FAR WEST TEXAS — Jeff Davis County Emergency Services Director Vickie Fowler, who has been in the role for over 13 years, is set to retire from the volunteer-run service this June, causing the county to seek out a replacement in earnest and even assess the option of partnering with a private company.
Jeff Davis County isn’t alone in its predicament. Much of the tri-county area — in which few emergency service providers struggle to meet the needs of residents spread across a vast region — is undergoing a period of turnover when it comes to critical EMS leadership positions.
In South Brewster County, Terlingua Fire and EMS Chief Greg Hennington has begun a search for his replacement. County officials representing North Brewster County recently voted to contract private company Emergent Air to fill the void left by the sudden death of Alpine EMS Director and Fire Chief Michael Scudder. Emergent Air is set to take over the 911 service from Terlingua Fire and EMS, who stepped in to prevent a lapse in service, in early May and is working to build up its staff, which will include a director.
Presidio Emergency Services received a new EMS director this February, Troy Sparks, an EMT who moved up into the role after his predecessor Malynda Richardson moved on from the job after four years. Richardson declined to comment on her time as EMS director for Presidio EMS. Sparks did not respond to requests for comment.
Jeff Davis County EMS is the only remaining service in the tri-county area operating on a volunteer basis — all other EMS departments operate with paid medics. Fowler’s position as EMS director is the only role paid for by the county. While Fowler gets paid to run the administrative side of the EMS service, she does not get paid to go out on 911 calls, which she does in addition to a variety of other essential duties.
“Running the books, the building, keeping track of all the narcotics, the drugs, what can be had on the ambulance, keeping everything in compliance, making sure your medics are in compliance with their certifications and scheduling everyone to make sure the shifts are all covered,” said Jeff Davis County Judge Curtis Evans of the job description.
In addition to competing with Terlingua Fire and EMS and Emergent Air for a new EMS director, whoever fills Fowler’s role will need to run the volunteer-service while bringing the department into the next phase of operating with paid EMTs.
“Volunteer services are dying because people are aging out, and that’s certainly true for our service,” said Fowler. “The only way volunteer services, especially in the rural areas, are going to survive is by becoming hybrid and eventually transitioning to fully-paid service.”
As local EMS directors like Fowler move on from their physically and emotionally demanding roles, counties and municipalities are tasked with coming up with quick, viable solutions to ensure there are no gaps in ambulance service. But retiring old-timers are difficult to replace and there is not an abundance of young people ready to step in, said Fowler. Attracting candidates to remote areas like Fort Davis poses special challenges, she said.
“It’s hard to attract young families here. We really don’t have much industry except for the school, the observatory or the state park. When kids graduate, if they want to make a living, they really need to leave the area,” said Fowler.
At the March 31 Big Bend Regional Hospital District meeting, Hennington spoke to the problem succinctly: “It’s all of us old people, so to speak, and not a lot of backfill on that.”
In light of the region-wide issue, there have been recent ongoing discussions amongst county and city officials as well as Big Bend Regional Hospital District, which serves Presidio and Brewster counties, regarding the long-term need to establish a regional EMS solution in order to centralize operations.
At the recent hospital district meeting, Hennington advised the board to prepare to revisit a discussion about that concept, noting there would be “some logic” to joining forces and that it “could be a pretty good operation.” But the reality of orchestrating an emergency response operation on such a scale is no easy feat, and would hardly come together overnight.
“The regional EMS concept may still be on the table down the road, but that will take a tremendous amount of work,” said Hennington in an interview with The Big Bend Sentinel.
With a potential streamlined, regional solution years down the road, Jeff Davis County is facing the immediate problem of replacing Fowler as she exits the role of EMS director this summer. The hope is to find a replacement that can serve the community as well as Fowler has, said Judge Curtis Evans.
“We’re used to a certain type of service from what Vickie has created. It’s a personable service and they know the people in the community and they take care of them,” said Evans.
But while the preference may be to hire a local director, the county hasn’t ruled out the option of going with a private company — this is largely a matter of practicality, noted Fowler, as there are limited locally-based options. Jeff Davis County Ambulance Service is in continued, preliminary talks with Emergent Air, the company soon to be servicing North Brewster County, but is still accepting applications for the EMS director position, and has fielded some promising candidates.
“We don’t want to hand off to a company, just because these are our people, our community, we want to be the ones taking care of them,” said Fowler. “But realistically, we don’t have the staffing and management experience.”
Hennington originally retired from his position as chief of Terlingua Fire and EMS a couple of years ago, but resumed the role this past May after his successor didn’t quite work out. He said they are beginning the search for someone to take his place as he seeks to move on to his next phase of life, potentially serving as Brewster County judge, a race in which voters will soon elect the Republican and Democratic candidates in a runoff election in May.
Hennington will focus on finding an individual with past EMS management experience to replace him, he said, and is not currently considering partnering with a private company in any capacity. The ultimate goal would be for Hennington to train his replacement for six months to a year, he said, in order to have adequate time to cover the job’s varied responsibilities.
“It’s everything from working with the politicians, to talking to the press, to knowing the community, knowing all of the 3,000 square miles of land down here,” said Hennington. “Working with the park service, Border Patrol, there’s a lot of nuances that just take time to learn.”
Fowler said she wanted to retire in order to make room for new leadership which could better serve Jeff Davis County EMS moving forward. But her reasons for stepping down are also personal — being over the age of 60, she said she didn’t want to work up until the end of her life. Sharon Falkner, who previously served as Jeff Davis County’s EMS director before Fowler took over, died in 2010 in a plane crash on route to the Midland International Airport with a patient. Michael Scudder, of Alpine EMS, died of a cardiac emergency while responding to a 911 call this past December at age 61.
“I didn’t want to be on the ambulance when I was 55. I figured that’s too long, I’m too old at that point. I should be doing other things and let the younger people treat the patients. And then I turned 60 in December, and I’m still treating patients on the ambulance,” said Fowler.
The job has also become increasingly demanding, with the volume of 911 calls coming into the service steadily rising each year — this year, that volume spiked 21 percent from the year before, said Fowler, and before that the volume has increased at least 10 percent year to year. On average, the service receives around 25 emergency calls a month. (Hennington, too, reported Terlingua Fire and EMS call volumes were increasing at a rate of 8 to 10 percent each year.) Because the region is so vast, and locations of callers can be remote, response times can range anywhere from 30 minutes to two and a half hours, said Fowler. The service also provides mutual aid to Marfa and Presidio EMS.
Fowler said she gave six months notice that she’d been moving on from Jeff Davis County Ambulance Service, also referred to as the Mountain Medics, in order to spend more time with her grandchildren and on her hobbies of quilting and gardening. This coming November will mark her 34th year in EMS. She moved to Fort Davis from Cloudcroft, New Mexico, in 1997 when her husband got a job at the University of Texas McDonald Observatory. Before becoming director she served as a volunteer for the service for years.
Fowler will be leaving the department in good standing, with a solid crew of dedicated volunteer paramedics and EMTs, she said. Most of the Mountain Medics have full time jobs, said Fowler. Their team includes a veterinarian, pastor and business owner. The majority of their volunteers have been involved for 10 plus years, she said, and the median age of the volunteers is upper 50s, with a couple in their mid-70s still serving on the EMS force. Ambulance drivers are often spouses of on-call medics.
Jeff Davis County provides some funding for the service — it pays Fowler’s salary, and contributes accounting services, as well as funding for the facility and utilities. Money Jeff Davis County EMS receives comes, in part, from a half-cent sales tax, plus money the service brings in by billing insurance companies and Medicare.
One of the benefits of being a volunteer service is that Jeff Davis County Ambulance Service more readily qualifies for grants, said Fowler. Their service has been funded for the past 10 years by both the FMH and Yarborough Foundations, both based out of Midland.
“Those are the main two that we have worked with over the last couple of years, and they’ve been instrumental in helping to fund our state of the art ambulances,” said Fowler.
In addition to funding for ambulances, training equipment and a Raizer lift that helps medics with lift assistance, FMH also awarded Jeff Davis County Ambulance Service a grant to commission architectural renderings for a potential bunkhouse for the facility. Fowler said the designs for the structure, complete with simple bedrooms, bathroom and kitchen have recently been finalized and they intend to apply for additional funding to get the bunkhouse constructed in the next grant cycle this summer. The new build will likely cost around $300,000.
“Even though some of my former medics who come back and help us out are happy sleeping on a cot upstairs in a classroom, new guys we’re going to be hiring are not going to be happy doing that,” said Fowler. “We realized that what we really needed in order to be able to attract people would be a place for them to sleep and hang out, so we decided to go with a bunk house.”
Fowler wears a gold necklace with a star of life charm, the EMS symbol, and a radio which monitors local police and fire traffic strapped to her hip. She said she never imagined she’d become so involved with EMS, but she fell into it and over time realized it was what she was meant to do.
“I never looked at it like, ‘Oh, I get to save lives,’” said Fowler. “But making a difference in somebody else’s life, to me, that’s what it’s all about,” said Fowler. “Just being there for somebody else when they’re having the worst day of their life.”
For older medics, decades of being on call and moving patients take a toll on the body, and continued exposure to emergency medical events can cause mental health issues such as post-traumatic stress disorder (PTSD), said Fowler.
“It gets very difficult on the psyche, it’s hard to sleep at night,” said Fowler.
EMTs can also be easy targets, said Fowler, and are subject to being assaulted by their patients. The role requires a lot of resilience, said Fowler.
“Now with the pandemic, there’s a lot more mental illness, people are just a lot angrier, and they’re a lot more willing to just take it out on the first person they see. It’s not their typical personality, it’s just their way of coping with what’s happened to them,” said Fowler.
Mountain Medics try to treat their patients at home whenever possible, Fowler said, to prevent burdening them with the financial cost of an ambulance ride. A trip to the hospital also takes around three hours round trip, taking medics out of commission to help with any other calls that might come in during that time. The majority of the 911 calls Jeff Davis County Ambulance receives are medical as opposed to reports of major trauma, like a car accident or shooting. Serving the elderly and low-income populations often requires performing patient education, said Fowler.
“We become primary medical care for a lot of people because they can’t afford a doctor or they don’t have a way to get to a doctor. Or they just don’t know they need to be going,” said Fowler.
Because Medicare does not pay for a 911 call unless it results in a patient being transported to a hospital, Jeff Davis County Ambulance does not charge patients for “treat and release” visits. While the job is mostly thankless, said Fowler, there are occasions where a small act of kindness from a community member, like a freshly-brewed cup of coffee for their EMTs upon arrival at a 2 a.m. emergency call, goes a long way.
The Texas Department of Safety awarded Jeff Davis County Ambulance Service a Regional Commander’s Award in 2014 for their work performing a 30-hour rescue of a hiker in Hell’s Canyon in the Davis Mountains, where the crew cared for and stayed overnight with the patient because a helicopter ran out of fuel. Fowler and a team recovered the distressed individual from down in the canyon just before heavy rainfall flooded the area.
Another standout memory was that of an emergency call involving a young girl, around seven or eight years old, that suffered a seizure while in a church service. Fowler hadn’t realized what an impact she’d made on the child, who recovered without needing to be taken to the hospital, until her mother dropped off a framed drawing the girl had made for Fowler, describing her experience, saying she made her feel safe and secure.
“That is among my prized possessions from this business,” said Fowler.