'Multiple People Will Die': Alabama County Grapples With EMS Access

Blount County, Alabama, sits in the rocky foothills of the Appalachian Mountains. The county covers 651 square miles (1,690 square kilometers) with a population of 60,163. Blount County also only has five ambulances, with one additional BLS-only truck at a volunteer fire department.

On Sept. 30, 2025, the Chairman of the Blount County Fire and EMS Association, and Chief of the West Blount Fire District, Clay Jones, called a press conference and announced the county was in danger of losing its EMS contract at the end of the year. 

Lifeguard Ambulance, a Global Medical Response company, has held the EMS contract in the county since 2022, taking over the contract from Northstar Ambulance subsidiary Blount EMS. The contract was originally scheduled to end on Oct. 1, but the company extended to the contract to Dec. 31 to enable the county to host a formal bid process, said a Lifeguard representative.  

“Earlier this year, we informed the county that due to increased operational costs and limited payor reimbursement, we would be unable to renew under the previous terms,” the representative told EMS World in a statement. “This is a common challenge in our industry, as EMS systems across the country face similar issues.”

The county’s primary payor mix is Medicare and Medicaid. Lifeguard is not currently contracted with the state’s largest insurance company, Blue Cross/Blue Shield of Alabama, explained Bradley Harvey, chair of the Blount County Commission.

Every bid the county has received, Jones said, has requested a subsidy to make up operational losses. The solution, he said in a letter to Blount County residents, is to reinstate a two-mill property tax, which would be around $50 more per year in taxes. 

This option isn’t popular with residents, who earn a median $61,096 per year, according to the U.S. Census Bureau. Roughly 14% of the county lives in poverty.

“I think it just caught us off guard, from a county standpoint,” Harvey told EMS World. “It’s an area where low tax is prioritized. I think it’s going to end up with people, in the long run, having to realize and make that decision, whether it comes from a referendum or a decision made at the county level … If things go bad and the lack of service becomes an actual detriment … we’ll have to get creative.”

The Blount County EMS contract is usually handled by the county’s 9-1-1 Commission, but with the possibility of a tax increase, the decision was passed to the commission.

Lifeguard’s five ambulances are distributed throughout the county. During the day, three are stationed in the county seat of Oneonta (see map), one is stationed in Cleveland, and one is stationed in Smoke Rise, near Interstate 59. Blountsville, which is a volunteer department, houses the only other BLS truck in the county. The highest call volumes in the county are from Oneonta and West Blount, Jones said. 

Lifeguard pays rent on two of their three stations. Jones said the offer has been extended to house the ambulances and their staff within the fire departments, not just to Lifeguard, but to any private ambulance company in the county, saving on rent, but no company has taken the offer. Lifeguard’s administrative offices and shop are housed in Oneonta. 

Not Just Funding

No matter the Blount County town, residents are around 30 minutes from definitive care. The largest and best equipped Trauma I hospital in the state is the University of Alabama at Birmingham (UAB) main hospital. Birmingham is also home to the state’s pediatric Trauma I hospital. The county has one UAB Trauma III emergency room and outpatient center, and other freestanding ERs are between 40 minutes and one hour away. Residents in the northern part of Blount County can also access a Trauma I center in Huntsville.

“An ambulance may only do three, four, or five transports at day, but if they’re not going to UAB Blount, then they’re out of service for as many as five hours,” Jones told EMS World.

Another issue Jones raised is with UAB Blount. The hospital is a rural access hospital that has to transfer most higher level cases, though the ER team now has telehealth access to trauma doctors at the main UAB campus. The hospital also uses federal funding to supply fluids and blood products to the area fire departments and Lifeguard. However, the outpatient surgery center closes at 5 p.m. each day, and any patients not fully recovered are transferred to another hospital. 

“It’s a great resource for our county to have,” Jones said. “But it does strain our EMS system …You can’t reduce the amount of surgeries you do, or the center will close. But if we have five ambulances during the day and four at night, and we do five transfers between 4 p.m. and 6 p.m., we have zero ambulances in the county.”

Jones said he would like to see UAB provide a subsidy for the county ambulance system, as other hospitals have done, and as the system has done at other locations. This would also allow at least one dedicated transport ambulance for the county. Harvey said UAB was involved in the contract talks but wasn’t aware of a subsidy coming from the system.

‘Nobody’s Coming’

There are 20 fire departments serving Blount County; only two, the Oneonta Fire Department and the West Blount Fire District, are career departments—all others are volunteer, Jones explained.

The West Blount Fire District services the towns of Hayden and Warrior, and was a long and hard-fought battle with residents of those towns, Jones said. 

“We harped on it for 10 years—we need to become a fire district,” he said. “Everybody was like, ‘nope, I’ll never support it.’ We didn’t have any funding. We only had volunteer firefighters, and there were calls that were going unanswered. People were waiting forever for our neighboring fire department to run calls because we didn’t have anybody available.”

Jones said the community realized they lacked fire coverage, and during a fire department board meeting, the 3,000-square-foot station was standing room only. The funding to form the district and fully fund the department was passed eight months later. Jones said it will likely take something similar for EMS issues in Blount County to get resolved.

“It’s going to take the county realizing nobody’s coming,” Jones said. “That’s just the staunch reality of it. Multiple people will probably die.”

Harvey agreed that it will likely take time for Blount County citizens to realize the full impact of losing the county’s ambulance contract or having a degradation of service.

“I’ve heard from several people, ‘I’ve never needed an ambulance,’” Harvey said. “You're very fortunate. I’m glad you haven’t needed one. But you’re never immune to needing an ambulance.”

Press Time Updates

On Nov. 20, a Request for Proposal period closed. The commission went with the recommendation of the 9-1-1 commission to choose Ameripro. The company will be providing four ambulances, three ALS and one BLS 24/7. The company will also handle its own dispatching and stay in network with major insurers, Jones said.

"It's not what we wanted. We need six or eight trucks," he said. "But it's better than it could be."