Fire Department 215 6th Street E Ashland, WI 54806 NOT TRANSFERABLE 1 | P a g e Quick Response Vehicle Emergency Medical Services Proposal for Bayfield County, Wisconsin Submitted to: Bayfield County, Wisconsin Submitted by: Bryan D. Ziemann, NRP, County EMS Coordinator Date: March 31st, 2026 2 | P a g e Introduction This proposal represents the collective input of Emergency Medical Services (EMS) Directors from multiple Bayfield County EMS agencies, who convened in July, September, November, and December 2025. The EMS planning process was facilitated by Mr. James Small of the University of Wisconsin Office of Rural Health. Bayfield County, Wisconsin has long been served by 9 EMS organizations. Seven of those EMS agencies: Barnes, Bayfield, Iron River, Mason, Red Cliff, South Shore, and Washburn- are considered “volunteer” BLS ambulance services. They typically provide minimal compensation to their EMT’s, but more recently some of the agencies have hired a handful of full time EMT’s or increased call time compensation for their existing EMT’s to help them cover gaps in staffing. Two EMS agencies, Ashland Fire Department and Great Divide EMS are considered career ALS (Paramedic level) agencies and employ both career EMT’s and Paramedics. Geography, not call volume, has long dictated the location of ambulances in Bayfield County. The current system has been in place for decades, and those organizations have served Bayfield County well since the 1970’s. Over time, multiple factors have contributed to a systemic decline in volunteer EMS everywhere- including here in Bayfield County. Our volunteers are not the problem- but a lack of volunteers is the problem. We’re seeing a decrease in availability of ambulances, increased response times, and frequent scenarios where multiple ambulances are unable to respond due to lack of staffing. As a result, patients are potentially placed at risk and patient outcomes are impacted. The decline in rural EMS is happening nation-wide, and we are not immune from the fallout from that decline. In this proposal, it is important to emphasize that OUR EMS VOLUNTEERS IN BAYFIELD COUNTY ARE CORE TO OUR FUTURE SUCCESS. It is important to note that there is no simple solution to our EMS system’s decline. The approach must be multifaceted, with strategies to address short-term problems, and provide the scalability to become a long-term solution. As a solution, we are proposing: 1. Retain and support the current EMS system in Bayfield County. Bayfield County will allocate $200,000 annually to establish a performance-based EMS staffing Grant Fund for local EMS agencies. The funding is intended to: Support direct staffing costs, improve local staffing availability, reduce missed EMS calls, and incentivize accountability and performance. 2. Quick Response Vehicles staffed with Emergency Medical Technicians (EMTs) who are capable of performing a wide range of duties, including serving as first responders to EMS calls and functioning as EMT crew members alongside our volunteer EMS agencies. These units are designed to supplement and strengthen our 3 | P a g e existing volunteer EMS system, working in partnership with local agencies to support and enhance the vital services they already provide to the community. The Bayfield County EMS plan is designed to be scalable. In its initial phase, it will include one staffed Quick Response Vehicle (QRV) operating at the Basic Life Support (EMT- Basic) level, capable of deployment throughout the county to address gaps in EMS coverage. The system can expand to a second QRV if needed, or transition to a transporting service. These vehicles will provide versatile support, responding to a range of incidents—from emergent 911 calls, to lift assists and medical alarms—at the request of local volunteer EMS partners. The Quick Response Vehicle will be strategically positioned to supplement areas experiencing insufficient volunteer staffing. Additionally, the EMT’s assigned to the QRV will be cross-credentialed, enabling them to integrate seamlessly as crew members with the various ambulance services operating across Bayfield County. It is noteworthy that both Ashland Fire Department and Great Divide EMS play an important role as emergency 911 ambulance providers and provide Paramedic intercept support for the county’s volunteer BLS agencies. It is anticipated that they will continue in those roles as they do today. The timeline for the project is as follows: - Q1 2026, 2 proposals: Quick Response Vehicle and Transporting Ambulance Service will both be completed and submitted to Bayfield County administration - Q2 2026, Public engagement will occur. Meet with municipal, tribal, and EMS communities to present the proposals and receive feedback before April 15th. Host Town Hall forums for municipalities, tribal, and EMS communities followed by separate Town Halls for the general public to discuss the proposals by May 10th. Present the outcomes and stated support for the two proposals for the County Board to approve by June 30th, 2026. - Q3 & Q4 2026, Bayfield County EMS will execute an implementation plan that will be provided to the County Board - Go live will occur January 1, 2027 Cost Overview: There are many potential funding sources to assist Bayfield County in the formation of their new EMS system, but the lion’s share of funding will need to come via the county’s EMS tax levy. Wisc. Statute 66.0602(3)(e)6 identifies an exemption for local levy limits for county-wide EMS. It clearly defines the exemption: https://docs.legis.wisconsin.gov/document/statutes/66.0602(3)(e)6. The amount that a county levies in that year for a countywide emergency medical system. Initial startup costs in Q3 & Q4 of 2026 are expected to be $188,999 depending upon availability of SUV’s to serve as Quick Response Vehicles along with any additional facility costs. The staffing cost of an EMT level Quick Response Vehicle is approximately $1,045,924.88. Annual Operating costs are estimated to be $120,000. 4 | P a g e Multiple Grant sources are available to Bayfield County to potentially help fund our system. We intend to pursue grants from the State of Wisconsin which will potentially cover some of the cost of the transition. The State’s EMS Funding Assistance Program can potentially contribute $100,000 to our startup costs. In addition, $50B has been federally allocated to the States in the form of the Rural Health Transformation Program. Guidelines are still being developed for the Rural Health Transformation Grant which will distribute those funds in rural Wisconsin and place an emphasis on rural health workforce development. Bayfield County’s EMS levy is exempt from the levy cap. The County can address funding for Bayfield County EMS by any of the following 3 options: 1. Equal Share County-wide EMS Levy: Bayfield County levies for all EMS agencies in the County, including the existing transporting ambulance services in the County. This relieves the Towns of the burden of having to levy for EMS, and mitigates concerns over double taxation. 2. Utilization-based Cost Sharing: Levy municipalities based on their utilization of Bayfield County EMS. Metrics such as EMS incidents dispatched, patient contacts, etc. can be used as the basis for a levy for the municipalities that utilize the new agency the most. 3. Bayfield County levies just for the cost of operation of Bayfield County EMS, and local Towns will continue to levy for their local agencies as they have previously. There will be minimal revenue generated from patient billing. However, beginning January 1, 2027, Wisconsin Medicaid will begin reimbursing $175 for “Treatment, No Transport” thereby providing revenue for calls such as lift assists. The rest of the EMS agencies in the county will continue to bill patients as they do today. Staffing one EMS QRV for continuous 24/7/365 operation requires 8 EMTs and a County-Wide EMS Coordinator, resulting in a total annual personnel cost of $1,045,924.88. This model ensures operational readiness, system oversight, and sustainable workforce coverage across the county. The staffing budget estimates below are based upon 24-hour shifts but could be changed to reflect 12-hour shifts based upon employee preference. Operational Details Bayfield County has traditionally been served by 9 ambulance services: Ashland Fire Department, Barnes Ambulance, Bayfield Ambulance, Great Divide EMS, Iron River Ambulance, Mason Ambulance, Red Cliff Ambulance, South Shore Ambulance, and Washburn Ambulance. The areas covered by each of those agencies in Bayfield County are shown below: 5 | P a g e Bayfield County EMS would become its own department within Bayfield County and maintain its own budget. For management of the new organization, the EMS Coordinator position would likely transition to an EMS Director role, and a Team Lead position could be hired during the implementation process to assist with planning, capital purchasing, and 6 | P a g e new employee onboarding. For Medical Direction, and to maintain consistency across the EMS system, Dr. Jonathan Shultz would continue to be utilized in the Medical Director role. Vehicles: The County’s EMS Quick Response Vehicles would typically consist of SUV’s such as a Dodge Durango or Ford Explorer, configured to safely transport EMT’s and the necessary medical equipment required for rapid response. These vehicles would likely be outfitted in a manner similar to the County’s law enforcement fleet to ensure operational consistency and reliability. Initial outfitting and startup costs would include essential equipment and technology such as radios, emergency lighting/sirens, Automatic Vehicle Location (AVL) systems, mobile data computers, and related communication and response equipment. These components represent a significant portion of the startup investment required to place each unit into service. Recommended planning budget: Approximately $80,000 per unit for a fully equipped EMS Quick Response SUV. Each ambulance service in the county could serve as a host location for QRV crew when they are providing coverage within that agency’s service area. Utilizing existing EMS facilities would support coordination with local providers and allow QRV personnel to integrate effectively with on-duty crews. Additionally, an assessment of existing County facilities would be necessary to identify suitable locations where QRV units could be stationed when providing coverage across multiple service areas or supporting more than one agency. This evaluation would help ensure that QRV resources are strategically positioned to maximize response efficiency and countywide coverage. It is intended that the location of the QRV’s would not be static, but dynamic to cover locations in the County where limited or no volunteer staffing exists. Partnerships with Townships, Fire Departments, and our existing EMS partners can aid in identification of “posting locations” for the QRV’s. The use of scheduling software will be essential in determining where Quick Response Vehicles (QRVs) should be positioned throughout the county. Ambulance services will provide their anticipated EMT staffing shortages and availability, allowing the County to identify gaps in volunteer coverage and strategically deploy QRVs to areas where additional support may be needed. If a QRV is dispatched to a call in one of these areas and the local volunteer agency is able to respond, the QRV can be cancelled or reassigned as appropriate. This approach helps ensure that a responder is dispatched more consistently, improving overall reliability of emergency medical response across the county. The County’s 911 Communications Center/PSAP will also be better equipped to ensure that the appropriate resources are dispatched to medical emergencies. By having visibility into staffing gaps and ambulances that are temporarily out of service, dispatchers can make more informed decisions that support more consistent responses, improved response times, and fewer missed calls. Additionally, with the planned implementation of Emergency 7 | P a g e Medical Dispatch (EMD) in 2026, dispatchers will have enhanced tools to triage medical calls more effectively. This will further strengthen their ability to ensure that the closest and most appropriate emergency responders are notified and dispatched. The combination of EMD within the dispatch center and the ability to deploy the closest appropriate resources from the outset should significantly improve the overall reliability and response times of the county’s EMS system. Local volunteer ambulance services will continue to bill patients for transport through outside agencies that specialize in EMS billing. Several such companies operate in Wisconsin and typically retain a percentage of the revenue they collect. Patient billing revenue will remain an important source of support for local ambulance services. Beginning January 1, 2027, Bayfield County EMS will also be able to bill Wisconsin Medicaid $175 for services such as lift assists, though this is expected to generate only limited revenue. Group purchasing contracts such as the Savvik EMS buying group (https://savvik.com/) would be utilized to leverage best pricing for capital equipment, medical supplies and if needed the QRV’s and technology. Coop buying leverages the aggregation of volume from coop members nationwide. Why Are We Doing This? Zip Code shouldn’t dictate the quality of the emergency medical care you receive. It’s not an exaggeration to say that we are seeing failures in Bayfield County’s EMS system, and we need to take meaningful steps short term to try to stem further decline. In 2025, 108 calls were unanswered by the closest community ambulance- which was a 65% increase over the previous year. In many cases, multiple ambulance services were dispatched in order to find one that could respond to the call. In particular, the ambulance services in Washburn and Red Cliff have experienced the biggest staffing challenges, but it is important to note that their percentage of missed calls is similar to other agencies in the county. Their missed call data is skewed due to Washburn and Red Cliff having the highest call volume among volunteer EMS agencies in Bayfield County. Especially over the past decade, rural communities across the country have faced a steady decline in volunteer EMS personnel, creating a growing strain on the ability to provide timely and effective emergency care. Many rural EMS agencies, once sustained by strong volunteer bases, are now struggling to recruit and retain members due to factors such as an aging population, increased training requirements, demanding time commitments, and limited financial incentives. Young adults are often drawn to urban centers for employment opportunities, leaving fewer residents available to serve in volunteer capacities. As a result, response times in many rural areas have increased, and remaining volunteers are experiencing higher workloads and burnout. This decline threatens the sustainability of rural EMS systems and highlights the urgent need for innovative strategies, funding 8 | P a g e support, and community engagement to ensure that all residents—regardless of location— continue to receive prompt, high-quality emergency medical care. Since COVID, EMS call volumes have risen significantly due to a combination of demographic, social, and healthcare-related factors. An aging Bayfield County population has contributed to a higher frequency of medical emergencies, particularly among individuals with chronic conditions such as heart disease, diabetes, and respiratory illness. Additionally, limited access to primary care and mental health services, especially in our rural and underserved areas, has led many individuals to rely on EMS as their first point of contact for non-emergent medical needs. Increases in senior housing, longer life spans, and early discharge from hospitals further add to the burden. Dramatic increases in other non- emergent calls such as lift assists, medical alarms, and welfare checks have made it difficult to get volunteers to cover. The ongoing opioid crisis and increases in behavioral health emergencies have also driven up the number of 911 calls. Furthermore, our county’s increased seasonal population growth, greater public awareness of emergency services, and a lower threshold for calling for help have all contributed to the overall increase in EMS demand. All together, these trends have had a dramatic impact on our EMS systems, requiring expanded resources, staffing, and innovative service delivery models to meet growing community needs. Goals & Objectives There are 3 key areas of emphasis in the creation of Bayfield County EMS: - To develop a reliable, sustainable EMS response model - Provide a reliable safety net for the existing volunteer EMS system - Improve patient outcomes through improved response times and timely critical patient care interventions What we’re addressing: - Reliability- Between our existing volunteer EMS agencies, and full-time county Quick Response Vehicles to back them up, we’ll strive to eliminate missed calls. We’re adding a critical layer to the EMS system that will function as a safety net now and into the future. - Performance- we’ll expand the scope of what our EMT’s can do and encourage them to respond to the scene directly if they are not part of an ambulance crew thereby improving response times - Sustainability- Career staff being supported by consistent funding - Recruitment & Retention of Existing Volunteers- Bayfield County EMS is intended to supplement the existing volunteer system and should provide relief for volunteers who have experienced burn out due to lack of depth in staffing 9 | P a g e - Safety Net- Calls such as lift assists, welfare checks, and medical alarms that are increasing can be transitioned to Bayfield County EMS to reduce the burden on our volunteer responders Performance of the new EMS service will be carefully monitored, with regular reports to the County ongoing. Performance indicators such as volume, response times, clinical performance, reimbursement, and review of QRV locations relative to call volume will be regularly reviewed. The Bayfield County Sheriff’s Committee will monitor service performance in collaboration with our volunteer providers. Scope of Services / Service Model Bayfield County EMS will be licensed through the State of Wisconsin DHS as an “Emergency Medical Technician, 911 Non-Transporting Service” and adhere to State Statute. In 2023, Bayfield County created a licensed non-transport agency called Bayfield County MCI Team. From a licensing standpoint: the name would be changed, the service level would remain the same, and the operation plan would simply need to be updated. The joint Ashland/Bayfield Emergency Communications Center will provide dispatching for Bayfield County EMS, and they will be a key partner in making sure that the new agency is immediately dispatched in scenarios where volunteer staffing at the local level is lacking. Communications will be done on the county’s existing radio system. Physician Medical Direction will be provided by Dr. Jonathan Shultz via Aspirus Health/St. Luke’s Hospital in Duluth. Dr. Shultz currently provides Medical Direction to the majority of the Bayfield & Ashland County EMS systems. He will conform to all requirements for Medical Direction https://www.dhs.wisconsin.gov/ems/med-dir.htm as outlined in WI State Statute 256.15. https://docs.legis.wisconsin.gov/statutes/statutes/256/15/8m As a non-transport entity, Bayfield County EMS would not provide hospital-to-hospital interfacility transport. But, if an emergent interfacility transfer from Tamarack Health/Ashland Medical Center arises to Duluth, and no other options are available for interfacility transport, Bayfield County EMS could potentially help to provide 911 coverage that would enable Ashland Fire Department or Great Divide EMS to complete the transport. The first priority is serving the needs of 911 calls in Bayfield County. Training & Management Ongoing EMS Continuing Education is necessary to help EMS staff maintain their patient care skills and readiness. Through a combination of internal education, online content, 10 | P a g e Medical Director education, and courses offered through Northwoods Technical College, Bayfield County would need to commit the necessary funding to allow EMT’s to maintain their licensure. Education programs would be available quarterly, and coordinated with license renewals of our EMS providers. Attendance of EMS conferences outside of the area for continuing education would likely be encouraged. Onboarding of new employees is critical to assure that a proper baseline for performance is set. New employee onboarding will consist of classroom education along with ride-alongs with experienced EMT’s. Skills checks will be utilized regularly as required by Medical Direction. More specialized skills within the Wisconsin EMT scope of practice including: Non-Visualized Airways, ETCO2 monitoring, CO monitoring, mechanical CPR, 12 lead ECG acquisition/transmission, and nebulized airway medications would be standardized. Equipment, Facilities & Technology Ideally, Bayfield County will develop Bayfield County EMS as a collaborative effort with our existing volunteer providers. The Quick Response Vehicle model could provide up-front cost savings versus pursuing a full-blown transporting ambulance service. The costs associated with the purchase of new ambulances vary significantly, but in general a new ambulance can easily exceed $275,000.00, whereby SUV’s can be purchased at a significantly lower cost. A realistic budget for a street-ready Quick Response Vehicle is approximately $80,000.00. From an equipment perspective, several pieces of equipment would need to be budgeted for and purchased. Utilizing some aggressive EMS buying groups such as Savvik, https://savvik.com/ , significant money can be saved up front and streamline the purchasing process. Up front costs for medical equipment including bags, cardiac monitor, Lucas CPR device, other durable goods, disposables, etc. would likely be around $80,000.00. An important priority in our implementation will be related to connectivity & technology. Computer technology plays a vital role in EMS by enhancing the speed, accuracy, and quality of patient care. Advanced communication will allow the QRV’s to receive real-time dispatch information, navigate to a scene, access patient histories, and coordinate effectively with hospitals before arrival. Electronic patient care reports improve documentation accuracy and enable faster data sharing, which supports better clinical decision-making and continuity of care. Electronic Patient care reports flow seamlessly to patient billing systems, and associated data fulfills Wisconsin EMS data reporting requirements. Technologies such as cardiac monitor (12 lead ECG transmission) will be leveraged to provide advanced notice to receiving facilities for cardiac patients that potentially need to be sent to Duluth to the Cath Lab. Wireless routers for data access, ruggedized tablets for patient care reports, and mobile data terminals to receive dispatch/CAD data will be key technology components. 11 | P a g e A significant cost savings can be achieved if existing County facilities are utilized as stations/crew quarters. Other options include collaboration with our existing volunteer ambulance services to base out of when providing coverage for those volunteer agencies. The nature of this proposal allows Bayfield County EMS to act as a safety net and deploy to wherever they are needed. As a result, agreements would be identified early on during the implementation process. Assuming that agreements for facilities can be secured, an estimated start up budget is attached below. Budget/ Financials / Cost Proposal This proposal outlines the financial requirements to establish and operate a 24/7 Basic Life Support (BLS) Quick Response Vehicle. The model ensures continuous staffing, regulatory compliance, and high-quality patient care across the service area. Personnel Costs The system is staffed with: 8 Full-Time EMTs to support 24/7 ambulance coverage 1 Full-Time EMS Coordinator for system oversight, compliance, and administration Total Annual Personnel Cost: $1,045,924.88 Personnel costs include wages, overtime, and a comprehensive benefits package (health insurance, retirement, payroll taxes, and other employer-paid benefits). Startup Costs (One-Time) Initial investment required to establish the Quick Response Vehicle includes: Personnel onboarding and training Vehicle purchase and emergency upfitting Medical equipment and supplies Communications and reporting technology Total Estimated Startup Cost: $247,785 12 | P a g e (Facility-related costs are not included and will vary depending on available infrastructure.) Annual Operating Costs (Non-Personnel) Ongoing operational expenses include: Medical supplies and medications Vehicle fuel, maintenance, and repairs Communications systems and data services Training and continuing education Administrative and professional services Community outreach and program support Total Estimated Annual Operating Cost: $120,000 (Facility and utility costs are not included and should be determined based on local arrangements.) Total Annual Cost of Service Personnel: $1,045,924.88 Operations: $120,000 Total Annual Operating Cost: $1,165,924.88 Total First-Year Cost (Including Startup) Startup: $247,785 Staffing: $1,045,924.88 Total First-Year Investment: $1,293,709.88 13 | P a g e Summary Bayfield County’s Emergency Medical Services (EMS) system is facing a critical decline in volunteer availability, leading to increased response times, missed calls, and growing strain on local ambulance services. Although Bayfield County has long depended on nine EMS agencies—seven volunteer Basic Life Support services and two career Advanced Life Support providers—rising call volume, demographic shifts, and nationwide challenges in volunteer recruitment have pushed the current model to the point of unsustainability. Despite these pressures, local volunteer EMTs remain essential to the future success of EMS in Bayfield County, and this proposal focuses on reinforcing, not replacing, the existing system. To address immediate needs and build a scalable, long-term solution, Bayfield County proposes a countywide EMS model built around two key strategies: 1. A $200,000 annual EMS Staffing Grant Fund to support local EMS agencies, improve staffing reliability, reduce missed calls, and incentivize performance. 2. Deployment of county-operated Quick Response Vehicles staffed by EMTs who will respond to 911 calls, assist volunteer agencies, and integrate directly into ambulance crews when needed. The initial implementation includes one EMT-level Quick Response Vehicle (QRV) capable of dynamic deployment anywhere volunteer staffing is insufficient. These units will respond to a wide range of incident types—including medical emergencies, lift assists, alarms, and welfare checks—thereby reducing the burden on volunteer responders. EMTs assigned to the QRVs will be credentialed to operate seamlessly with all ambulance services in the county. The proposal includes a phased project timeline through 2026, with a target Go-Live date of January 1, 2027. Initial startup costs are estimated at $165,000–$188,999, depending on vehicle availability and facility needs. Annual staffing costs for an EMT-staffed, 24/7/365 QRV are projected at $1,045,924.88, with annual operating costs estimated at approximately $120,000. Multiple grant sources including the Wisconsin EMS Funding Assistance Program and forthcoming Rural Health Transformation funds—may offset a portion of startup expenses. Because countywide EMS levy funding is exempt from state levy limits, Bayfield County has several viable options for distributing costs, including countywide levy support, utilization-based cost sharing, or hybrid models. While revenue from patient billing will remain limited, new Medicaid reimbursement for “Treatment, No Transport” beginning in 2027 will provide some supplemental income. By combining targeted financial support to local EMS agencies with a flexible, county-staffed response model, Bayfield County EMS aims to improve reliability, reduce missed calls, 14 | P a g e strengthen volunteer agencies, and ensure timely emergency care for all residents— regardless of geography. The Quick Response Vehicle model offers a sustainable and scalable solution that stabilizes EMS delivery today while preparing the system for the challenges of the future. 1 | P a g e Ambulance Service Emergency Medical Services Proposal for Bayfield County, Wisconsin Submitted to: Bayfield County, Wisconsin Submitted by: Bryan D. Ziemann, NRP, County EMS Coordinator Date: March 31st, 2026 2 | P a g e Introduction This proposal represents one of two options for consideration by the Bayfield County Board to enhance Emergency Medical Services in the County. EMS Directors from multiple Bayfield County EMS agencies, convened in July, September, November, and December 2025. The EMS planning process was facilitated by Mr. James Small of the University of Wisconsin Office of Rural Health. Bayfield County, Wisconsin has historically been served by nine EMS organizations. Seven of these—Barnes, Bayfield, Iron River, Mason, Red Cliff, South Shore, and Washburn—operate as “volunteer” Basic Life Support ambulance services. These agencies have traditionally provided only minimal compensation to their EMTs, though in recent years some have begun hiring a small number of full-time EMTs or increasing on-call compensation to help address staffing gaps. The remaining two agencies, Ashland Fire Department and Great Divide EMS, are career Advanced Life Support (Paramedic-level) services that employ both full-time EMTs and Paramedics. In Bayfield County, geography rather than call volume has long shaped ambulance placement. This system has been largely unchanged for decades and has served the county effectively since the 1970s. Over time, multiple factors have contributed to a systemic decline in volunteer EMS everywhere- including here in Bayfield County. Our volunteers are not the problem- but a lack of volunteers is the problem. We’re seeing a decrease in availability of ambulances, increased response times, and frequent scenarios where multiple ambulances are unable to respond due to lack of staffing. As a result, patients are potentially placed at risk and patient outcomes are impacted. The decline in rural EMS is happening nation-wide, and we are not immune from the fallout from that decline. In this proposal, it is important to emphasize that OUR EMS VOLUNTEERS IN BAYFIELD COUNTY ARE CORE TO OUR FUTURE SUCCESS. It is important to note that there is no simple solution to our EMS system’s decline. The approach must be multifaceted, with strategies to address short-term problems, and provide the scalability to become a long-term solution. As a solution, we are proposing: 1. Retain and support the current EMS system in Bayfield County. Bayfield County will allocate $200,000 annually to establish a performance-based EMS staffing Grant Fund for local EMS agencies. The funding is intended to: Support direct staffing costs, improve local staffing availability, reduce missed EMS calls, and incentivize accountability and performance. 2. A Transporting Ambulance Service- Bayfield County will formally establish a county-operated ambulance service to strengthen and support the existing emergency medical services system. This new agency will serve as a critical safety net, helping to fill coverage gaps when local volunteer EMS agencies are unable to 3 | P a g e staff or respond to calls. The intent is not to replace volunteer services, but to supplement and reinforce them—working in partnership with local agencies to ensure reliable emergency medical response while complementing the vital work already being done by volunteer providers across the county. Bayfield County EMS will be scalable. Initially, it will consist of 1 staffed Basic Life Support level ambulance, (with the option to add 1 quick response vehicle) able to be deployed across the county to fill gaps in EMS coverage. The ambulance service can provide emergent and non-emergent patient transport. The addition of a quick response unit could add additional versatility to being able to respond to everything from lift assists to medical alarms when requested by our local BLS volunteer partners. The staffed ambulance will be moved strategically to areas of the county where there is inadequate volunteer staffing. It is important to note that both the Ashland Fire Department and Great Divide EMS serve critical roles as 911 emergency ambulance providers and as Paramedic intercept services supporting the county’s volunteer BLS agencies. It is anticipated that they will continue to fulfill these responsibilities as they do today. The timeline for the project is as follows: - Q1 2026, 2 proposals: Quick Response Vehicle and Transporting Ambulance Service will both be completed and submitted to Bayfield County administration - Q2 2026, Public engagement will occur. Meet with municipal, tribal, and EMS communities to present the proposals and receive feedback before April 15th. Host Town Hall forums for municipalities, tribal, and EMS communities followed by separate Town Halls for the general public to discuss the proposals by May 10th. Present the outcomes and stated support for the two proposals for the County Board to approve by June 30th, 2026. - Q3 & Q4 2026, Bayfield County EMS will execute an implementation plan that will be provided to the County Board - Go live will occur January 1, 2027 Cost Overview: There are many potential funding sources to assist Bayfield County in the formation of their new EMS system, but the lion’s share of funding will need to come via the county’s EMS tax levy. Wisc. Statute 66.0602(3)(e)6 identifies an exemption for the local levy limit: https://docs.legis.wisconsin.gov/statutes/statutes/66/vi/0602/3/e/6 Initial startup costs during the third and fourth quarters of 2026 could reach $555,900 if Bayfield County elects to purchase a new 4x4 ambulance built on a Ford F-450 chassis. Options to reduce capital costs may include purchasing a low-mileage used ambulance or acquiring a remounted unit. 4 | P a g e Another potentially more cost-effective approach would be to lease an existing, fully equipped backup ambulance from one of the county’s local EMS agencies. This option would allow municipalities that have previously invested in ambulances and equipment to recover a portion of those costs, while also strengthening partnerships with local EMS providers and fostering continued trust with the communities they serve. Facility costs may also influence the overall annual budget, depending on agreements made with local agencies or municipalities to house the ambulance and its crew. The estimated annual staffing cost for a Basic EMT-level ambulance is approximately $1,045,924.88, with additional annual operating expenses estimated at nearly $200,000. Multiple Grant sources are available to Bayfield County to potentially help fund our system. We intend to pursue grants from the State of Wisconsin which will potentially cover some of the cost of the transition. The State’s EMS Funding Assistance Program can potentially contribute $100,000 to our startup costs. In addition, $50B has been federally allocated to the States in the form of the Rural Health Transformation Program. Guidelines are still being developed for the Rural Health Transformation Grant which will distribute those funds in rural Wisconsin and place an emphasis on rural health workforce development. Bayfield County’s EMS levy is exempt from the levy cap. The County can address funding for Bayfield County EMS by any of the following 3 options: 1. Equal Share County-wide EMS Levy: Bayfield County levies for all EMS agencies in the County, including the already existing ambulance services in the County. This relieves the Towns of the burden of having to levy for EMS, and mitigates concerns over double taxation. 2. Utilization-based Cost Sharing: Levy municipalities based on their utilization of Bayfield County EMS. Metrics such as EMS incidents dispatched, patient contacts, etc. can be used as the basis for a levy for the municipalities that utilize the new agency the most. 3. Bayfield County levies just for the cost of operation of Bayfield County EMS, and local Towns will continue to levy for their local agencies as they have previously. Bayfield County Ambulance will be able to bill for patient transports to local hospitals. To ensure sustainable and compliant EMS operations, our proposed ambulance billing structure will align with both federal reimbursement standards and common Wisconsin industry practices. For local Medicare beneficiaries, reimbursement follows the national Ambulance Fee Schedule with local rural adjustments, resulting in typical allowed amounts of approximately $260–$310 for BLS Non-Emergency transports, $420–$480 for BLS Emergency transports, and $8–$9 per loaded mile. These rates are fixed and non-negotiable under Medicare rules. To maintain financial viability across all payer types, our standard rate would reflect prevailing Wisconsin EMS billing norms, with BLS Non-Emergency transports typically billed at $600–$900, BLS Emergency transports at $900–$1,400, and mileage at $15–$25 per mile. This structure ensures compliance 5 | P a g e with federal requirements while supporting the operational readiness and long-term sustainability of ambulance services in our community. Without being able to anticipate call volume, it is difficult to provide estimates for annual ambulance revenue. Beginning January 1, 2027, Wisconsin Medicaid will begin reimbursing $175 for “Treatment, No Transport” thereby providing revenue for calls such as lift assists. Other EMS agencies in the county will continue to bill patients as they do today. Staffing one ambulance for continuous 24/7/365 operation requires 8 EMTs and a County-Wide EMS Coordinator, resulting in a total annual personnel cost of $1,025,624.60. This model ensures operational readiness, system oversight, and sustainable workforce coverage across the county. The staffing budget estimates below are based upon 24-hour shifts but could be changed to reflect 12-hour shifts based upon employee preference. Operational Details Bayfield County has traditionally been served by 9 ambulance services: Ashland Fire Department, Barnes Ambulance, Bayfield Ambulance, Great Divide EMS, Iron River Ambulance, Mason Ambulance, Red Cliff Ambulance, South Shore Ambulance, and Washburn Ambulance. The areas covered by each of those agencies in Bayfield County are shown below: 6 | P a g e Bayfield County EMS would become its own department within Bayfield County and maintain its own budget. For management of the new organization, the EMS Coordinator position would likely transition to an EMS Director role, and a Team Lead position could be hired during the implementation process to assist with planning, capital purchasing, and new employee onboarding. For Medical Direction, and to maintain consistency across the EMS system, Dr. Jonathan Shultz would continue to be utilized in the Medical Director role. Vehicles: Ideally, the County’s ambulance would consist of a 4x4 Type I ambulance, designed to safely transport EMTs, patients, and the medical equipment necessary to provide emergency care and rapid response. These ambulances, typically built on a heavy- duty truck chassis, are well suited for the rural terrain and winter conditions commonly encountered throughout Bayfield County. The vehicles would be outfitted to meet state ambulance standards and equipped in a manner consistent with existing standards of care. Initial outfitting and startup costs would include essential equipment and technology such as two-way radios, emergency lighting/ sirens, Automatic Vehicle Location (AVL) systems, mobile data computers, patient care equipment, and other communication and response tools necessary for emergency medical operations. These components represent a significant portion of the startup investment required to place each ambulance into service. 7 | P a g e Recommended planning budget: Approximately $450,000 per unit for a new fully equipped ambulance, $350,000 for a fully equipped Remounted unit, and $250,000 for a fully equipped used ambulance. Each local ambulance service in the county could serve as a host location for the County’s crew when they are providing coverage within that agency’s service area. Additionally, an assessment of existing County facilities would be necessary to identify suitable locations where crews could be stationed when providing coverage across multiple service areas or supporting more than one agency. This evaluation would help ensure that ambulance resources are strategically positioned to maximize response efficiency and countywide coverage. It is intended that the location of the County’s ambulance would not be static, but dynamic, to cover locations in the County where limited or no volunteer staffing exists. Partnerships with Townships, Fire Departments, and our existing EMS partners can aid in identification of “posting locations” for the ambulance. The use of scheduling software will be essential in determining where the County ambulance should be positioned throughout the county. The volunteer ambulance services will provide their anticipated EMT staffing shortages and availability, allowing the County to identify gaps in volunteer coverage and strategically deploy their unit to areas where additional support may be needed. If Bayfield County EMS is dispatched to a call in one of these areas and the local volunteer agency is able to respond, the County’s ambulance can be cancelled or reassigned as appropriate. This approach helps ensure that a responder is dispatched more consistently, improving overall reliability of emergency medical response across the county. The County’s 911 Communications Center/PSAP will also be better equipped to ensure that the appropriate resources are dispatched to medical emergencies. By having visibility into staffing gaps and ambulances that are temporarily out of service, dispatchers can make more informed decisions that support more consistent responses, improved response times, and fewer missed calls. Additionally, with the planned implementation of Emergency Medical Dispatch (EMD) in 2026, dispatchers will have enhanced tools to triage medical calls more effectively. This will further strengthen their ability to ensure that the closest and most appropriate emergency responders are notified and dispatched. The combination of EMD within the dispatch center and the ability to deploy the closest appropriate resources from the outset should significantly improve the overall reliability and response times of the county’s EMS system. As stated above, both Bayfield County EMS and the local volunteer ambulance services will continue to bill patients for transport through outside agencies that specialize in EMS billing. Several such companies operate in Wisconsin and typically retain a percentage of the revenue they collect. Patient billing revenue will remain an important source of support for local ambulance services. 8 | P a g e Group purchasing contracts such as the Savvik EMS buying group (https://savvik.com/) would be utilized to leverage best pricing for capital equipment, medical supplies and if needed ambulances, QRV’s, and technology. Coop buying leverages the aggregation of volume from coop members nationwide. Why Are We Doing This? Zip Code shouldn’t dictate the quality of the emergency medical care you receive. It’s not an exaggeration to say that we are seeing failures in Bayfield County’s EMS system, and we need to take meaningful steps short term to try to stem further decline. In 2025, 108 calls were unanswered by the closest community ambulance- which was a 65% increase over the previous year. In many cases, multiple ambulance services were dispatched in order to find one that could respond to the call. In particular, the ambulance services in Washburn and Red Cliff have experienced the biggest staffing challenges, but it is important to note that their percentage of missed calls is similar to other agencies in the county. Their missed call data is skewed due to Washburn and Red Cliff having the highest call volume among volunteer EMS agencies in Bayfield County. Especially over the past decade, rural communities across the country have faced a steady decline in volunteer EMS personnel, creating a growing strain on the ability to provide timely and effective emergency care. Many rural EMS agencies, once sustained by strong volunteer bases, are now struggling to recruit and retain members due to factors such as an aging population, increased training requirements, demanding time commitments, and limited financial incentives. Young adults are often drawn to urban centers for employment opportunities, leaving fewer residents available to serve in volunteer capacities. As a result, response times in many rural areas have increased, and remaining volunteers are experiencing higher workloads and burnout. This decline threatens the sustainability of rural EMS systems and highlights the urgent need for innovative strategies, funding support, and community engagement to ensure that all residents—regardless of location— continue to receive prompt, high-quality emergency medical care. Since COVID, EMS call volumes have risen significantly due to a combination of demographic, social, and healthcare-related factors. An aging Bayfield County population has contributed to a higher frequency of medical emergencies, particularly among individuals with chronic conditions such as heart disease, diabetes, and respiratory illness. Additionally, limited access to primary care and mental health services, especially in our rural and underserved areas, has led many individuals to rely on EMS as their first point of contact for non-emergent medical needs. Increases in senior housing, longer life spans, and early discharge from hospitals further add to the burden. Dramatic increases in other non- emergent calls such as lift assists, medical alarms, and welfare checks have made it difficult to get volunteers to cover. The ongoing opioid crisis and increases in behavioral health emergencies have also driven up the number of 911 calls. Furthermore, our county’s 9 | P a g e increased seasonal population growth, greater public awareness of emergency services, and a lower threshold for calling for help have all contributed to the overall increase in EMS demand. All together, these trends have had a dramatic impact on our EMS systems, requiring expanded resources, staffing, and innovative service delivery models to meet growing community needs. Goals & Objectives There are 3 key areas of emphasis in the creation of Bayfield County EMS: - To develop a reliable, sustainable EMS response model - Provide a reliable safety net for the existing volunteer EMS system - Improve patient outcomes through improved response times and timely critical patient care interventions What we’re addressing: - Reliability- Between our existing volunteer EMS agencies, and a full-time county ambulance service to back them up, we’ll strive to eliminate missed calls. We’re adding a critical layer to the EMS system that will function as a safety net now and into the future. - Performance- we’ll expand the scope of what our EMT’s can do and encourage volunteers to respond to the scene directly if they are not part of an ambulance crew thereby improving response times substantially - Sustainability- Career staff being supported by consistent funding - Recruitment & Retention of Existing Volunteers- Bayfield County EMS is intended to supplement the existing volunteer system and should provide relief for volunteers who have experienced burn out due to lack of depth in staffing - Safety Net- Calls such as lift assists, welfare checks, and medical alarms that are increasing can be transitioned to Bayfield County EMS to reduce the burden on our volunteer responders Performance of the new EMS system will be carefully monitored, with regular reports to the County ongoing. Performance indicators such as volume, response times, clinical performance, reimbursement, and review of ambulance locations relative to call volume will be regularly reviewed. The Bayfield County Sheriff’s Committee will monitor system performance in collaboration with our volunteer providers. Scope of Services / Service Model 10 | P a g e Bayfield County EMS will be licensed through the State of Wisconsin DHS as an “Emergency Medical Technician, 911 Transporting Service” and adhere to State Statute. In 2023, Bayfield County created a licensed non-transport agency called Bayfield County MCI Team. From a licensing standpoint: the name would be changed, the service level would be upgraded to a transport status, and the operation plan would need to be updated. The joint Ashland/Bayfield Emergency Communications Center will provide dispatching for Bayfield County EMS, and they will be a key partner in making sure that the new agency is immediately dispatched in scenarios where volunteer staffing at the local level is lacking. Communications will be done on the county’s existing radio system. Physician Medical Direction will be provided by Dr. Jonathan Shultz via Aspirus Health/St. Luke’s Hospital in Duluth. Dr. Shultz currently provides Medical Direction to the majority of the Bayfield & Ashland County EMS systems. He will conform to all requirements for Medical Direction https://www.dhs.wisconsin.gov/ems/med-dir.htm as outlined in WI State Statute 256.15. https://docs.legis.wisconsin.gov/statutes/statutes/256/15/8m The top priority of Bayfield County EMS is serving the needs of 911 patients in Bayfield County. As a result, Bayfield County EMS would not provide hospital-to-hospital timeline transport. But, if an emergent interfacility transfer from Tamarack Health/Ashland Medical Center arises to Duluth, and no other options are available for interfacility transport, Bayfield County EMS could potentially help to provide 911 coverage that would enable Ashland Fire Department or Great Divide EMS to complete the transport. Training & Management Ongoing EMS Continuing Education is necessary to help EMS staff maintain their patient care skills and readiness. Through a combination of internal education, online content, Medical Director education, and courses offered through Northwoods Technical College, Bayfield County would need to commit the necessary funding to allow EMT’s to maintain their licensure. Education programs would be available quarterly and coordinated with license renewals of our EMS providers. Attendance of EMS conferences outside of the area for continuing education would likely be encouraged. Onboarding of new employees is critical to ensure that a proper baseline for performance is set. New employee onboarding will consist of classroom education along with ride-alongs with experienced EMT’s. Skills checks will be utilized regularly as required by Medical Direction. More specialized skills within the Wisconsin EMT scope of practice including: Non-Visualized Airways, ETCO2 monitoring, CO monitoring, mechanical CPR, 12 lead ECG acquisition/transmission, and nebulized airway medications would be standardized. 11 | P a g e Equipment, Facilities & Technology Ideally, Bayfield County EMS will be developed as a collaborative effort in partnership with existing volunteer EMS providers. The cost of purchasing new ambulances can vary significantly; however, a standard new ambulance can easily exceed $275,000, with four- wheel-drive units built on a Ford F-450 chassis often exceeding $350,000. Partnering with local Towns to lease an existing ambulance in the county presents a practical and cost-effective alternative. Some of our local agencies have backup equipment & ambulances that they can no longer reliably staff. Leasing local ambulances could potentially reduce upfront capital costs for the County, and provide an opportunity for Towns to recoup a portion of their prior investment in ambulances and equipment, further strengthening collaboration within the countywide EMS system It is likely that several pieces of equipment would need to be budgeted for and purchased. Utilizing some aggressive EMS buying groups such as Savvik, https://savvik.com/ , significant money can be saved up front and streamline the purchasing process. Up front costs for medical equipment including bags, cardiac monitor, Lucas CPR device, other durable goods, disposables, etc. would likely be over $100,000. An important priority in our implementation will be related to connectivity & technology. Computer technology plays a vital role in EMS by enhancing speed, accuracy, and quality of patient care. Advanced communication will allow our ambulances to receive real-time dispatch information, navigate to a scene, access patient histories, and coordinate effectively with hospitals before arrival. Electronic patient care reports improve documentation accuracy and enable faster data sharing, which supports better clinical decision-making and continuity of care. Electronic Patient care reports flow seamlessly to patient billing systems, and associated data fulfills Wisconsin EMS data reporting requirements. Technologies such as cardiac monitor (12 lead ECG transmission) will be leveraged to provide advanced notice to receiving facilities for cardiac patients that potentially need to be sent to Duluth to the Cath Lab. Wireless routers for data access, ruggedized tablets for patient care reports, and mobile data terminals to receive dispatch/CAD data will be key technology components. A significant cost savings can be achieved if existing County facilities are utilized as stations/crew quarters. Other options include collaboration with our existing volunteer ambulance services to base out of when providing coverage for those volunteer agencies. The nature of this proposal allows Bayfield County EMS to act as a safety net and deploy to wherever they are needed. As a result, agreements would be identified early on during the implementation process. Assuming that agreements for facilities can be secured, an estimated start up budget is attached below. 12 | P a g e Budget/ Financials / Cost Proposal This proposal outlines the projected personnel, startup, and annual operating costs required to establish and sustain a Basic Life Support (BLS) ambulance service and Quick Response Unit (QRU). The financial model reflects industry-standard staffing levels, equipment needs, and operational requirements to ensure reliable, 24/7 emergency medical coverage. 1. Personnel Costs Personnel is the largest component of the EMS budget, representing the staffing required to maintain two EMTs on duty at all times. The model includes 8 full-time EMTs and 1 County-Wide EMS Coordinator. Total EMT Personnel Cost: $885,642.88 EMS Coordinator Compensation: $160,282.00 Total Annual Personnel Cost: $ 1,045,924.88 This cost includes wages, overtime, FICA, Medicare, retirement contributions, life insurance, and health insurance. Benefits represent a significant portion of total compensation, driven primarily by health insurance costs. 2. Startup Costs Initial startup costs include the purchase of a fully equipped ambulance, medical equipment, communications systems, and onboarding/training expenses. Personnel & Training: $29,800 Vehicle & Equipment: $497,900 Communications & Technology: $64,186 Facilities & Operations: Unknown (pending site selection) Total Startup Cost: $591,886 The ambulance and associated medical equipment account for nearly 90% of startup expenditures. 3. Annual Operating Costs (Non-Personnel) Ongoing operating costs support medical supplies, fleet operations, technology, training, administrative services, and capital replacement planning. Medical Supplies & Clinical Operations: $18,750 13 | P a g e Vehicle / Fleet Operations: $27,950 Communications & Technology: $5,500 Training & Professional Development: $18,850 Administrative & Professional Services: $30,050 Miscellaneous / Operational Support: $18,500 Capital Replacement Reserve (Optional): $78,500 Total Annual Operating Cost: $198,100 Facility-related costs remain undetermined and may materially affect the final operating budget. 4. Total Cost Summary Total Annual EMS Cost: $1,220,824.56 Total First-Year Cost (Startup + Personnel): $1,637,810.88 5. Key Considerations & Opportunities Personnel costs dominate the budget; alternative scheduling models or part-time staffing may reduce overtime exposure. Health insurance is a major cost driver; consortium or municipal plans may offer savings. Facility costs must be finalized to complete the operating budget. Capital reserves ensure long-term sustainability for vehicles, equipment, and technology. Summary Bayfield County’s Emergency Medical Services system is at a critical turning point. Increasing call volumes, declining volunteer availability, and rising response gaps have created an urgent need for a more reliable and sustainable model of care. This proposal outlines a balanced, forward-thinking approach that preserves the strengths of the current system while addressing its most significant challenges. The recommended solution is a hybrid model that supports and sustains existing volunteer EMS agencies while introducing a county-operated transporting ambulance service to serve as a dependable safety net. This approach ensures that no community is left without coverage while reinforcing—not replacing—the vital role of local EMS providers. 14 | P a g e By implementing a performance-based grant model for the existing agencies, strategically deploying a county-staffed ambulance, and leveraging data-driven deployment and coordination, Bayfield County can significantly reduce missed calls, improve response times, and enhance patient outcomes. The plan is intentionally scalable, allowing the system to adapt to future demand and workforce realities. While the financial investment is substantial, it is both necessary and justified to ensure equitable access to emergency medical care across the county. Importantly, available state and federal funding opportunities, combined with EMS billing revenue, can help offset costs and support long-term sustainability. At its core, this proposal is about ensuring that where someone lives does not determine the quality or timeliness of emergency medical care they receive. By acting now, Bayfield County can build a resilient EMS system that supports its communities, protects its residents, and honors the commitment of its EMS volunteers. 1 | P a g e Bayfield County Emergency Management Response to Request for Proposal by St. Mary’s EMS dba Essentia Health EMS Al Hurley Joe Newton Allen Skochenski Chief Operating Officer Senior Director- EMS Regional Manager- EMS Essentia Health- East Market Essentia Health EMS Essentia Health EMS 2 | P a g e Table of Contents Executive Summary ................................ ................................ ................................ ......................... 4 7.1 Cover Letter ................................ ................................ ................................ ............................... 5 7.2 Organizational Overview ................................ ................................ ................................ ............. 6 7.2.1 Company History ................................ ................................ ................................ ................. 6 7.2.2 Organizational Structure ................................ ................................ ................................ ...... 6 7.2.3 Years in Operation ................................ ................................ ................................ ................ 6 7.2.4 Geographic Service Areas ................................ ................................ ................................ .... 7 7.2.5 EMS Licensure Information ................................ ................................ ................................ .. 7 7.2.6 Relevant Experience ................................ ................................ ................................ ............ 8 7.3 Operational Plan................................ ................................ ................................ ......................... 9 7.3.1 Proposed Service Model ................................ ................................ ................................ ....... 9 7.3.2 Hours and Levels of Coverage ................................ ................................ .............................. 9 7.3.3 Staffing Model ................................ ................................ ................................ ...................... 9 7.3.4 Deployment Strategy................................ ................................ ................................ .......... 10 7.3.5 Unit Location or Staging Concept ................................ ................................ ....................... 10 7.3.6 Coordination with Existing EMS Agencies ................................ ................................ ........... 11 7.3.7 Response Capabilities ................................ ................................ ................................ ....... 11 7.3.8 Interfacility Transportation Priority ................................ ................................ ..................... 12 7.3.9 Mutual Aid and Coverage Participation ................................ ................................ ............... 12 7.3.10 Communications and Dispatch Integration ................................ ................................ ...... 13 7.3.11 Reporting and Data Sharing ................................ ................................ .............................. 13 7.3.12 Compliance ................................ ................................ ................................ ..................... 14 7.3.13 Service Implementation ................................ ................................ ................................ ... 14 7.4 Staffing Plan ................................ ................................ ................................ ............................. 16 7.4.1 Number and Level of Personnel ................................ ................................ .......................... 16 7.4.2 Staffing Schedules ................................ ................................ ................................ ............. 16 7.4.3 Recruitment and Retention Strategies ................................ ................................ ................ 16 7.4.4 Training and Continuing Education Programs ................................ ................................ ..... 17 7.4.5 Background Screening Procedures ................................ ................................ ..................... 17 7.5 Quality Assurance and Clinical Oversight ................................ ................................ ................. 18 3 | P a g e 7.5.1 Medical Direction ................................ ................................ ................................ ............... 18 7.5.2 Clinical Quality Improvement Programs ................................ ................................ ............. 18 7.5.3 Patient Care Review Processes ................................ ................................ .......................... 18 7.5.4 Clinical Guideline Development ................................ ................................ ......................... 19 7.5.5 Safety Programs ................................ ................................ ................................ ................. 19 7.5.6 Infection Control Practices ................................ ................................ ................................ 19 7.6 Financial Proposal ................................ ................................ ................................ .................... 20 7.7 Equipment and Fleet Information ................................ ................................ ............................. 23 7.8 References ................................ ................................ ................................ ............................... 25 7.9 Required Attachments ................................ ................................ ................................ ............. 26 Appendix A - Optional Information Requested ................................ ................................ ................ 28 A.1 Proposed Response Time Goals ................................ ................................ ............................ 28 A.2 GIS Coverage Maps ................................ ................................ ................................ ............... 29 A.3 Examples of Rural EMS Partnerships ................................ ................................ .................... 29 A.4 Community Paramedicine Capabilities ................................ ................................ ................. 30 A.5 Disaster Response Plans ................................ ................................ ................................ ...... 30 A.6 Staffing Contingency Plans ................................ ................................ ................................ ... 31 A.7 Seasonal Surge Staffing Plans ................................ ................................ .............................. 31 4 | P a g e Executive Summary St. Mary’s EMS dba Essentia Health EMS is pleased to submit this proposal in response to Bayfield County’s Request for Proposals for supplemental ambulance services. Bayfield County has identified the need for a dependable EMS safety net to supplement its existing volunteer ambulance agencies in response to staffing shortages, increasing call volumes, rural response challenges, and seasonal population growth. Essentia Health EMS proposes a collaborative model that strengthens local EMS capacity without replacing current providers. Essentia Health EMS proposes to provide: • One 24/7 paramedic-level ambulance based in Bayfield County • A co-dispatch support model to supplement existing volunteer ambulance agencies • ALS response, first response support, ALS intercept capability, and response completion when local providers are unable to respond • A fully staffed, non-on-call model with one Paramedic and one EMT/AEMT per ambulance • One EMS Field Supervisor serving in a dual-role capacity as both a Paramedic and onsite EMS leader • Regional leadership support through an Essentia Health EMS Regional Manager • Redundant coverage from Essentia Health EMS regional resources, including Superior, Wisconsin • Integration with County dispatch, public safety agencies, healthcare partners, and tribal response organizations • Strong medical direction, quality assurance, reporting, and operational accountability Essentia Health EMS operates across a large rural footprint, responds to approximately 14,000 calls annually, employs more than 170 prehospital professionals, and maintains a fleet of more than 40 vehicles. We believe this proposal aligns with Bayfield County’s goals of reliable ambulance availability, improved rural EMS coverage, sustainable staffing, strong clinical standards, financial transparency, and long-term system stability. 5 | P a g e 7.1 Cover Letter June 22, 2026 Bayfield County, Wisconsin Emergency Management 117 E. Sixth Street Washburn, Wisconsin, 54891 Re: Proposal for Supplemental Ambulance Services Dear Bayfield County Board of Supervisors: St. Mary’s EMS dba Essentia Health EMS is pleased to submit this proposal in response to Bayfield County’s Request for Proposals for supplemental emergency medical services. Essentia Health brings our mission, “We are called to make a healthy difference in people’s lives, ” together with our values of Quality, Hospitality, Respect, Joy, Justice, Stewardship, and Teamwork to every community we serve. Bayfield County’s goal of strengthening EMS coverage and staffing resiliency while supporting local volunteer agencies aligns well with Essentia Health EMS’s rural experience, clinical strength, and collaborative service model. Legal Name of Organization: St. Mary’s EMS dba Essentia Health EMS Primary Contact Person: Joe Newton, EMS Senior Director Address: 421 North 6th Avenue East, Duluth, MN 55805 Phone Number: 612-968-8288 Email: Joe.Newton@EssentiaHealth.org Thank you for your consideration. We welcome the opportunity to discuss this proposal further and partner with Bayfield County to support reliable, high-quality EMS service for its residents and visitors. Sincerely, Joe Newton EMS Senior Director 6 | P a g e 7.2 Organizational Overview 7.2.1 Company History St. Mary’s EMS dba Essentia Health EMS is a separate 501(c)(3) organization operated by Essentia Health. Essentia Health is an integrated health system serving patients in Minnesota, North Dakota, and Wisconsin, with significant experience in rural medicine and regional healthcare delivery. Headquartered in Duluth, Minnesota, Essentia Health includes more than 15,000 employees and more than 2,200 physicians and advanced practitioners. The organization serves patients through: • 14 hospitals • 78 clinics • 6 long-term care facilities • 6 assisted living and independent living facilities • 8 ambulance services • 27 retail pharmacies • 1 research institute Essentia Health also serves Northwest Wisconsin through clinics and Community Paramedic services. 7.2.2 Organizational Structure Essentia Health EMS operates within a unified structure supported by: • EMS operational leadership • EMS Board-certified physician medical direction • Interfacility ambulance dispatch center • Internal mobile emergency vehicle maintenance • Centralized administrative and clinical leadership For Bayfield County, Essentia Health EMS will provide both local and regional leadership. A Bayfield County-based EMS Field Supervisor will serve in a dual-role capacity as both a Paramedic and onsite EMS leader and will report directly to an Essentia Health EMS Regional Manager. 7.2.3 Years in Operation Essentia Health and its subsidiaries have owned, leased, and/or operated ambulance services throughout the organization’s history. Prior to 2018, ambulance services operated through subsidiary hospital entities. In 2018, ambulance operations were consolidated under St. Mary’s EMS, creating a 7 | P a g e unified model for equipment, ambulances, leadership structures, clinical guidelines, medical direction, and operational standards. 7.2.4 Geographic Service Areas Essentia Health EMS serves rural and regional communities in Minnesota, North Dakota, and Wisconsin. Essentia Health EMS consists of: • 8 ambulance operational locations • 10 ambulance base locations • 8 community paramedic locations • 170+ employees • 40+ fleet vehicles • Approximately 14,000 calls annually Services include: • Primary emergency 911 response • ALS intercept services • Mutual aid response • Interfacility transport • Critical care transport • Community paramedicine Essentia Health EMS currently provides primary emergency response across approximately 4,900 square miles of rural northern Minnesota in portions of ten counties and provides critical care transportation support in Northwest Wisconsin. 7.2.5 EMS Licensure Information Essentia Health EMS operations are licensed at the highest applicable prehospital levels in the states in which they operate: • Minnesota operations are licensed at the Advanced Life Support (Paramedic) level through the Minnesota Office of EMS • Wisconsin operations are licensed at the Paramedic with Critical Care Endorsement level through the Wisconsin Department of Health Services EMS program A copy of the Wisconsin ambulance service license is included in the attachments. 8 | P a g e 7.2.6 Relevant Experience Essentia Health EMS has extensive experience in: • Rural 911 ambulance response • ALS and paramedic-level emergency care • Mutual aid participation • ALS intercept services • Interfacility transportation • Critical care transportation • Community paramedicine • Coordination with public safety agencies, hospitals, dispatch centers, and local governments This experience is particularly relevant to Bayfield County’s rural geography, seasonal demand, and limited local hospital access. 9 | P a g e 7.3 Operational Plan 7.3.1 Proposed Service Model Essentia Health EMS proposes a supplemental EMS safety net model designed to strengthen the County’s EMS system while preserving the role of local volunteer ambulance agencies. Under this model, Essentia Health EMS would provide paramedic-level 911 ambulance coverage throughout Bayfield County in coordination with current ambulance providers and the Ashland-Bayfield County Emergency Communications Center. Essentia Health EMS proposes a co-dispatch model, subject to County approval and final dispatch protocol development. Under this approach, the local ambulance provider could: • Cancel Essentia Health EMS response • Continue Essentia Health EMS response for first response support • Use Essentia Health EMS for ALS intercept services • Request additional assistance on scene • Rely on Essentia Health EMS to complete the response when the local service is unable to respond This model is intended to reduce uncovered calls, improve ALS availability, and provide a dependable safety net without replacing existing local services. 7.3.2 Hours and Levels of Coverage Essentia Health EMS will provide: • One licensed ambulance • 24 hours per day, 7 days per week • At the Paramedic / ALS level Each unit will be staffed with: • One Paramedic • One EMT or AEMT 7.3.3 Staffing Model Essentia Health EMS will use a fully staffed model rather than an on-call response model. The Bayfield County operation will also include a dedicated EMS Field Supervisor serving in a dual-role capacity as both a licensed Paramedic and onsite EMS leader. This position will provide field leadership, 10 | P a g e operational support, staff mentorship, and coordination. The EMS Field Supervisor will report directly to an Essentia Health EMS Regional Manager. If the Bayfield County unit cannot be staffed because of illness, injury, or similar unexpected absence, Essentia Health EMS will redeploy a Paramedic unit from Superior, Wisconsin to maintain coverage. 7.3.4 Deployment Strategy Essentia Health EMS intends to establish a centrally located ambulance base within Bayfield County based on • Call volume • Geographic coverage needs • Community needs • Seasonal demand patterns • Travel considerations • Year-round accessibility • Collaboration with public safety partners This deployment strategy is intended to improve countywide coverage while maintaining flexibility to support local volunteer agencies during high-demand periods, simultaneous incidents, and staffing shortages. In addition to maintaining a centrally located Bayfield County ambulance, Essentia Health EMS may also forward deploy or redeploy ambulance crews to specific areas of Bayfield County when notified in advance that a local ambulance service will be out of service for a defined period of time. This proactive deployment approach is intended to improve coverage in affected areas, reduce service gaps, and support continuity of emergency response during known periods of local unit unavailability. • Forward deployment decisions would be coordinated, as appropriate, with: • The affected local ambulance service • Ashland-Bayfield County Emergency Communications Center • Bayfield County leadership or EMS oversight personnel 7.3.5 Unit Location or Staging Concept Essentia Health EMS intends to identify and establish a long-term Bayfield County ambulance base location that is centrally positioned for efficient response across the County. Final site selection would be coordinated with Bayfield County based on operational feasibility, service needs, and the availability of suitable space for ambulance operations, employee support, and equipment storage. 11 | P a g e While the primary model includes a centrally located base, Essentia Health EMS may also utilize staging, forward deployment, or temporary redeployment within specific areas of Bayfield County when operational conditions support that approach. This may include situations in which Essentia Health EMS is notified in advance that a local ambulance service will be out of service for a planned or defined period of time, allowing the Bayfield County unit or other available Essentia Health EMS resources to be positioned closer to the anticipated coverage gap. • This flexible staging approach is intended to: • Improve response readiness in affected areas • Reduce service gaps during known periods of local unit unavailability • Strengthen support for existing volunteer ambulance agencies • Improve system resiliency during peak demand or staffing shortages In addition to the Bayfield County frontline unit, Essentia Health EMS can support continuity of service through regional deployment from Superior and through reserve fleet capacity when needed. 7.3.6 Coordination with Existing EMS Agencies Essentia Health EMS supports Bayfield County’s goal of supplementing, not replacing, existing volunteer ambulance agencies. Essentia Health EMS will coordinate with: • Existing local EMS agencies • Bayfield County Emergency Management • Bayfield County Sheriff’s Office • Local fire departments • Local and regional hospitals • Ashland-Bayfield County Emergency Communications Center • Tribal emergency response agencies • Local units of government as required This model is designed to preserve local agency participation while adding a dependable layer of EMS support during staffing gaps, surge demand, and simultaneous incidents. 7.3.7 Response Capabilities Essentia Health EMS can provide: • Emergency 911 ambulance response • ALS emergency care 12 | P a g e • Paramedic intercept services • Mutual aid response • Secondary emergency response • Peak-demand coverage • Dedicated standby coverage • Disaster and mass casualty support • Interfacility transportation • Critical care transport capability within the broader Essentia Health system Essentia Health also maintains strong aeromedical transport partnerships to support patients who require rapid access to specialty or tertiary care. Essentia Health is a consortium member-owner of Life Link III and partners with Life Link III for aeromedical ambulance transportation. For 911 scene responses, Essentia Health EMS follows a closest available and appropriate helicopter resource approach and utilizes the aeromedical provider best positioned to meet the patient’s immediate needs. Because Essentia Health does not directly own and operate the entirety of an aeromedical transport service, it remains neutral in determining which helicopter resource is requested and receives no exclusive financial advantage from that decision. This approach helps ensure patients receive access to the soonest available air medical transport resource. 7.3.8 Interfacility Transportation Priority Essentia Health EMS understands and supports Bayfield County’s requirement that 911 emergency response remain the highest operational priority. Routine interfacility transport requests will not be assigned to the ambulance based in Bayfield County. Those requests will instead be handled by ambulance units specifically staffed for interfacility transport, including units based in Superior, Wisconsin, or other Essentia Health EMS service locations. In the event of an emergency interfacility transport requiring immediate transfer for definitive intervention, and if no other ground or air medical transport resource is available, Essentia Health EMS may assign the Bayfield County unit if it is the closest appropriate resource. In that circumstance, a unit from Superior, Wisconsin will be redeployed concurrently to Bayfield County to maintain coverage. Interfacility transports may be delayed, rescheduled, or declined when necessary to preserve emergency response availability and countywide coverage. 7.3.9 Mutual Aid and Coverage Participation Essentia Health EMS regularly participates in mutual aid and coverage support operations. The Bayfield County unit will be available to: • Assist local agencies when requested 13 | P a g e • Provide ALS intercept or scene support • Participate in county or regional mutual aid • Support surge operations during seasonal demand • Assist in major incidents or disaster response 7.3.10 Communications and Dispatch Integration Ambulances used in Bayfield County operations will be capable of communicating with: • Ashland-Bayfield County PSAP / Emergency Communications Center • Current ambulance service providers • Fire departments • Law enforcement agencies Communications capabilities include: • VHF P25 FDMA • 7/800 MHz P25 FDMA/TDMA • Conventional VHF • Conventional 7/800 MHz • Clear and encrypted communications modes Units will also be equipped with: • CAD tablets • ePCR tablets • Cell phones • LTE/5G connectivity • Vehicle telematics / GPS tracking Essentia Health EMS intends to integrate with local PSAP computer-aided dispatch software and communications systems to support interoperability and operational coordination. 7.3.11 Reporting and Data Sharing Essentia Health EMS will provide regular reporting to the Bayfield County EMS Office and the Bayfield County Board, including: • Response time reporting 14 | P a g e • Call volume statistics • Missed call reports • Staffing shortage reports • Quality assurance data • Incident reporting • Financial reports • Operational reports Essentia Health EMS uses an electronic charting and analytics environment capable of integrating near- live data into Power BI and Tableau. 7.3.12 Compliance Essentia Health EMS will comply with all applicable: • Wisconsin EMS licensing requirements • Federal healthcare regulations • HIPAA requirements • OSHA requirements • Medicare and Medicaid billing requirements • Local ordinances and policies 7.3.13 Service Implementation Upon award, Essentia Health EMS will work with Bayfield County to complete implementation activities including: • Final negotiations • Finalization of base location • Staff recruitment and scheduling • Hiring of the EMS Field Supervisor • Regional leadership onboarding • Vehicle acquisition and deployment • Communications programming and testing • CAD/dispatch integration 15 | P a g e • Orientation with County and local EMS stakeholders • Final operating protocols for dispatch and coordination 16 | P a g e 7.4 Staffing Plan 7.4.1 Number and Level of Personnel Essentia Health EMS intends to hire 13 employees for the Bayfield County operation as follows: Position Full-Time Part-Time Total Paramedics 4 2 6 EMTs / AEMTs 4 2 6 EMS Field Supervisor (Paramedic / Leadership) 1 0 1 Total 9 4 13 Each ambulance crew will include one Paramedic and one EMT or AEMT. 7.4.2 Staffing Schedules Full-time staff will be scheduled for 36 hours per week. Part-time staff will be scheduled for 12 to 24 hours per week. Staff will work a two-week rotating schedule that includes: • One 24-hour shift per week • One 12-hour shift per week All staff working 24 hours per week or greater are benefit eligible, including paid time off accrual. The EMS Field Supervisor will provide onsite leadership and operational support for the Bayfield County service. 7.4.3 Recruitment and Retention Strategies Essentia Health EMS offers competitive compensation and benefits designed to recruit and retain qualified EMS professionals. For 2026, wage ranges are: • Paramedic: $31.40 to $43.96 per hour • EMT: $22.63 to $31.69 per hour Additional compensation and retention supports include: • Up to $7,500 sign-on bonus for Paramedics • Night differential: $2.50 per hour 17 | P a g e • Weekend differential: $2.00 per hour • Additional pay for Critical Care endorsement • Additional pay for Advanced EMT licensure • $700 annually for outside continuing education • $2,500 tuition reimbursement • Free access to the FOAMfrat online EMS education platform 7.4.4 Training and Continuing Education Programs Essentia Health EMS requires all staff to complete approximately 50 hours of continuing education annually through a combination of: • Online learning management system coursework • In-person lecture • High-fidelity simulation training All newly hired staff must complete Essentia Health EMS’s internal five-step onboarding process: 1. Academy classroom training 2. Field observation 3. Field training 4. Shadow clinical lead experience 5. Medical Direction clearance examination 7.4.5 Background Screening Procedures All employees must pass healthcare background screening in both Minnesota and Wisconsin prior to employment and must complete Essentia Health’s pre-employment and onboarding requirements. 18 | P a g e 7.5 Quality Assurance and Clinical Oversight 7.5.1 Medical Direction Medical direction within Essentia Health EMS is provided through physicians who are board certified in Emergency Medicine and/or have completed an EMS fellowship program. Medical direction supports: • Clinical guideline development • Case review • Provider oversight • Protocol compliance • Education and feedback • Ongoing quality improvement 7.5.2 Clinical Quality Improvement Programs Essentia Health EMS maintains a robust continuous quality improvement program that includes: • Review of patient care reports • High-acuity case review • Peer and leadership review • Video review of endotracheal intubations Essentia Health EMS has also been an early adopter of advanced therapies including: • Buprenorphine for post-overdose care • IV antibiotics for sepsis and open wound care • Nebulized ketamine for pain control • Rural ECMO support for cardiac arrest care 7.5.3 Patient Care Review Processes Each patient care report is reviewed for documentation quality and clinical oversight. Staff may also request review through: • Medical direction • Peer review • Interesting case review 19 | P a g e • Leadership review Weekly meetings between medical direction and operational leaders support trend review and continuous improvement. The Bayfield County EMS Field Supervisor will support local implementation of Essentia Health EMS standards and field mentorship. 7.5.4 Clinical Guideline Development Essentia Health EMS maintains a Clinical Care Guidance Committee consisting of: • EMTs • Paramedics • Field Training Officers • Field Supervisors The committee meets monthly to review suggested guideline modifications for medical direction approval. Employees may access guidelines through a mobile application and Handtevy. 7.5.5 Safety Programs Essentia Health maintains multiple safety programs, including a “Stop the Line” policy that allows any person to raise a concern whenever they believe someone is at risk of harm. Essentia Health EMS also maintains: • Safety policies • Emergency vehicle operator course through external vendor • Fatigue management initiatives • Standard operating procedures • Standard work documents • Employee safety expectations • Operational readiness procedures 7.5.6 Infection Control Practices Infection control is managed at both the local leadership level and systemwide. All vehicles and equipment are checked daily for: • Cleanliness • Expiration dates • Safety 20 | P a g e • Readiness Vehicles are stocked with appropriate PPE and medical supplies consistent with Wisconsin regulations and Essentia Health EMS standards. 7.6 Financial Proposal Proposed Contract Term Essentia Health EMS proposes a five-year contract term, with the understanding that Bayfield County may negotiate an initial term of five years. Service Fees / County Subsidy Requirement Contract Year County Subsidy Requirement Year 1 $990,000 Year 2 $1,039,500 Year 3 $1,091,475 Year 4 $1,136,049 Year 5 $1,203,351 Cost Assumptions The proposed subsidy includes: • One 24/7 Bayfield County ALS ambulance • One Paramedic and one EMT/AEMT per scheduled unit • One dedicated EMS Field Supervisor • Regional management support • Full wage and benefit staffing • Medical equipment, medications, supplies, and PPE • Fleet maintenance and communications support • Medical direction, quality assurance, and reporting support • Operational redundancy through regional Essentia Health EMS resources The proposed subsidy also assumes that Bayfield County will provide a base location for the Bayfield County ambulance operation, including garage space, employee quarters, and storage space. The 21 | P a g e location must be mutually agreed upon by Bayfield County Administration and Essentia Health EMS leadership and must be suitable for ambulance operations, personnel support, and equipment storage. If Bayfield County is unable to provide a mutually acceptable base location, the annual County subsidy would increase by $95,000 per year to cover facility-related costs associated with securing and operating an ambulance base. Transport Billing Practices All patient care billing is administered internally through the Essentia Health EMS Billing Office. Essentia Health is contracted with multiple private insurance companies, Medicare, and Medicaid. Essentia Health also offers: • Financial assistance programs • Uninsured discounts • Catastrophic discounts • Charity Care Dedicated Event Standby Rates Service Rate ALS Ambulance (Paramedic) $300/hour ALS Ambulance (Paramedic) – Nonprofit Group $200/hour BLS Ambulance (EMT) $250/hour BLS Ambulance (EMT) – Nonprofit Group $175/hour Single Role Paramedic $200/hour Single Role Paramedic – Nonprofit Group $90/hour Single Role EMT $175/hour Single Role EMT – Nonprofit Group $75/hour 22 | P a g e ALS Intercept Fees Service Rate Paramedic provides care in BLS service ambulance $400 Paramedic crew completes transport from BLS crew $300 payment by Essentia Health to BLS service Cancelled on scene or prior to arrival $0 Ambulance Transport Billing Schedule Service (FY26 rates) HCPCS Code Charged Amount ALS 2 Base Rate A0433 $2,528 ALS 1 Emergent Base Rate A0427 $2,376 ALS 1 Non-Emergent Base Rate A0426 $2,144 BLS Emergent Base Rate A0429 $1,672 BLS Non-Emergent Base Rate A0428 $1,520 Mileage A0425 $35.50 Paramedic Intercept A0432 $400 Specialty Care Transport A0434 $3,134 Treat, No Transport – Level 1 A0998 $551 Treat, No Transport – Level 2 A0998 $938 Treat, No Transport – Level 3 A0998 $1,519 Other Cost Assumptions Except as otherwise identified in this proposal, the subsidy amounts above reflect the anticipated County financial obligation for the proposed service model. Optional services beyond the contracted base scope would be billed separately unless otherwise negotiated. 23 | P a g e 7.7 Equipment and Fleet Information Ambulance Inventory Essentia Health EMS currently operates: • 25+ ambulances • 40+ total fleet vehicles, including Type I, II, and III ambulances, quick response vehicles, and Community Paramedic vehicles For the Bayfield County proposal, Essentia Health EMS intends to purchase and deploy: Unit Type Service Level Status Bayfield County Frontline Unit Type I 4x4 Ambulance ALS / Paramedic New dedicated frontline unit Redundant Coverage Unit Essentia EMS Paramedic Unit from Superior, WI ALS / Paramedic Backup / redeployment resource Additional Regional Reserve Regional reserve ambulance resources ALS / Paramedic as available Contingency support Vehicle Specifications The proposed Bayfield County frontline ambulance will be a Type I 4x4 ambulance selected for rural response conditions and year-round reliability. Fleet Age and Replacement Plans The Bayfield County frontline ambulance will be newly purchased for this proposal. Across the broader fleet, Essentia Health EMS maintains a preventive maintenance program managed by an internal mobile repair unit operated by an Emergency Vehicle Technician. Vehicles are generally scheduled for replacement between 300,000 and 350,000 miles, or sooner if warranted. Communications Capabilities Ambulances used in Bayfield County operations will have the ability to communicate with: • Ashland-Bayfield County PSAP / Emergency Communications Center • Current ambulance service providers • Fire departments • Law enforcement agencies Systems are capable of: 24 | P a g e • VHF P25 FDMA • 7/800 MHz P25 FDMA/TDMA • Conventional VHF • Conventional 7/800 MHz • Clear and encrypted operation Specialized Equipment All ambulances are equipped with: 1. Zoll X-Series monitor 2. LUCAS 3 3. Hamilton T-1 ventilator 4. Glidescope Go2 video laryngoscope 5. Multi-channel IV infusion pumps 6. P25 mobile and portable radios with encryption 7. Computer-aided dispatch tablet 8. Electronic patient care report tablet 9. Cell phone 10. Cradlepoint LTE/5G Wi-Fi router 11. Forward- and cab-facing AI-enabled safe driver cameras 12. Vehicle telematics tracking 13. Power patient stretchers 14. Power stretcher loading device 15. Stair chair 16. Scoop stretcher 17. Portable power suction 18. Blood product tubing 19. LED warning lights and traffic light emitter 20. Secured, access-controlled medication and controlled substance storage 25 | P a g e 7.8 References Municipality Contact Person Email Address Description of Services Provided Itasca County Eric Villeneuve, Health and Human Services Director Eric.Villeneuve@co.itasca.mn.us Rural EMS operations, ambulance service support, and county-level coordination City of Buhl Tony Jeffries, Administrator tjeffries@cityofbuhlmn.co Ambulance service operations and EMS response support in a rural municipal setting Pine County Sherrif Office Scott Grice Chief Deputy Scott.Grice@co.pine.mn.us County wide ambulance service, medical direction to PSAP, Sheriff Office, and First Responders 26 | P a g e 7.9 Required Attachments 1. Wisconsin Ambulance Service License 2. Proof of Insurance 1. Available upon request 3. W-9 1. Available upon request 4. Relevant Certifications / Recognitions o American Heart Association ▪ 2025 Mission Lifeline EMS Bronze Award • Numerous rural locations ▪ 2026 Mission Lifeline EMS Silver Award • Numerous rural locations • 27 | P a g e ▪ 2026 Mission Lifeline EMS Medical Oversite Award • o Minnesota Office of Emergency Medical Services ▪ 2023 to present: Clinical Excellency 5. Pending Litigation Disclosure 1. None 6. Financial Stability Statement / Evidence of Financial Stability 1. Available upon request 2. Essentia Health holds a solid investment-grade credit rating of 'A-' with a Positive outlook from both Fitch and S&P ratings. 28 | P a g e Appendix A - Optional Information Requested Bayfield County encouraged respondents to provide additional information regarding operational performance, rural EMS partnerships, community paramedicine, disaster response, and contingency planning. Essentia Health EMS is pleased to provide the following supplemental information. A.1 Proposed Response Time Goals Due to the rural geography and large service area of Bayfield County, a single countywide enroute-to-on- scene response time goal would not be the most meaningful or reliable way to evaluate performance. Instead, Essentia Health EMS monitors multiple operational time intervals throughout the life of each incident to evaluate system readiness, crew performance, and deployment effectiveness. Essentia Health EMS monitors and/or requires the following: • Unit notified by dispatch to unit enroute: Goal of 90 seconds or less 90% of the time, regardless of time of day, with a maximum expected threshold of 3 minutes • Unit on scene to at patient time: Any time greater than 5 minutes requires additional crew documentation • At patient time to transporting time or clearing incident on no-transport calls: Any time greater than 20 minutes requires additional documentation • Arrival at destination to clearing destination: Any time greater than 30 minutes requires additional documentation • Enroute to on-scene time: Any response interval greater than 30 minutes requires additional documentation and incident review Essentia Health EMS reviews the following time intervals on a regular basis: • PSAP time to unit notified • Unit notified to unit enroute • Unit enroute to unit on scene • Unit on scene to at patient • At patient to unit transporting • Unit transporting to arrival at destination • Arrival at destination to unit clearing destination • Unit clearing destination to return to service area 29 | P a g e These intervals are reviewed weekly, with a deeper quarterly review performed to identify increases or decreases in response performance, operational bottlenecks, and opportunities for deployment improvement. These findings are also used to guide decisions regarding where EMS crews are staffed and posted during scheduled service hours. A.2 GIS Coverage Maps See attached coverage map for Essentia Health EMS Minnesota services. A.3 Examples of Rural EMS Partnerships Essentia Health EMS maintains strong working partnerships with public safety agencies and healthcare organizations throughout the rural communities we serve. Examples include providing medical direction to county Public Safety Answering Points (PSAPs), including those in: • St. Louis County, Minnesota • Pine County, Minnesota • Douglas County, Wisconsin These systems use emergency medical dispatch platforms including ProQA and IntellaComm. Essentia Health EMS also provides medical direction, clinical support, and EMS education to numerous law enforcement agencies, fire departments, first responder groups, and ambulance services, including: 30 | P a g e • Douglas County EMS, Wisconsin • St. Louis County Sheriff Search and Rescue • Pine County Sheriff’s Office • Audubon Rescue • Hoyt Lakes Ambulance • Ely Ambulance • Superior Fire Department • Duluth Fire Department A recent example of rural partnership work in North Dakota includes the Southern Valley Fire Department, where Essentia Health EMS provides community paramedic services in the community and medical direction for fire department first response personnel to the paramedic level. A.4 Community Paramedicine Capabilities Essentia Health EMS has a robust Community Paramedic program that has been in operation for more than 10 years, serving thousands of patients throughout rural Minnesota, North Dakota, and Wisconsin. Essentia Health EMS maintains a partnership with a local community college to offer Community Paramedic education to current Paramedics who wish to further their training and expand their role in rural healthcare delivery. Essentia Health EMS currently employs Community Paramedics working from 8 locations, in addition to multiple hybrid and part-time locations. A.5 Disaster Response Plans Essentia Health EMS works with local county and city emergency management partners on emergency planning and disaster response preparedness. Essentia Health EMS also maintains staffing plans for mass casualty incidents (MCIs) and other large- scale emergencies that require increased ambulance coverage. For example, when an EMS crew declares an MCI within one of our service areas, Essentia Health EMS may shift three to four additional EMS crews to that location to support: • Initial incident response • Transport coordination • Transfer of critical patients to Level I or Level II trauma facilities • Ongoing system coverage during the event 31 | P a g e A.6 Staffing Contingency Plans Essentia Health EMS has developed staffing plans for each community it serves. These plans identify: • Minimum staffing • Ideal staffing • Maximum staffing To support these plans, Essentia Health EMS offers: • Additional incentive pay to achieve minimum or ideal staffing levels • Open shifts to qualified employees who meet site-specific requirements • Overtime opportunities when necessary to maintain coverage When staffing shortages occur, Essentia Health EMS may divert staffed units from interfacility transport locations or multi-unit service locations to maintain minimum ambulance coverage in priority service areas. In addition, supervisors and higher-level leadership personnel are assigned quick response vehicles that may be used for incident response and travel to other locations to assist with staffing and operational support. A.7 Seasonal Surge Staffing Plans Essentia Health EMS staffs multiple ambulance crews in Superior, Wisconsin, which could be redeployed to Bayfield County during periods of seasonal surge demand. If selected for award, Essentia Health EMS would welcome the opportunity to meet with County leadership to further discuss seasonal population trends, high-demand periods, and potential strategies for surge staffing and deployment support. Request for Proposal Bayfield County, WI FIN Number 41 - 0729979 4501 68 th Ave North, Brooklyn Center, MN 55429 Scott Sampey Vice President Ambulance Services 763 - 581 - 9902 1 | Page Contents LETTER AUTHORIZING PROPOSAL ........................................................................................................ 2 INTRODUCTION TO THE PROPOSAL ...................................................................................................... 3 CONTRACTOR INFORMATION ................................................................................................................. 3 ORGANIZATIONAL STRUCTURE ............................................................................................................. 4 COMMUNITY INVOLVEMENT .................................................................................................................. 4 OPERATIONAL LOCATIONS ...................................................................................................................... 5 MANAGEMENT TEAM PROFILES ............................................................................................................ 6 MEDICAL DIRECTION .............................................................................................................................. 10 CLINICAL CARE ......................................................................................................................................... 11 QUALITY ..................................................................................................................................................... 12 TRAINING AND EDUCATION .................................................................................................................. 13 BILLING & COLLECTIONS ....................................................................................................................... 14 VEHICLE FLEET ......................................................................................................................................... 14 COMMUNICATIONS CENTER .................................................................................................................. 15 AIR CARE .................................................................................................................................................... 15 EMERGENCY MANAGEMENT ................................................................................................................ 16 HIRING AND RETENTION ........................................................................................................................ 16 PROPOSED OPERATIONS PLAN .............................................................................................................. 17 REFERENCES .............................................................................................................................................. 21 2 | Page North Memorial Health Ambulance Services is pleased to offer a response to the Bayfield County Proposal Request. North Memorial Health Ambulance (NMHAS) started in 1961. In 2025, utilizing a team of over 800 skilled team members, we transported over 100,000 patients. We have successfully collaborated with many communities on custom solutions that fit with their interests and resources. Our goal is to establish long-term partnerships. We do that by leveraging our resources, collaborating with other public safety agencies in the community, and by operating ethically in all business dealings. The team at NMHAS starts with extraordinary medical leadership. Our Medical Directors are residency trained, Board Certified Emergency Physicians. They also possess subspecialty board certifications in EMS (Emergency Medical Services) Medical Direction. They ensure our staff is well trained and that every policy, procedure, medication, and piece of medical equipment is deployed based on the finest evidence-based medical literature available. Our staff are motivated, caring, and compassionate caregivers; in fact, 98% of our patients and their families rate their interaction with us as either good or very good. Our customer service survey scores consistently put us among the highest achievers in the country. Our teams have risen to every occasion with courage and professionalism whether it is a complicated 911 call, tornado, missing person, or a multi-agency response. Our strength in emergency management principles is second to none among industry peers. Our leading-edge quality management system is based on world class ISO principles that are commonly utilized in many of the most successful companies in the world. We are proud to be ISO 9001 Certified. This ensures that the quality of the service is delivered with precision, quality, and consistency. We are also accredited by the Commission on Accreditation of Ambulance Services (CAAS). CAAS standards are very demanding and independently assure communities deal with a company that cares about being much better than simply good enough. We believe in excellence in EMS. Finally, I would like to point out the value of dealing with an organization that is independent. Healthcare is deeply personal. There are exciting new healthcare options being introduced into the community over the next couple of years. Ideally, your ambulance service should be agnostic to the interests of powerful health care organizations or insurance companies. The team should be unconflicted to preserve individual patient and family choice. Our absence of other business interests in the community allows us the latitude to always do the right thing. Respectfully submitted, Scott Sampey Vice President / Chief North Memorial Health Ambulance Services 3 | Page INTRODUCTION TO THE PROPOSAL North Memorial Health Ambulance understands that Bayfield County is seeking proposals to provide Supplemental EMS ambulance services within the county. North Memorial Health Ambulance is confident that it can provide high-quality ambulance services to Bayfield County. North Memorial will offer a proposal that will meet all the requirements set forth in the RFP. CONTRACTOR INFORMATION North Memorial Health Ambulance Service 4501 68th Ave North Brooklyn Center, MN 55429 Contact persons Scott Sampey Vice President / Chief North Memorial Health Ambulance Services Office (763) 581-9902 Fax (763) 581- 9901 Scott.Sampey@NorthMemorial.com Brent Custard Ambulance Operations Director / Assistant Chief North Memorial Health Ambulance Services Office (763) 581-9925 Fax (763) 581- 9901 Brent.Custard@NorthMemorial.com Tax ID Federal EIN – 41-0729979 4 | Page ORGANIZATIONAL STRUCTURE North Memorial Health Ambulance Service (NMHAS) is a business line of North Memorial Health, a 501(c)(3) nonprofit organization. With a legacy spanning over 60 years, NMHAS has established itself as a leader in the industry, delivering responsible and dedicated service to the community. Annually, NMHAS responds to more than 100,000 service requests. The NMHAS Central Administrative Offices are located at 4501 68th Avenue North in Brooklyn Center. This 45,000-square-foot facility houses essential support services, including dispatch communications, quality assurance, billing, vehicle maintenance, materials management, education, and administration. As one of the largest hospital-based ambulance services in the United States, NMHAS provides comprehensive medical transportation solutions across Minnesota and Western Wisconsin, including:  Ground Ambulance Services – Advanced Life Support (ALS), Basic Life Support (BLS), wheelchair transportation, and Critical Care  Helicopter Emergency Medical Services  Community Paramedicine To ensure excellence in service, NMHAS has obtained ISO 9001 certification and accreditation from the Commission on Accreditation of Ambulance Services (CAAS). We take pride in being one of only three accredited ambulance services in Minnesota and one of four in Wisconsin. The CAAS accreditation represents the "gold standard" in the medical transportation industry, exceeding typical state and local licensing requirements. Achieving this distinction means NMHAS has met more than 150 rigorous performance standards set by a panel of industry experts. Additionally, our Air Care service holds accreditation from the National Accreditation Alliance of Medical Transport Applications (NAAMTA). COMMUNITY INVOLVEMENT At NMHAS, we believe that our long-standing success is rooted in the relationships we build with the communities we serve. We are committed to active community engagement and regularly participate in local events. While we typically provide these services at no charge, exceptions may apply for private promotions or commitments requiring extended time and resources. Our community involvement includes, but is not limited to:  Dedicated standby services and fire standbys  Community days and parades  Safety camps and school visits  Career days  Injury prevention programs  Civic group collaborations  Community and industrial education initiatives Through these efforts, NMHAS remains dedicated to not just providing emergency medical care but also enhancing the well-being and safety of the communities we serve. 5 | Page OPERATIONAL LOCATIONS NMHAS has numerous operational sites throughout Minnesota and Western Wisconsin as illustrated on the map below. In total, we cover an area larger than the state of Massachusetts. We have urban, rural, and super rural sites. There are full-time and part-time on-site staffing models. Response times vary accordingly. We are proud of our success in providing excellent response times and customer service to the areas we serve. We are excited at the potential of providing similar services to Bayfield County. 6 | Page MANAGEMENT Scott Sampey, MSMT, RN Vice President / Chief Scott Sampey joined North Memorial Health in 2020 as Vice President and Chief of Ambulance Services. Scott provides executive leadership for 911 and critical care ground transport, the Air Care aeromedical program, community paramedicine, and the services that support these programs, all of which work together to deliver care to patients across Minnesota and northwestern Wisconsin. Prior to joining North Memorial Health, Scott served in a variety of EMS, nursing, air medical, and hospital leadership roles across the country. Brent Custard, MBA, NRP Director / Assistant Chief, Ground Ambulance Operations Brent has over 20 years of EMS experience working as an EMT, Paramedic, Field Training Officer, Operations Supervisor, Educator, and Manager of Quality and Clinical development. Currently he is the Director of Ambulance Operations. Brent is responsible for the oversight of North Memorial’s Ambulance Service ground operations that are spread throughout Minnesota and Wisconsin. Simone Ramler, NRP Operations Manager / District Chief Ground Ambulance Operations Simone began her career with North Memorial Health Ambulance in 2014. Throughout her tenure, she has held a variety of progressive clinical and leadership roles, including Wheelchair Driver, EMT, Paramedic, Field Training Officer, Tactical Paramedic, and Operations Supervisor. She has Operations leadership experience in both urban and rural settings across Minnesota and Wisconsin. Simone now serves as Operations Manager/District Chief for the Wisconsin region, where she is responsible for oversight of all ground ambulance operations in Burnett and Washburn Counties. 7 | Page Travis Stowe, CC-EMT-P Operations Supervisor / Captain Ground Ambulance Operations With 30 years of experience in Emergency Services, Travis has served in multiple roles including EMT, Fire Fighter, Motor Pump Operator, Paramedic, Lead Special Response Team Paramedic, Crew Chief, Field Training Officer, Fleet Maintenance Manager and Operations Supervisor. Travis is currently responsible for the daily operations of North Memorial Ground Ambulances in Burnett and Washburn County, which serves 32 townships and 2 cities. Travis has been a part of our Wisconsin Operations since 2009. Shimon Cohen, DHSc, MBA, RN, NRP , CMTE Director / Assistant Chief Air Care Clinical Services Shimon brings over 25 years of experience in emergency services, including more than 20 years with North Memorial's Air Care division. Throughout his career, he has served in various roles as a Paramedic and Registered Nurse in both rural and urban settings, to include holding experience with fire rescue and military service. As part of the leadership team for North Memorial Ambulance Services, Shimon is responsible for oversight across seven helicopter bases in Minnesota and Wisconsin. Jeffrey Connors, NRP, CCP-C Director / Assistant Chief, Ancillary Services Jeffrey's journey in both rural and urban emergency medical services, including air and ground transportation, has been marked by his recent appointment as the Director of Ancillary Services at North Memorial Ambulance Services in April 2021. In this role, he leads the education, quality, fleet, technology, and communication center teams, highlighting his commitment to the field. However, it is his passion for mentoring and developing industry leaders that truly sets him apart, inspiring and motivating those around him. 8 | Page Mari Moran, MBA Director, Financial Integration Ambulance Services Mari began her career with North Memorial in 2012 as a senior financial analyst supporting various departments throughout her tenure such as Patient Care, IT, Home Health and Hospice, and Ambulance Services. Mari leads the financial planning and analysis functions for Ambulance Services as well as work closely with the Billing Director to assure billing processes are optimized and compliant with all regulatory authorities. Rosie Anderson Director, Ambulance Billing Rosie Anderson has over forty years of experience in billing and healthcare reimbursement in areas such as Physician Clinics, Long Term Care, Home Health, Inpatient and Outpatient Hospitals, and for the last eighteen years, Medical Transportation. She is responsible for the centralized billing and compliance for twenty-seven ambulance sites in Minnesota and Wisconsin and is well known as a resource for helping ambulance providers navigate the complicated arena of healthcare reimbursement. Steve Grimaldi Safety Manager NMH Ambulance Services With 38+ years of aviation experience and 24+ years of safety program management, Steve has diverse experience across both military and civilian aviation and safety roles, successfully managing aviation and ground safety programs ranging in size from small military companies up to large civilian and military organizations. Steve’s educational background includes certifications and experience in aviation management, safety management systems, accident investigation, technology, training, and education. Steve joined North in January 2023 9 | Page Kevin Lee Emergency Services Relationship Specialist Kevin is the Emergency Services Relationship Specialist for North Memorial. Kevin formerly served as the District Chief in the Brainerd Region for 15 years. Kevin has over 40 years of experience in EMS as an EMT, Paramedic, Flight Paramedic, Supervisor, and Manager. Kevin focuses and excels in building and nurturing strong relationships with customers, partners, and stakeholders to foster long-term partnerships and maximize support for our team and customers. Kevin lives in rural Brainerd. Mike Zolik Outreach Relationship Specialist Mike Zolik has been the Outreach Relationship Specialist for North Memorial Air Care for the past 4 years. He has 20+ years of business relationship management in healthcare. Mike is passionate about connecting with our customers and leverages his expertise in marketing and outreach to drive meaningful connections between North Memorial and our customers, contributing to business growth and success. He and his wife raised 7 kids and reside in Plymouth. Kevin 10 | Page MEDICAL DIRECTION The effectiveness of any medical enterprise will be directly correlated to the experience, commitment, and time allotted to the medical director's function. To that end, NMHAS has invested significant resources to ensure that our medical direction is the foundation from which everything else flows. Dr. Peter Tanghe Pete is North Memorial Health Ambulance Service’s Medical Director. This includes operational support of North Memorial’s Air Care, Ground Ambulance and Community Paramedic programs. He also works clinically at both North Memorial’s Robbinsdale Hospital Emergency Department (Level 1 trauma center) and Maple Grove Hospital’s Emergency Department, and in WI - Spooner Health Hospital (Critical Access). He is an ATLS and CALS instructor and is committed to education and the evolution of EMS. Before becoming a physician, he worked as an EMT in various rural and urban settings. In some capacity he has been involved in EMS for 30+years. His special interests include teamwork, population health, telemedicine, medical education, and tactical/wilderness emergency medicine. Pete is board certified in both Emergency Medical Services and Emergency Medicine. He is a graduate of St John’s University/College of St Benedict’s and attended Medical School at the University of Minnesota. He completed an Emergency Medicine Residency at Region’s Hospital. He has additional training in quality improvement, LEAN methodology, and EMS operational medical direction. Dr. Zachary Finn Zach is board certified Emergency Medical Services and Emergency Medicine physician. He was born and raised in Minnesota. He attended undergraduate at Emory University in Georgia and then medical school at Duke University in North Carolina. He missed his Minnesota roots and returned to complete his Emergency Medicine Residency and subsequent EMS fellowship at Regions Hospital in Saint Paul. He has served in his role as an EMS physician/Associate Medical Director with North Memorial Health Ambulance Services since 2021. His role involves the support of the clinical, operational, educational, and quality arms of the North’s ground, air, and community paramedicine systems. He works his ER shifts at North Memorial’s Robbinsdale Hospital, a level one trauma center, and North Memorial’s Maple Grove Hospital, a community hospital. He has worked as an ER physician in many facilities throughout MN, including rural Minnesota. He has a distinct interest in quality improvement work, especially as it relates to prehospital airway management and cardiac arrest care. NMHAS Medical Directors also serve as Medical Directors for many allied agencies in the areas we serve. 11 | Page CLINICAL CARE North Memorial Health Ambulance has a long-standing reputation as a leader in emergency medical care. As one of the first ambulance services in Minnesota to carry heart monitors and provide advanced care, we continue to pioneer advancements in emergency and trauma medicine. Our cutting-edge capabilities include:  12-lead EKGs  Mechanical CPR devices  Video laryngoscope advanced airway management  Hamilton Ventilators  Specialized pediatric equipment  Advanced medical protocols Under the guidance of our Medical Directors and in collaboration with our administrative and clinical teams, NMHAS has participated in numerous national studies, contributing to the development of innovative patient care practices. Additionally, we provide both air and ground neonatal transportation, ensuring specialized care for our most vulnerable patients. 12 | Page QUALITY Overview North Memorial Health Ambulance Services is dedicated to maintaining excellence through a robust Quality Management System (QMS), utilizing data-driven approaches, industry standards, and a culture of accountability to enhance performance, patient outcomes, and operational efficiency. Quality Monitoring and Staff Development  KPI Monitoring: Continuous tracking of key performance indicators (KPIs) to assess service quality.  Data Analysis & QA Process: Identifies trends and areas for improvement.  Targeted Training Programs: Clinical Development team, in partnership with Medical Directors, develops training to enhance staff performance and patient care. Commitment to Industry Standards  ISO 9001: Ensures consistent quality management practices.  Det Norske Veritas (DNV): Promotes a culture of continuous improvement.  Commission on Accreditation of Ambulance Services (CAAS): Maintains high standards of care and compliance.  IAED ACE Accreditation: Internationally recognized standards for excellence in emergency dispatch protocols, quality assurance, and patient care. Innovative Quality Improvement Approaches  Lean Six Sigma: Reduces variability and eliminates inefficiencies.  Just Culture Principles: Balances system accountability with individual actions.  Specialized Training: Quality Improvement team trained by the National Association of EMS Physicians to ensure consistent and effective quality initiatives. Just Culture: Driving Risk Management and Process Improvement  Balanced Accountability: Evaluates system design and individual behaviors to address errors effectively.  Root Cause Analysis: Identifies systemic and individual factors contributing to errors.  Proactive Risk Management: Ensures continuous quality improvement and safer outcomes. 13 | Page QAPI Framework for Continuous Improvement  Quality Assurance (QA): Ongoing monitoring to ensure compliance with established standards.  Performance Improvement (PI): Data-driven identification opportunities for enhancement.  Metrics Assessment: Evaluation of response times, patient outcomes, and staff protocol adherence.  Collaborative Approach: Multidisciplinary teams implement and monitor evidence-based solutions. Commitment to Excellence  Proactive Strategy: Continuous improvement through data analysis, targeted interventions, and adherence to best practices.  Community Impact: Ensuring high-quality care and operational efficiency that directly benefits the communities we serve. TRAINING AND EDUCATION New team members undergo a comprehensive training academy, beginning with two weeks of onboarding at our Education Center in Brooklyn Park, Minnesota. Training includes:  Our mission, vision, and values  Clinical assessment protocols  Certified Emergency Vehicle Operations (CEVO) training  Hands-on skills training and equipment competency validation  Scenario-based critical thinking exercises  Safety Training is led by our Clinical Development Team, including educators, quality specialists, Medical Directors, and Field Training Officers (FTOs). Following the academy, team members participate in:  Clinical field training and regional orientation with an assigned field training officer  Daily performance evaluations conducted by the FTO and local leadership  A final Capstone event, featuring: o Mass Casualty Incident (MCI) training o Scenario-based evaluations o Clinical competency assessments with the Medical Director North Memorial Health Ambulance Services employs the Field Training Evaluation Program (FTEP), a nationally recognized, standardized framework that guides field training officers in delivering consistent training experiences for new team members. This program ensures that recruits are assessed based on clear, objective standards. 14 | Page Continued training includes:  In-person skills labs  Interactive case reviews  Individual feedback and monitoring  Quarterly online education  Evaluations by Medical Directors (at least annually) We also provide specialized EMS training in Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Basic Life Support (BLS), as well as Emergency Medical Responder (EMR) training for law enforcement and fire departments. BILLING & COLLECTIONS As a service primarily funded through user fees, efficient billing practices are crucial to financial sustainability. Our dedicated billing department ensures all processes are:  Aggressive yet compassionate in collections  Compliant with complex regulatory standards  Efficient processing approximately 8,000 new transports per month The Billing Department, based in Brooklyn Center, Minnesota, includes:  Rosie Anderson, Director of Billing  Kris Suhon & Sherri Dzuik, Billing Supervisors  20 Plus Billing Team Members Our team is frequently consulted by the Minnesota and Wisconsin Ambulance Associations for industry best practices. VEHICLE FLEET North Memorial Health Ambulance operates a fleet of 110+ ambulances, along with specialized non- transport vehicles, including:  12 Medical Director & Supervisor response vehicles  5 Community Paramedic vehicles  2 UTVs for special event coverage  29 other support/maintenance vehicles Our Vehicle Maintenance Department, staffed by six experienced mechanics (each averaging 13+ years in ambulance maintenance), operates from bases in Brooklyn Center and Brainerd, with additional support from local businesses. Our fleet redundancy ensures rapid vehicle replacement when needed. 15 | Page COMMUNICATIONS CENTER Our ACE Accredited Communications Center is a leader in EMS dispatch, ensuring rapid, cost-effective service for 911 callers and hospital facilities. Staffing:  1 Operational/Communications Director  1 Operational/Communications Manager  4 Operational/Communications Supervisors  9 Communications Training Officers (CTOs)  40 Certified EMDs (IAED-certified) Operations:  Two 24/7 staffed communications centers (Brooklyn Center & Robbinsdale)  Coordination of 12 ambulance service regions  Dispatch for 7 helicopters across MN & WI  Oversight of 3 Fixed-Wing Aircraft (2 in ND & one in MT)  130,000+ service requests processed in 2025  Collaboration with 30 Public Safety Answering Points (PSAPs)  Pre-Arrival Instructions & T-CPR support for 10 counties across MN & WI Benefits to Residents:  “Zero response time” – Calls are immediately transferred to NMHAS for direct dispatch.  Highly trained dispatchers – EMDs determine the most appropriate response, from BLS to ALS or helicopter transport.  Safety-focused dispatching – Reducing unnecessary lights-and-sirens responses to prevent roadway accidents. AIR CARE Since 1985, North Memorial Air Care has provided helicopter emergency medical services (HEMS) with nine twin-engine helicopters equipped with:  Helicopter Terrain Awareness & Warning Systems (HTAWS)  Night Vision Goggles (NVG)  On-board color radar for weather tracking Our flight nurses and paramedics hold advanced specialty certifications, and our highly trained pilots utilize Instrument Flight Rules (IFR) for safe, all-weather navigation. We operate seven air bases in Minnesota and Wisconsin, ensuring that 80% of medical facilities in Minnesota and Northwest Wisconsin are under a 30-minute flight time. 16 | Page EMERGENCY MANAGEMENT North Memorial Health Ambulance is fully integrated into emergency preparedness efforts, providing:  All-Hazard emergency preparedness & incident management training  Incident monitoring & response coordination  Dedicated Internal Incident Management Team We actively participate in statewide preparedness initiatives, with trained specialists in:  Emergency Management & Incident Command  Infection Prevention & Highly Infectious Disease Transport (ISOPODS)  Ambulance Strike Team Leadership HIRING AND RETENTION When acquiring a new ambulance service coverage area, our priority is to maintain relationships with existing local agencies. Each region has its own:  Recruitment & Retention work plan  Core staff & Management team  Community integration strategy, with leaders involved with civic groups North Memorial Health Ambulance Service has a labor management & scheduling team. This allows for dynamic staffing models to be implemented based on the current volume trends.  1 Manager of Labor and Business development  4 Scheduling Coordinators Our low turnover rate reflects our commitment to staff retention and development. 17 | Page PROPOSED OPERATIONS PLAN Throughout this document, you will see that we do not believe in a standard formula or a cookie-cutter approach to the needs of any community. We have systems that utilize two paramedics, a paramedic and an EMT, or two EMTs per vehicle. We believe in a community-based EMS model; therefore, the community should have input into what they want. We use our experience with all these models to share with the communities the positive and negative of each model and the cost differences. Whatever the model, each area has its own core staff, management, and other support to retain the community-based relationship necessary to be effective. Our philosophy is that our team should be integrated into the community. This includes living in or close to the area. Work Plan Bayfield County is currently served by nine EMS organizations, including seven volunteer BLS agencies and two full-time ALS agencies. NMHAS is prepared to provide two options for supplemental staffing in Bayfield County. These options are as follows: Option 1 1 ambulance staffed 12 hours per day. This would be staffed by 2 EMTs (BLS) working 1 shift. The hours of the shift would be consistent each day of the week and would be mutually agreed upon between NMHAS and Bayfield County. Requests to change the hours worked would need a minimum of 3 months before implementing the change. Option 1 would result in approximately 4.2 FTEs of staff accounting for 6 team members. It is also understood that under extreme circumstances, NMAS would be unable to provide a truck due to unforeseen circumstances, such as illness of staff working. Option 2 1 ambulance staffed 24 hours per day. This would be staffed by 2 EMTs (BLS) working 12-hour shifts making up 2 shifts per day. Option 2 would result in approximately 8.4 FTEs and 12 team members. It is also understood that under extreme circumstances, NMHAS would be unable to provide a truck due to unforeseen circumstances, such as illness of staff working. AEMT and Paramedic The long-term staffing goal is to hire EMTs, train them to the AEMT level, and then have them trained to the Paramedic level. This is a long term that is dependent on our ability to staff, retain, and send people to school. Due to the shortage of Paramedics, there is no formal time frame. Mutual Aid Agreements NMHAS will seek mutual aid agreements with surrounding agencies. Assets Available to Contractor NMHAS is requesting the use of existing bases including vehicle bays, living quarters, EMS specific storage cabinets, and access to shared areas in the building rent free for the duration of the contract. 18 | Page Implementation Schedule Option 1 One truck (BLS) coverage 12 hours a day Task Estimated Completion Execute Contract for Service 07/15/2026 Continued Recruiting & Hiring of staff 07/15/2026 Provide New Employee Orientation Ongoing after contract execution Take over Ambulance PSA & Operations 01/01/2027 *anticipated depending on staffing availability Option 2 One truck (BLS) coverage 24 hours a day Task Estimated Completion Execute Contract for Service 06/17/2026 Continued Recruiting & Hiring of staff 06/17/2026 Provide New Employee Orientation Ongoing after contract execution Take over Ambulance PSA & Operations 01/01/2027 (One 12-hour BLS Truck) Extending to 24-hour Coverage 06/01/2027(Two 12-hour BLS Trucks) Fees for Service North Memorial Health Ambulance Service reviews and updates our fees for service on a yearly basis. The charge rates are set on NMHA’s cost of providing service, and what it costs to recapitalize the service. Updated rates go into effect on January 1st of the new year. 2026 Fees for Service Crew make up, medical necessity, and treatments provided determine level of services, as set by the Centers of Medicare & Medicaid Services. ALS 1 Emergency - $2.035.00 ALS 2 Emergency - $2,120.00 ALS CPR – no transport - $2,035.00 ALS Scene treatment no transport - $715.00 BLS Emergency - $1,910.00 Mileage per loaded mile- $35.00 Standby Events: These events are charged by the hour. Als Standby - $250.00 BLS Standby - $181.00 NMHAS does not charge for the ambulance to respond, or for the patient to be evaluated on scene. 19 | Page Costs The service provided for herein shall be accounted for as an independent cost center. Revenue would be accounted for using NMHA’s account receivable system where receivables will be derived from the units of service directly delivered to the patient. The cost of providing service will be accounted for using two categories, direct and indirect. Direct expenses shall be accounted for using NMHA’s internal accounting system. These expenses are reported under the heads of total payroll and benefits, total supplies, total purchased services, utilities, maintenance and repairs, rentals, other expenses, and depreciation. The parties to this agreement acknowledge that the present net profit (net revenues, less direct and indirect expenses, plus subsidy) margin goal for NMHC ambulance contract services is ten percent (10%). NMHAS goal is to provide high-quality service at a sustainable rate. Sustainability includes both operational and capital costs. We believe it is of vital importance that both parties understand the cost of operating an ambulance service. Option 1 Subsidy request for the first three years of the contract. Year 1 2027 Amount Initial Start-up $817,883.00 Operational expenses $854,131.00 Total year 1 subsidy $1,672,014.00 Year 2 2028 Amount 5% Increase $896,837.00 Year 3 2029 Amount 5% Increase $941,678.00 Option 2 Subsidy request for the first three years of the contract. Year 1 2027 Amount Initial Start-up $966,767.00 Operational expense $1,445,103.00 Total year 1 subsidy $2,411,870.00 Year 2 2028 Amount 5% Increase $1,517,358.00 Year 3 2029 Amount 5% Increase $1,593,226.00 For any extension period, an evaluation of the subsidy amount would occur. Considerations would include costs, volumes, reimbursement rates, and inflation. Year 1 subsidy includes necessary start-up costs associated with acquiring capital, equipment, hiring, and orientating new team members. NMHAS is committed to operating in good faith financially. This is based on what is anticipated for volumes, collection rates, and expenses. This number has the potential to decrease based on the factors listed above (volumes, revenues, staffing). NMHAS is anticipating having to offer substantial amounts of overtime, hiring bonuses, and shift incentives to maintain staffing. Ounce there is an opportunity to provide operations and collect further data, NMHAS is willing to negotiate the subsidy amounts. NMHAS’ goal is to provide high-quality service at a sustainable rate. Sustainability includes both operational and capital costs. 20 | Page Example Form of Agreement This would include: 1) Operation of Ambulance Service 2) Terms 3) Ambulance Reporting Relationship 4) Facilities 5) Ambulances and Equipment 6) Dispatching 7) Radio Frequencies 8) Training/Education 9) Personnel 10) Management 11) Licensing 12) Billing and Collections 13) Charges and Rates 14) Financial Reporting 15) Basis for Financial Reporting 16) Subsidy 17) Insurance 18) Indemnity 19) Assignment 20) No Joint Ventures or Partnerships 21) Assumed Liabilities 22) Data Practices 23) Consequential or Punitive Damages 24) Severability 25) No Modifications 26) Binding Effect 21 | Page REFERENCES Josh Stevenson- Cass County Administrator 303 Minnesota Ave. W, Walker, MN 56484 218-547-7204 josh.stevenson@casscountymn.gov Mark Wedel- Aitkin County Board Chair 307 2nd St. NW, Aitkin, MN 56431 218-838-9324 mark.wedel@co.aitkin.mn.us Joshua Tetzlaff- New Prague City Administrator 118 Central Ave. N, New Prague, MN 56071 952-758-4401 jtetzlaff@ci.new-prague.mn.us April Kurtock- Nashwauk City Administrator 301 Central Ave. Nashwauk, MN 55769 218-885-1210 akurtock@nashwaukmn.gov State of Wisconsin Department of Health Services DIVISION OF PUBLIC HEALTH 210 EAST WASHINGTON AVE. P.O. BOX 2659 MADISON WI 53701-2659 TELEPHONE: 608-266-1568 dhs.wisconsin.gov/EMS 6/08/2026 North Memorial Ambulance-WI Region 26543 Muskey AveP.O. Box 600 Webster, WI 54893 This is your Emergency Medical Services Provider license. Wis. Admin. Code § 110.46 states: A License issued by the department to an emergency medical service provider is valid as long as the provider remains in continuous compliance with EMS-related federal and state statutes, this, chapter, and the operational plan approved by the department, or until the provider notifies the department in writing that it intends to cease providing emergency medical services or the department suspends or revokes the license. License Number 6001317 State of Wisconsin Valid Through 06/30/2029 DEPARTMENT OF HEALTH SERVICES License Paramedic with Critical Care Endorsement 911 Transporting Service, ALS Intercept Service, 911 Non-Transporting Service, Interfacility Transport Service, Critical Care (Ground) Service The EMS Service Provider listed below has complied with the provisions of the Wisconsin statutes and is hereby authorized to engage in this activity. North Memorial Ambulance-WI Region 26543 Muskey AveP.O. Box 600 Webster, WI 54893 NOT TRANSFERABLE Park Rapids North Memorial Health Ambulance Services Ambulance Bases Ambulance Service Areas Marshall Twin Cities Burnett/ Washburn Cty, WI Douglas Cty. Longville Aitkin Walker New Prague Waseca Spooner Milaca Zimmerman Brainerd Princeton Faribault McGregor Nashwauk Grand Rapids Brainerd Princeton Bemidji Siren Faribault Park Rapids Air Care Bases 15 min response time 30 min response time 45 min response time North Memorial Health Air Care Services North Memorial Health Ambulance Services Ambulance Bases Ambulance Service Areas Marshall Twin Cities Burnett/ Washburn Cty, WI Douglas Cty. Longville Aitkin Walker New Prague Waseca Spooner Milaca Zimmerman Redwood Falls McGregor Grand Rapids Nashwauk ~ 1 ~ Bayfield County, Wisconsin Request for Proposals (RFP) Due: June 24, 2026 Supplemental Emergency Medical Services (EMS) Ambulance Service Provider 1. Introduction Bayfield County is actively working to address the growing challenges facing our rural ambulance providers. Bayfield County, Wisconsin (“County”) is soliciting proposals from qualified Emergency Medical Services (EMS) ambulance service providers to create a “Safety Net” that will supplement the County ’s existing volunteer ambulance service agencies. Bayfield County recognizes the critical importance of timely and reliable emergency medical response services for residents and visitors throughout the County. It is intended that the existing volunteer ambulance agencies will remain operational and continue to serve their respective communities. The intent of this Request for Proposals (RFP) is to identify one or more outside EMS providers capable of supplementing the existing services by improving system coverage, response capability, staffing resiliency, and operational readiness. The County seeks proposals from agencies with demonstrated experience in ambulance operations, EMS staffing, emergency response coordination, rural healthcare delivery, and collaboration with local volunteer agencies and local units of government. This RFP does not guarantee the award of a contract. Bayfield County reserves the right to reject any or all proposals, waive informalities, negotiate modifications, and accept the proposal deemed most advantageous to the County. ~ 2 ~ 2. County Background Bayfield County, located in northwestern Wisconsin on the south shore of Lake Superior, is one of the state’s largest counties by land area and is home to numerous lakes, streams, rivers, and the Apostle Islands National Lakeshore. Despite its size, Bayfield County has the 12th-smallest permanent population in Wisconsin, with 16,220 residents according to the 2020 Census. At the same time, the County continues to grow, ranking as the sixth fastest-growing county in Wisconsin based on 2020 Census data. During the summer months, the population nearly doubles due to seasonal residents and tourists. While tourism provides significant economic benefits to the region, it also results in increased 911 calls and greater demand for emergency services throughout the County. The County includes several small rural communities, seasonal tourism destinations, National and County Forest areas, tribal communities, and remote islands in Lake Superior. No hospitals are located in Bayfield County. Bayfield County has traditionally been served by nine EMS organizations. Seven of these (Barnes, Bayfield, Iron River, Mason, Red Cliff, South Shore, and Washburn) are licensed volunteer Basic Life Support (BLS) ambulance services. Although these EMS agencies have historically operated with limited financial compensation for personnel, several have recently begun hiring full-time EMTs or increasing on-call pay in an effort to address ongoing staffing shortages. The remaining two agencies, the Ashland Fire Department and Great Divide EMS, are staffed by career personnel and licensed to provide Advanced Life Support (ALS) services at the paramedic level. Historically, ambulance placement within Bayfield County has been driven more by geography than by call volume. This system has served the County well since the 1970’s; however, the conditions that once supported its success have changed significantly over time. Challenges impacting EMS delivery Bayfield County include: • Recruitment and retention of volunteer EMS personnel; • Increasing 911 call volumes and service demand; • Geographic distances and rural response challenges; • Workforce shortages and demographic trends; • Seasonal population increases; • Ambulance coverage gaps during daytime and overnight periods; • Long-distance interfacility transport requirements. As the number of available EMTs declines, so does the number of ambulances able to respond to emergencies. This results in longer response times and situations where the closest ambulance may be unavailable due to insufficient staffing. In 2025, ambulance ~ 3 ~ services in Bayfield County missed 108 calls, primarily because of staffing shortages, a 65% increase from the previous year. The decline of rural EMS is a nationwide challenge, and Bayfield County is not immune to its effects. At the same time, our EMS volunteers remain vital to the continued success and sustainability of emergency medical services throughout the County. The County intends for any awarded contractor(s) to operate collaboratively with existing volunteer agencies and career public safety partners. The intent is to create a “safety net” to supplement the existing EMS system in Bayfield County, not replace it. 3. Purpose of the RFP The purpose of this RFP is to solicit proposals for supplemental EMS services that may include, but are not limited to: • Emergency ambulance response; • Peak-demand coverage; • Standby ambulance coverage; • Advanced Life Support (ALS) or Basic Life Support (BLS) response; • Shared service or regional EMS deployment; • Mutual aid participation; • Disaster or mass casualty response support; • Temporary or long-term ambulance stationing within Bayfield County. The County is open to innovative service delivery models and encourages respondents to propose flexible operational approaches that support sustainable EMS service throughout the County. 4. Scope of Services The selected provider(s) will be expected to provide the following services as part of EMS system operations: 4.1 Emergency EMS Response • Respond to emergency 911 calls as dispatched by the joint Ashland/Bayfield County Emergency Communications Center; • Provide ALS and/or BLS care consistent with Wisconsin EMS regulations; • Coordinate with existing volunteer ambulance services; ~ 4 ~ • Participate in mutual aid and coverage responses; • Maintain response readiness 24 hours per day, 7 days per week, as proposed. 4.2 Interfacility Transportation • The Contractor shall ensure that 911 emergency medical response is always the highest operational priority. Staffing, unit availability, deployment planning, and resource allocation must be structured so that emergency calls for service receive precedence over interfacility transfers. Interfacility transports may be delayed, rescheduled, or declined when necessary to maintain adequate 911 system coverage, response times, and readiness for time-critical emergencies. If the contractor provides service for interfacility transfers, they must demonstrate the ability to meet interfacility transport needs without compromising the performance, reliability, or availability of the “Safety Net” in Bayfield County. 4.3 Staffing Support • Provide Wisconsin licensed EMTs, Advanced EMTs, and/or Paramedics; • Provide adequate staffing for an ambulance or other EMS response unit to serve as a critical safety net, helping to fill coverage gaps when local volunteer EMS agencies are unable to staff or respond to calls. The intent is not to replace volunteer services, but rather to supplement and strengthen them by working in partnership with local agencies to ensure reliable emergency medical response while supporting the vital work already being performed by volunteer providers throughout the County. 4.4 Coordination and Integration • Coordinate operations with: o Bayfield County Emergency Management; o Bayfield County Sheriff’s Office; o Local fire departments; o Existing local EMS agencies; o Local/Regional hospitals; o Ashland-Bayfield County Emergency Communications Center; o Tribal emergency response agencies; o Local units of government as required. 4.5 Compliance The provider shall comply with all applicable: • Wisconsin EMS licensing requirements; • Federal healthcare regulations; • HIPAA requirements; ~ 5 ~ • OSHA requirements; • Medicare and Medicaid billing requirements; • Local ordinances and policies. 4.6 Equipment and Vehicles The provider shall furnish and maintain: • Initially, one licensed unit with enough redundancy to provide 24/7 coverage; • Medical equipment appropriate for the level of care provided; • Communications equipment; • Required medications and supplies; • Personnel protective equipment (PPE); • Vehicle maintenance and inspection programs. 4.7 Reporting and Data Sharing The provider will present regular reports to the Bayfield County EMS Office and the Bayfield County Board regarding system performance including: • Response time reporting; • Call volume statistics; • Missed Call and Staffing Shortage reports; • Quality assurance data; • Incident reporting; • Financial and operational reports. 5. Desired Service Goals Bayfield County seeks proposals that demonstrate: • Reliable ambulance availability; • Improved rural EMS coverage; • Reduced response times when feasible; • Strong collaboration with volunteer agencies; • Sustainable staffing models; • High clinical standards; • Financial transparency; • Long-term operational stability; • Community engagement and responsiveness. ~ 6 ~ 6. Minimum Qualifications Respondents must demonstrate the following minimum qualifications: 1. Current licensure to operate ambulance services in the State of Wisconsin; 2. Minimum of three (5) years of EMS operational experience; 3. Ability to provide adequately licensed EMS personnel; 4. Ability to meet insurance requirements identified in this RFP (see section 8); 5. Experience operating within rural or regional EMS systems; 6. No significant unresolved regulatory violations within the past five (5) years. 7. Proposal Submission Requirements Proposals shall contain the following information: 7.1 Cover Letter Include: • Legal name of organization; • Primary contact person; • Address, phone number, and email; • Statement of interest; • Signature of authorized representative. 7.2 Organizational Overview Provide: • Company history; • Organizational structure; • Years in operation; • Geographic service areas; • EMS licensure information; • Relevant experience. 7.3 Operational Plan Describe: ~ 7 ~ • Proposed service model; • Hours and levels of coverage; • Staffing model; • Deployment strategy; • Unit locations or staging concepts; • Coordination with existing EMS agencies; • Response capabilities; • Mutual aid/coverage participation; • Communications and dispatch integration. 7.4 Staffing Plan Provide: • Number and level of personnel; • Staffing schedules; • Recruitment and retention strategies; • Training and continuing education programs; • Background screening procedures. 7.5 Quality Assurance and Clinical Oversight Describe: • Medical direction; • Clinical quality improvement programs; • Patient care review processes; • Safety programs; • Infection control practices. 7.6 Financial Proposal Provide detailed pricing information, including: • Service fees; • Hourly or standby rates; • Transport billing practices; • Any other cost assumptions not otherwise addressed; • Proposed contract terms; • Anticipated County financial obligations based upon an agreement of three (3) to five (5) years. ~ 8 ~ 7.7 Equipment and Fleet Information Include: • Ambulance inventory; • Vehicle specifications; • Fleet age and replacement plans; • Communications capabilities; • Specialized equipment. 7.8 References Submit municipal references demonstrating experience with similar EMS contracts or service operations. Include: • Municipality name; • Contact person; • Phone number; • Email address; • Description of services provided. 7.9 Required Attachments Include copies of: • Wisconsin ambulance service license; • Proof of insurance; • W-9; • Relevant certifications; • Any pending litigation disclosures; • Financial statements or evidence of financial stability. 8. Insurance Requirements The selected provider shall maintain insurance coverage including, at minimum: • Commercial General Liability; • Professional Liability / Medical Malpractice; • Automobile Liability; • Workers’ Compensation; ~ 9 ~ • Cyber Liability. Minimum coverage amounts shall be determined during contract negotiations. Bayfield County shall be named as an additional insured where appropriate. 9. Contract Term The County anticipates entering into a contract with an initial term of three (3) to five (5) years with possible renewal options upon mutual agreement. The final contract term will be negotiated with the selected provider. 10. Proposal Evaluation Criteria Proposals may be evaluated using criteria including, but not limited to: Evaluation Criteria Weight Experience and Qualifications 20% Operational Plan and Coverage Model 20% Ability to Coordinate with Existing Volunteer Agencies 15% Staffing and Workforce Stability 15% Financial Proposal 15% Quality Assurance and Clinical Oversight 15% The County may conduct interviews, request additional information, or negotiate with one or more respondents. 11. Tentative RFP Schedule Milestone Date RFP Issued June 1, 2026 Questions Due June 10, 2026 Responses to Questions Issued June 17, 2026 Proposal Submission Deadline June 24, 2026 Interviews (if conducted) July 1, 2026 Notice of Intent to Award July 15, 2026 ~ 10 ~ Milestone Date Contract Negotiations July 20, 2026 Anticipated Service Start Date (no later than) January 1, 2027 The County reserves the right to modify this schedule. 12. Submission Instructions Proposals must be received no later than June 24, 2026 at 11:59 PM Central time. Submit proposals electronically and in hard copy as directed below: Bayfield County Emergency Management 117 E. Sixth Street P.O. Box 423 Washburn, Wisconsin, 54891 And via email to: bryan.ziemann@bayfieldcounty.wi.gov and meagan.quaderer@bayfieldcounty.wi.gov Late submissions may be rejected. 13. Questions and Clarifications All questions regarding this RFP must be submitted via email to: bryan.ziemann@bayfieldcounty.wi.gov and meagan.quaderer@bayfieldcounty.wi.gov Responses to substantive questions may be distributed to all known respondents. ~ 11 ~ 14. Reservations of Rights Bayfield County reserves the right to: • Reject any or all proposals; • Waive technicalities or informalities; • Request clarification or additional information; • Modify the scope of services; • Cancel or reissue the RFP; • Negotiate terms with one or more respondents; • Accept portions of proposals; • Award contracts to multiple providers. 15. Non-Discrimination The selected provider shall comply with all applicable federal and state nondiscrimination laws and regulations. 16. Confidentiality Proposal materials may become public records subject to Wisconsin public records laws. Respondents shall clearly identify any information claimed to be confidential or proprietary. 17. Additional Considerations Bayfield County encourages proposals that: • Support collaboration rather than replacement of existing volunteer agencies; • Include innovative rural EMS solutions; • Provide flexible deployment capabilities; • Demonstrate long-term sustainability; • Enhance regional emergency preparedness. ~ 12 ~ Appendix A – Optional Information Requested Respondents are encouraged to provide additional information including: • Proposed response time goals; • GIS coverage maps; • Examples of rural EMS partnerships; • Community paramedicine capabilities; • Disaster response plans; • Staffing contingency plans; • Seasonal surge staffing plans. ~ 13 ~ Appendix B – Existing System Overview ~ 14 ~ Ambulance Service 911 Calls in 2022 911 Calls in 2023 Coverage Area Ashland Fire Department* 70 111 70 square miles Barnes Ambulance Service 104 108 125 square miles Bayfield Ambulance Service 185 222 82 square miles Great Divide Ambulance Service* 428** 341** 358 square miles Iron River Ambulance Service 372 306 231 square miles Mason Ambulance Service 156 135 181 square miles Red Cliff Ambulance Service 336 325 53 square miles South Shore Ambulance Service 106 97 221 square miles Washburn Ambulance Service 438 499 186 square miles ~ 15 ~ Ambulance Service 911 Calls in 2022 911 Calls in 2023 Coverage Area Total in Bayfield County 2,195 2,144 1507 square miles *This is a career Paramedic level Service. **The numbers in this chart reflect only 911 calls responded to in Bayfield County, and do not account for any inter-facility transfers (IFT’s) performed by the Service. ~ 16 ~ EMS Glossary of Terms 4x4 Ambulance An ambulance with four-wheel drive, useful in rural areas, winter conditions, and difficult terrain. 911 EMS Response An emergency ambulance or EMS response initiated through the 911 dispatch system. AEMT — Advanced Emergency Medical Technician A licensed EMS provider with training above an EMT but below a paramedic. AEMTs may perform some additional skills such as limited IV therapy or medication administration, depending on state rules and local protocols. Air Care / Air Medical Medical transport by helicopter or airplane, generally used for serious emergencies, long distances, or specialized transport needs. ALS — Advanced Life Support Higher-level emergency medical care usually provided by a paramedic or advanced provider. ALS may include IVs, advanced airway management, cardiac monitoring, medication administration, and other complex treatments. ALS Intercept When a paramedic-level unit meets a Basic Life Support ambulance during a call to provide a higher level of care without necessarily replacing the local ambulance as the transporting unit. Ambulance Chassis The truck or van platform on which an ambulance is built, such as a Ford F-450 or F-550. AV L — Automatic Vehicle Location GPS-based technology that allows dispatch or supervisors to see where ambulances or response vehicles are located in real time. Billing Company A vendor or internal department that handles ambulance claims, insurance billing, Medicare/Medicaid billing, and patient billing. BLS — Basic Life Support Emergency medical care typically provided by EMTs. BLS includes basic assessment, CPR, bleeding control, oxygen, splinting, and other care allowed under state and local protocols. CAD — Computer-Aided Dispatch Software used by dispatch centers to track emergency calls, assign units, record response times, and manage emergency resources. CAAS — Commission on Accreditation of Ambulance Services A national ambulance accreditation organization. CAAS accreditation can indicate that a provider meets standards beyond basic state licensing. Call Volume The number of EMS calls handled during a specific period. Cancel / Continue / Intercept Decision Operational choices in a co-dispatch system. A local ambulance may cancel the supplemental unit, continue it for support, use it for ALS intercept, or rely on it to complete the response. Career EMS / Career Service An EMS agency staffed by paid professional personnel, often including full-time or part-time employees. Cardiac Monitor / Defibrillator Equipment used to monitor heart rhythms and deliver shocks for certain life-threatening cardiac emergencies. Clinical Guidelines / Protocols Written medical rules that tell EMS personnel what treatments they may provide in specific situations. Clinical Oversight The system for ensuring that EMS patient care meets medical standards, including physician review, training, protocols, and quality improvement. Clinical Quality Improvement Program A formal process for measuring, reviewing, and improving EMS patient care. Co-Dispatch A dispatch model where both the local ambulance and a supplemental safety-net provider may be dispatched at the same time or under defined protocols. Community Paramedicine A program where paramedics provide non-emergency, community-based care, often to reduce repeat 911 calls, support chronic disease management, or connect patients with services. Compliance Meeting applicable legal, licensing, billing, safety, privacy, and operational requirements. Cost Recovery Recovering some EMS operating costs through billing, contracts, grants, or other revenue sources. Coverage Gap A period, location, or situation where an ambulance may be unavailable because of staffing shortages, call volume, distance, or another operational issue. Coverage Response A response by another agency to cover an area or call when the primary ambulance service is unavailable. Critical Care Paramedic / Critical Care Endorsement A paramedic with additional training or authorization to provide a higher level of care for very sick or medically complex patients, often during interfacility transfers. Critical Care Transport Transport of very sick or medically complex patients who require advanced monitoring or treatment. Cross-Credentialed Personnel authorized or credentialed to work with multiple EMS agencies or under multiple medical direction arrangements. Deployment Strategy The plan for where EMS units are stationed or moved throughout the county to best cover demand and reduce response times. Disaster Response Support EMS capacity available during large emergencies, natural disasters, mass casualty incidents, severe weather, or other extraordinary events. Dispatch The process of receiving a 911 call and sending the appropriate ambulance, fire, law enforcement, or other responders. Dual-Role Position A position where one person performs both operational duties and another function, such as serving as both a paramedic and field supervisor. Dynamic Deployment Moving ambulances or quick response vehicles during a shift based on current coverage, call volume, risk, or staffing conditions. ECG / EKG — Electrocardiogram A test that records the heart’s electrical activity. EMS providers use ECGs to assess possible heart attacks or dangerous heart rhythms. Emergency Communications Center / Dispatch Center The center that receives emergency calls and dispatches emergency responders. Emergent Interfacility Transfer A time-sensitive transfer between healthcare facilities for a patient needing urgent or higher-level care. EMR — Emergency Medical Responder A first-responder level below EMT. EMRs can provide immediate lifesaving care before an ambulance arrives. EMS — Emergency Medical Services The overall system that provides emergency medical response, patient care, and ambulance transport before a patient reaches the hospital. EMS Levy / Countywide EMS Levy A county tax levy used to fund a countywide emergency medical system. EMT — Emergency Medical Technician A licensed EMS provider trained to deliver Basic Life Support care. ETCO₂ — End-Tidal Carbon Dioxide A monitoring measurement used to assess breathing, airway placement, and CPR quality. Fee Schedule The list of charges for EMS transports or services. Field Supervisor An EMS leader who works in or near the field, supports crews, coordinates operations, mentors staff, and helps manage service performance. First Response Support A model where an EMS provider arrives before or alongside an ambulance to assess the patient, begin treatment, and assist the transporting crew. Fleet Maintenance The process of keeping ambulances and response vehicles inspected, repaired, stocked, and operational. FTE — Full-Time Equivalent A staffing measure equal to one full-time position. Multiple part-time employees may together equal one FTE. FTEP — Field Training and Evaluation Program A structured program for onboarding, training, and evaluating EMS staff. FTO — Field Training Officer An experienced EMS provider who trains and evaluates new staff in the field. Fully Staffed Model A model where crew members are scheduled and physically available, rather than waiting to be called in from home. HCPCS Codes Billing codes used for ambulance services, mileage, and transport levels. HIPAA — Health Insurance Portability and Accountability Act Federal health privacy law protecting patient medical information. IFT — Interfacility Transport Transport of a patient from one healthcare facility to another, such as from a clinic or hospital to a higher-level hospital. Infection Control Policies and procedures to prevent the spread of disease among patients, EMS crews, and the public. Integrated Health System A healthcare organization that includes hospitals, clinics, ambulance services, and other healthcare operations. Interfacility Transport / IFT Transport of a patient from one healthcare facility to another. In the EMS proposals, this is important because interfacility transports can affect ambulance availability for 911 calls. ISO 9001 A quality management certification used across industries, including by some ambulance providers, to show standardized quality processes. KPI — Key Performance Indicator A measurable performance target, such as response time, unit availability, missed calls, staffing reliability, or documentation completion. Licensure State authorization for an EMS agency or provider to operate at a defined service level. LIFEPAK A common brand of cardiac monitor/defibrillator used in EMS. Local EMS Agency An existing community-based ambulance service, such as Barnes, Bayfield, Iron River, Mason, Red Cliff, South Shore, or Washburn. LUCAS Device A mechanical CPR device that provides automated chest compressions. Mass Casualty Incident / MCI An incident involving more patients than the normal EMS system can manage with routine resources, such as a major crash, fire, disaster, or large-scale emergency. Medical Direction Physician oversight of EMS care, including protocols, training, quality review, and clinical authorization. Medical Director A physician responsible for overseeing the clinical care provided by an EMS agency. Medicare / Medicaid Billing Billing to federal or state healthcare programs for eligible ambulance transports. Missed Call A 911 call that the primary local ambulance service could not answer, often because it lacked available crew. Mutual Aid Assistance provided by one EMS agency to another, often when the primary agency is unavailable, overwhelmed, or needs additional resources. NAAMTA — National Accreditation Alliance of Medical Transport Applications An accreditation organization for medical transport, including air medical services. No Hospital in County A key local EMS planning issue. Because Bayfield County has no hospital, ambulance transports may involve long travel times, which can reduce unit availability for additional 911 calls. Non-Emergent Transport A scheduled or lower-acuity transport that does not require lights-and-sirens emergency response. Non-Transport Response / First Response EMS response that provides care on scene but does not transport the patient. NRP — Nationally Registered Paramedic A paramedic credential issued through the National Registry of Emergency Medical Technicians. On-Call Model A model where personnel are available to respond when paged, but may not be physically stationed with the ambulance. On-Scene Time The time EMS spends at the incident location before transporting or clearing the call. Operational Accountability Expectations that the provider will report performance, meet standards, explain problems, and work with the County to improve service. Paramedic The highest common prehospital EMS provider level. Paramedics provide Advanced Life Support care. Patient Care Report / ePCR The electronic record completed by EMS personnel after a call, documenting patient condition, treatment, times, transport, and outcome. Patient Care Review Clinical review of selected EMS calls to evaluate whether care was appropriate and consistent with protocols. Paid-on-Premise / Station-Based Staffing Personnel are paid to be at the station or base location and ready to respond immediately. Peak-Demand Coverage Additional EMS staffing during predictable high-demand periods, such as tourism season, weekends, festivals, or times when call volume is higher. Performance-Based EMS Staffing Grant Fund A proposed local funding mechanism to support staffing costs, reduce missed calls, and incentivize EMS agency performance. PPE — Personal Protective Equipment Protective gear such as gloves, masks, gowns, eye protection, and other equipment used for responder safety. Power Load System A powered ambulance cot-loading system that helps load and unload patients safely and reduces lifting injuries. Powered Cot / Power Stretcher A stretcher that uses battery power to lift or lower patients, reducing physical strain on EMS crews. Protocols / Clinical Guidelines Written medical rules that tell EMS personnel what treatments they may provide under specific circumstances. PSAP — Public Safety Answering Point The 911 call center that answers emergency calls and initiates dispatch. Public Safety Partner An organization involved in emergency response, such as EMS, fire, law enforcement, dispatch, emergency management, hospitals, or tribal responders. QA — Quality Assurance Review processes used to confirm that EMS care and operations meet required standards. QAPI — Quality Assurance / Performance Improvement A combined quality system that reviews performance and uses findings to improve future service. QI — Quality Improvement Ongoing efforts to improve patient care, response performance, documentation, training, and system outcomes. QRU — Quick Response Unit A staffed EMS response unit that can provide care but generally does not transport patients. Similar to a QRV . QRV — Quick Response Vehicle A smaller EMS response vehicle, often an SUV or pickup, staffed by an EMT, AEMT, or paramedic. It can respond quickly and provide care but generally does not transport patients. Receiving Facility The hospital or healthcare facility that accepts the patient. Recruitment and Retention Strategies to attract new EMS workers and keep existing personnel. Redundancy / Backup Unit Extra vehicle or staffing capacity available if the primary unit is busy, out of service, under repair, or unavailable. Remounted Ambulance An ambulance patient-care module placed onto a newer chassis, often used to reduce capital costs compared to purchasing an entirely new ambulance. Response Completion When the supplemental provider finishes the EMS response because the local agency cannot respond or cannot complete the call. Response Readiness The state of having trained staff, equipment, vehicles, supplies, communications, and deployment plans in place so a unit can respond immediately. Response Time The time it takes for an EMS unit to arrive after being dispatched or after a call is received, depending on how the metric is defined. Revenue Collection The process of billing and collecting payments for ambulance services. Safety Net The supplemental EMS coverage Bayfield County is seeking. It is intended to fill coverage gaps when local volunteer agencies are unavailable, not replace existing local ambulance services. Scope of Practice The legally permitted skills, treatments, and medications an EMS provider may perform based on their license level. Seasonal Surge Staffing Additional staff or deployment changes used to address increased population and call volume during tourist or seasonal periods. Staffing Contingency Plan A backup plan for maintaining service when staff are sick, unavailable, resign, or cannot fill scheduled shifts. Staffing Model How a provider proposes to staff the service, such as full-time, part-time, on-call, paid-on- premise, volunteer, hybrid, or other arrangements. Staging Positioning an EMS unit at a location so it can respond more quickly to anticipated calls or coverage gaps. Stair Chair A device used to safely move patients up or down stairs. Standby Coverage A unit staged or assigned to be available during a certain period, event, or location. Supplemental EMS Additional EMS capacity layered onto the existing system to improve reliability, staffing resiliency, response coverage, and operational readiness. System Coverage Whether enough EMS units and personnel are available across the county to respond when calls occur. System Performance Reporting Regular reporting on response times, call volume, missed calls, staffing shortages, patient care quality, and operations. Transport Taking a patient by ambulance to a hospital, clinic, or other medical facility. Transport Time The time spent taking the patient from the scene to the hospital or other destination. Transporting Ambulance An ambulance licensed and equipped to transport patients to a hospital or other receiving facility. Travel Time The time between leaving the station or staging location and arriving on scene. Turnout Time The time between dispatch and when the ambulance begins responding. Unit Availability Whether an ambulance is free and staffed to respond to a new call. Long transports can reduce unit availability. Unit Location / Base Location Where an ambulance or QRV is housed, staffed, or staged. Volunteer Ambulance Service A local ambulance agency primarily staffed by volunteers or minimally compensated personnel. WISCOM Wisconsin’s statewide public safety radio communications system.