EMS President Seeks "Essential" Designation From County Supervisors

Decorah Vikings win, City Council votes, New Referenda on the ballot — we're the one telling Decorah's story. Donate now. DECORAH — Winneshiek County officials are preparing a long-term effort to secure stable funding for emergency medical services as volunteer shortages, training costs and rising operational demands continue to pressure rural ambulance systems. During Monday morning's Winneshiek County Board of Supervisors meeting, EMS President Steve Vanden Brink presented an EMS Week proclamation and discussed a proposed resolution that would designate emergency medical services as an essential county service. Vanden Brink said EMS providers in Winneshiek County responded to more than 2,000 service calls in 2025 and transported about 80% of those patients. He said ambulance crews also completed about 600 interfacility transfers between hospitals during the year. Emergency response coverage in the county is provided through a mix of volunteer and paid services, including WinnMed Ambulance and ambulance providers from nearby communities, including Cresco, Harmony, Spring Grove, Postville and Gundersen Ambulance. "We have around 50 people who are registered EMS providers with the state of Iowa in Winneshiek County," Vanden Brink told the board. He added that "about a dozen" registered nurses also assist on a volunteer basis through Iowa's RN exemption program. Still, the county's volunteer ranks have steadily declined over the past several decades. "When I came to town in 1991, we had nearly 100 EMS responders in the county," Vanden Brink said. "Over 35 years, we lost over half." He said recruiting and training volunteers remains one of the biggest challenges facing rural EMS systems. Community college certification classes often require minimum enrollment levels before courses are offered, creating barriers for smaller communities. The Board of Supervisors unanimously approved the EMS Week proclamation recognizing May 17-23 as EMS Week in Winneshiek County. Supervisors and EMS officials also discussed a draft resolution that would formally classify EMS as an essential service in the county, similar to fire protection. County officials said the proposal is modeled after measures recently advanced in neighboring Fayette County. Under the proposal, an EMS advisory board would help oversee funding recommendations and determine how tax dollars designated for EMS services would be used. Funds generated through the measure could only be spent on EMS-related expenses, including equipment, training, operational costs and potentially wages for EMS personnel. Current Iowa law allows counties to seek voter approval for a property tax levy or income surtax dedicated to EMS services. Officials said the proposal likely would not appear on the ballot until November 2027 to allow time for public education and outreach. Vanden Brink said many residents assume ambulance response is guaranteed in the same way as fire aid or law enforcement intervention, but Iowa law does not currently require communities to provide EMS coverage, something the proposed designation and funding structure would help address. "There's a big misconception [among] a lot of people," Vanden Brink said. "There's nothing in the state of Iowa that says an ambulance has to respond to your 911 medical call." Supervisors discussed how many townships struggle to support ambulance services because EMS currently shares funding mechanisms with fire protection, which already qualifies as an essential service under state law. The proposed funding structure also could help offset the cost of training and equipping volunteers. Vanden Brink estimated it costs about $5,000 to train and outfit a new EMS responder once tuition, radios, pagers and emergency equipment are included. Responders also must recertify every two years. Supervisors noted that passage of an EMS levy would require approval from 60% of voters. The discussion comes as rural ambulance systems across Iowa continue to face staffing shortages, financial strain and concerns about long-term sustainability. Supervisors did not take formal action on the essential services resolution Monday because county attorneys are still reviewing language changes related to Iowa's updated budget legislation. Officials said the resolution process requires publication and multiple readings before any ballot measure could advance. Be in the know, always! The free newsletter delivers local news, features, and tips directly to you—perfect for busy readers.