Four Northwoods towns unite to rebuild EMS — and cut response times in half

VILAS COUNTY, WIS. - As recently as a couple years ago, calling 911 in parts of rural Vilas County could mean a long wait for urgently needed emergency care, or, in rare cases, no ambulance at all.

That reality reflects a broader trend across rural Wisconsin, where emergency medical services are coming under increasing strain thanks to workforce shortages and rising costs. In fact, nearly half of the state's ambulance services struggle to reliably staff crews around the clock.

That's according to James Small, rural EMS outreach program manager at the Wisconsin Office of Rural Health (WORH). Housed within the University of Wisconsin School of Medicine and Public Health, WORH offers a wide range of services aimed at improving health outcomes in the state's rural communities. In his role, Small provides advice and support to elected officials grappling with EMS challenges.

At worst, these challenges manifest in delays in life-saving emergency care as dispatchers cycle through multiple EMS services before finding an ambulance that can respond. In some rural areas, that can stretch response times well beyond what patients can safely wait.

That pattern had become increasingly common across four Vilas County townships - Manitowish Waters, Boulder Junction, Presque Isle and Winchester - where aging volunteer rosters and limited availability made it difficult to respond quickly.

"We had ambulances, but not always the people to staff them," says John Hanson, who has served as town chairman in Manitowish Waters for more than two decades.

Dispatchers often had to assemble crews from multiple towns before an ambulance could even leave the station, says Lori Scarcelli, who oversees communications for the Vilas County Sheriff's Office. Combined with long travel distances and winding rural roads, those delays could push response times to 40 minutes or more.

The issue, Small says, wasn't a lack of commitment from volunteers. It was a system under strain.

"People were doing everything they could to keep it going," he says. "But they were under-resourced, and it wasn't sustainable."

The Wisconsin Office of Rural Health works with communities to assess and strengthen EMS systems. In Vilas County, that meant helping local leaders understand both the scope of the problem and the options for addressing it.

Small and his colleagues compiled dispatch and workforce data, showing not only long response times but also how few responders were consistently available across the four-town system. That data helped shift the conversation from one driven by anecdotes to one grounded in evidence.

"Once you can see what's actually happening, it becomes much easier to have a productive conversation about solutions," Small says.