In rural Brewster County, officials work to prevent void in ambulance services

Healthcare is already a limited resource across the Big Bend region. Now, local officials are scrambling to make sure that EMS crews will continue to show up when people call 911.

A view of Alpine, Texas. (Sarah Vasquez)

By Travis Bubenik

Jessica Scudder grew up around ambulances.

“For a very long time, the ambulance office was our house,” she said during a recent phone interview, recounting her family’s long ties to the community of first responders in small-town Alpine, Texas.

For decades, her father Mike Scudder ran the Big Bend area town’s only ambulance company, but his history as an emergency responder began much earlier.

As Jessica described it, her dad and his twin brother — who were teenagers when they became certified as EMTs — used to drive an ambulance to school.

“And if there was an ambulance call, they responded from school,” she said. “And I’m like, is that real life?”

Late last year, Mike Scudder died suddenly while responding to an emergency call, after what his company called a “cardiac emergency.” Since his death and the company closing up shop in January, local officials have been trying to answer an urgent question for parts of Brewster County: who is going to show up now when somebody calls 911?

Greg Henington is one of the people working on the problem. He’s the local fire and EMS chief in Terlingua, a “neighbor” by West Texas standards, though it’s still a good hour and a half away from Alpine. He’s also currently running for the county’s top executive seat in the Republican primary.

Henington’s five-person team usually only covers the southern half of Brewster County, the state’s largest county by size. Scudder’s company used to cover the northern half, but over the past few weeks, the Terlingua crew has been covering all of the county’s 6,200 square miles of sprawling Chihuahuan Desert terrain. 

“And we have put a limit on it, because it is stretching us pretty tightly,” Henington said.

A sign points the way to the South Brewster County Emergency Response Center in Terlingua, Texas. (Travis Bubenik / Marfa Public Radio)

Officials recently convened a local task force with a goal of finding a new ambulance provider for the county’s northern half by the end of April. Henington is serving as the task force chair.

“There is an urgency to get this done, because there is a limit to what Terlingua EMS and Fire can do,” he said. “We’re holding it together, but we don’t want to do it forever.”

The task force is looking at two main options: starting a new county-run ambulance service, or bringing in a new company for the job. Both options face hurdles, but EMS experts say it’s hard to convince an existing company to move into a rural area.

“I wouldn’t say it’s the best business model out there,” said Brent Smith, President of the Texas EMS Alliance, a statewide trade group.

According to Smith, because ambulance providers get paid each time they transport somebody, companies in rural, sparsely populated areas just can’t make enough trips to turn a profit. So, he said, government backing of some kind is probably the way to go for communities that find themselves in a situation like Brewster County’s.

“If there’s a local government entity that’s thinking about, well, are we going to have to fill a void and start our own ambulance service, they just need to come to the realization that it’s not a lucrative business,” Smith said. “They’re going to have to spend some money to do it.”

Henington, even as a Republican, is backing the government-run option. So is the county’s current top official, Democrat Eleazar Cano. (Cano recently announced he would not seek reelection.)

“I think my main concern is, with the private sector, if somebody goes belly-up, then what happens?” Cano said during a recent public meeting.

If the county does start its own operation, it won’t be cheap.

While grants and state funding can help, the Texas EMS Alliance says ambulances cost about $125,000, while a single heart monitor can run about $40,000.

The challenge here in the Big Bend also comes at a time when EMS crews across the U.S. are struggling with pandemic-related burnout and staffing shortages. Plus, according to Smith, it’s always been tougher hiring paramedics in rural areas.

State lawmakers are trying to tackle that particular problem. They recently approved about $22 million in funding for EMS recruitment efforts, particularly in rural and underserved areas, money that came from federal pandemic relief.

As Brewster County officials hash out a plan, Cano has pledged in discussions at public meetings that there won’t be a gap in ambulance services.

“Nobody wants to see services interrupted,” Sara Allen Colando, a local county commissioner, said at a meeting in mid-January.

“And that’ll never happen,” Cano responded. “We’ll figure out a way to keep the ball rolling.”

As officials continue to hold meetings on the issue, Henington, the task force chair, said they could have a plan together by mid-February.

For her part, Jessica Scudder said she doesn’t think parts of Brewster County would simply be left without an ambulance “at any point.”  The way she described it, the people who choose to do this type of work in far-flung places like the Big Bend take it very seriously.

Case in point: the day her father died while out on an ambulance call himself. Within an hour, she said, the rest of his crew was back out on other emergency calls.

“They never stopped,” Scudder said. “They never stopped, not one time.”

About Travis Bubenik

All Things Considered Host and Big Bend Reporter
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