Editor’s note: This is last in a three-part series covering the current financial crisis facing the Summit County Ambulance Service. Part one examined the root causes of the SCAS budget shortfall and part two addressed its impacts. Both stories are available online at summitdaily.com.

In the Upper Blue Basin, it’s not uncommon for two ambulances to respond to an emergency medical call: one from the Red, White and Blue Fire Protection District and one from the Summit County Ambulance Service (SCAS).

It’s the kind of overlap that is being re-examined as SCAS faces a budget shortfall that is in the hundreds of thousands of dollars and rising.

The ambulance service, a department under Summit County government that until recently was funded entirely by fees charged to patients without support from tax dollars, was hit hard by the recession. During the economic downturn, its call volumes dropped and bill collections plummeted from 69 percent to roughly 63 percent as more patients were uninsured or underinsured. The Summit Board of County Commissioners has kept the agency running by backfilling its budget with taxpayer dollars in recent years, but with the deficit on track to climb as high as $1 million, officials are now looking for more sustainable ways to continue to provide emergency medical services to Summit County into the future.

“There’s not a quick fix on the horizon,” county manager Gary Martinez said. “We really need to find a new financial model in order for us to be successful going forward.”

In their search for that model, officials commissioned a study to look at the feasibility of merging the ambulance service, in whole or in part, with local fire districts. The result is what has been dubbed the Almont report, an analysis of the fiscal problems within SCAS that reportedly also includes a number of alternatives for transferring, either partially or completely, ambulance responsibilities to the three fire departments in Summit County.

Local fire officials say they don’t have a specific implementation plan in place, but they do think a fire-based ambulance model is possible in Summit County and might even be profitable, as much of the needed infrastructure, training and staff already exists within the tax-funded fire districts. Summit County wouldn’t be the first to take such an approach. Grand Junction and other places around the state have already merged EMS with fire successfully, officials said.

“It’s widely utilized because it works,” Lake Dillon Fire chief Dave Parmley said. “It’s taking advantage of that resource being combined under one command system.”

Loosely, a fire-based model in Summit County would likely leave the existing 911 emergency dispatch — a central, county-run agency — unchanged. Each fire district would be staffed with ambulances and would handle medical calls within its boundaries, providing aid to one another as needed, which is the current setup for fire response. A single division for training and billing would be established for all three departments.

The approach would also allow ambulances to be placed at more locations around the county — the existing fire stations, which outnumber ambulance stations by more than 2-to-1.

“We did some work to analyze and examine how it might look, both functionally and from a funding budget standpoint,” Parmley said. “And with that we’re optimistic that you could do something that would not only add value but would provide a cost effective approach.”

But some of those who would be at the very center of a merger between EMS and fire are skeptical that it’s the best idea.

Emergency medical technician Jim Farquhar, like most ambulance service employees, has a second job. He’s a firefighter for the Copper Mountain Fire Department.

He thinks it would be difficult for a fire department with only 12 employees to increase its staff by 50 percent to bring on the additional six people it would take to operate a single ambulance around the clock

He said he’s not convinced it would be the best approach on the front lines of an emergency either, when the fire service would need to be prepared to handle not only fires, hazardous materials situations, on-scene medical care and extenuating circumstances — like extricating a trapped victim from a car — but also the longer term medical care of a patient during transport to a hospital.

“Here, we do what we do,” he said of SCAS. “I really have the best of both worlds. I have my apple cart perfectly balanced. I would see it being upset if this ambulance service went away. It would be bad.”

Fire service officials say their firefighters have the same level of training, are subject to the same tests and laws and — given the proper equipment — could deliver the same level of care as paramedics and emergency medical personnel with the ambulance service.

The Almont report may also explore a collaborative approach, which would split the responsibilities of emergency medical service between the fire districts and SCAS. A kind of cooperative agreement already exists between EMS and the Red, White and Blue, which can provide medical transports when SCAS is busy or unavailable. In those instances, the fire department keeps 55 percent of the money collected from the call. Fire officials say they’ve tried to extend the agreement, but the ambulance service has been hesitant to do so because it would mean giving up much-needed revenue.

But to Red, White and Blue chief Jim Keating, revenue isn’t the most important consideration. He said he hopes to find ways to give his teams more opportunities to use their paramedic and EMS training.

“We’ve developed a culture of EMS in this department,” he said. “Our paramedics rarely have the opportunity practice what they went to school and continue to receive education for.”

County officials may also consider asking voters to approve either continuing to support the ambulance service into the future — a model that has worked in Eagle County for several years — or privatizing the system. But whatever the final decision, it isn’t likely to be made soon.

County officials say they’re not leaning toward any one option over the others, and that they plan to have additional conversations with the EMS staff and finalize the Almont report before taking any kind of action.

The $19,500 Almont report has not yet been released publicly.