If you ever break a leg or have a heart attack at a forest campground in a remote corner of California, you probably won't be in a mood to ponder exactly why it is that an ambulance soon shows up with a paramedic who knows how to plug you with an IV, stabilize your injury and whisk you to a hospital.
But it might be worth considering now.
For 27 years, remote rural counties in California have had the same standards of emergency medical care as big urban centers thanks to a system of state subsidies and regional agencies that do everything from licensing paramedics and coordinating radio dispatch operations to planning how to respond to natural disasters and attacks with weapons of mass destruction.
Now that system is under strain. One regional emergency medical services agency on California's north coast is in danger of collapsing, and the one that serves five Lode counties, including Calaveras, has already cut services and may cut more in the coming year.
"This service is hanging by a thread," said Calaveras County Supervisor Bill Claudino, whose career as a California Highway Patrol officer gave him a close-up understanding of emergency medical service.
Calaveras Countyis one of five counties served by the Mountain-Valley Emergency Medical Services Agency. That agency gets state funding of about $347,000 a year to serve the region. Counties also contribute local dollars. Calaveras County's share is about $18,800 a year.
If the county had to manage emergency services on its own, it would cost $250,000 to $275,000 a year, Claudino said.
Officials say the regional EMS agencies are in financial trouble for a number of reasons:
--State funding of the regional agencies is 4 percent less per year than it was a decade ago, while workloads have more than doubled.
--Federal special project funds are no longer flowing to the regional agencies. Mountain-Valley used to receive $50,000 to $200,000 a year through these sources, said Steven L. Andriese, the agency's executive director.
--The agencies will likely face additional state cuts this year, at a time when pinched counties are unable to make up the difference.
Although the exact cuts remain to be determined, Gov. Arnold Schwarzenegger is proposing a 10 percent cut to the regional EMS agencies, the same cut he proposes for most other state programs. And the California Emergency Medical Services Authority, the state agency that oversees the program, is backing Schwarzenegger's proposal, said Shirley Tsagris, public information officer for the authority.
Tsagris said the authority has not been swayed by the pleas of regional agency officials who say their agencies may collapse if their budgets are cut further.
"It is a local decision as to how they will address the problem," Tsagris said. "Everyone is going to be forced to make some changes."
The regional EMS agencies serve two-thirds of California's geographic area.
More than one in every six Californians lives within the boundaries of those districts. But all Californians have a stake in the system, which was designed to plug gaps in emergency medical service in poor rural areas, said Larry Karsteadt, executive director of North Coast Emergency Medical Services Agency, which serves Humboldt, Del Norte and Lake counties.
"Anyone who lives anywhere in California who drives out of their metropolitan home area into a rural area benefits from this program," Karsteadt said.
Popular state and national parks, wilderness areas and ski resorts are largely in the rural areas served by the system, he said.
Karsteadt and other officials say North Coast would likely be the first district to collapse. His staff of four full-time employees and one part-time employee is already too small to adequately monitor the region's EMS infrastructure.
Mountain-Valley, meanwhile, has already cut an education program intended to help residents make better decisions about when to call 911 and ask for an ambulance.
Andriese said that cut means the number of people who inappropriately tie up ambulances with less-critical emergencies is likely to increase.
Andriese has recruited the Calaveras County Board of Supervisors as well as officials in other counties to write letters objecting to further state cuts in EMS oversight in the rural regions.
"If we had been adequately funded over the years, then I would say we should take the 10 percent cut like everybody else," Andriese said. "But that is not the case."
Contact reporter Dana M. Nichols at (209) 754-9534 or firstname.lastname@example.org