Over the last few years, conversations among local leaders have been ongoing about the future of Emergency Medical Services (EMS) in Marshall County as the current provider, UnityPoint Health — Marshalltown, has reported losing approximately $1 million a year on EMS. In 2025, the Marshalltown city council and the Marshall County Board of Supervisors jointly commissioned an outside study through Iowa EMS Consultants of Sac County, and back in January, the findings of the report were accepted by both governing bodies. A joint meeting between the city council and supervisors is scheduled for Tuesday, March 24, at 5:30 p.m. at city hall to determine the next steps.

Based on discussions at both meetings thus far, the most popular of the three options presented by the consultants seems to be a November ballot referendum to declare EMS as an essential service and levy up to $0.75 per $1,000 of property valuation to fund a 28E agreement between the city and the county, but no official course of action has been finalized yet.

Three members of the task force assembled to address the issue in 2024 — Marshalltown Fire Chief Christopher Cross, Marshall County Emergency Management Coordinator Kim Elder and Marshalltown Mayor Mike Ladehoff — recently answered a series of questions the T-R sent about the EMS situation, and their answers are printed below.

T-R: Now that the report has been released and accepted by both the Marshalltown city council and the Marshall County board of supervisors, do you feel like you have a clear sense of direction for the future of EMS?

Cross: The next step in the process is getting the two elected bodies together so they can discuss the report, ask further clarification questions and to ultimately give the task force the official recommendation on how to proceed. Both bodies are working on coming up with a joint meeting date which will be decided upon in the very near future.

Elder: Do I have a clear view? Not quite yet, but I can see the roads before us, as a county, and the choices presented to move forward with a more robust emergency medical services (first responder) system. There is still a lot of work to be done. I believe our county as a whole is moving in the correct direction, researching and analyzing what our goals and objectives are and making informed decisions. The decision making and action doesn’t happen overnight. The partner agencies and jurisdictions will need to get together and fine tune the options presented and decide what will work best for protecting and responding to the needs of the people of Marshall County. We currently have a system that is working but will not continue to be viable in the near future due to lack of new volunteers, lack of funding for EMS, and the increase in medical calls for services.

Ladehoff: I don’t think that we are quite there yet. The City and County need to get together and agree on the path forward. Everyone needs to be on the same page. A meeting has been set up, possibly March 26 at 5:30 in the Council Chambers to iron out any questions. Of course, the public is invited.

Of the three possible courses of action that were presented, the city-county partnership with an EMS levy seems to be the consensus choice. Is that still the case?

Cross: The Task Force believes that this option is the best path forward to ensure the service to the community can remain viable and consistent long term.

Elder: There are three choices that came from the collaboration between the taskforce and the vendor. The final report (study) show what the choices would entail, who would be responsible, the amount to fund the choice(s), and the funding mechanisms available, along with some budgets to consider. Picking one of these presented choices may not be the final answer to our dilemma, it may be a combination of the three, or as the process moves along there may be more information gathered that shows a better choice. I believe the 3 choices presented all have pros and cons and it is important to work with all partners involved to make the best final decision for our communities.

Ladehoff: Looking at all 3 options, the EMS levy is the best choice in my opinion for the care of residents of Marshalltown and Marshall County for the future. However, it is not my choice alone.

What are the biggest steps that still need to be taken and voted on by local governing bodies to move a proposal forward?

Cross: The next hurdle to clear is to have both governing bodies to meet jointly and make a formal declaration as to what they would like the project to look like. Once they give formal direction, we’ll determine the next step in the process.

Elder: Making EMS an essential service is number 1 on my list, this allows EMS funding to happen in our county. Recognizing that the EMS services are essential is vital. Educating the public in Marshall County what EMS becoming (or not becoming) an essential service means to them. The public needs to know that when they call an ambulance, there is no requirement to send one currently, although all partners attempt to respond, there is no requirement for that to happen, and there is no required taxation for EMS services (paid or volunteer). We need to be funding EMS and assuring there is a response when someone calls for emergency medical services during an emergent medical situation. Levying for funding, or taxing, is the step that almost no one wants to happen, but the dollars to fund these services must come from somewhere. Lastly, we need to choose the best way to enhance and strengthen our EMS system in Marshall County, finding the best way to provide EMS services equally to all of Marshall County, by including local healthcare providers, first responder volunteers, and other partners into a system that works well into the future.

Ladehoff: Putting together a plan with details that is easily understood by all residents is of utmost importance. Also, the benefits and improvements that could be had for all taxpayers. Being transparent should be our mantra.

Do you feel that overall EMS service can be improved and managed in a cost effective manner under a new system?

Cross: The Task Force believes the City/County option provides the best service for all of Marshall County. With this option, we believe by designating EMS as an essential service, it creates a publicly funded mandate. Currently, there is an expectation of service by the citizens, but no financial mechanism to equip, staff, and provide the service to the people. The option favored by the Task Force optimizes intergovernmental collaboration between the City and the County, allows the leverage of already existing management and facility infrastructure, and maintain local control of the system to provide quality assurance to the services rendered.

Elder: There are ways to check and balance the tax dollars that may be levied and I feel it is important to stay involved, be informed, attend meetings, ask questions, and volunteer for your community. It takes a village, we all have to help by supporting with funding, our time, and our interest in moving into a stronger future of EMS in Marshall County. Our county has so many great partners!

Ladehoff: Absolutely! More and continuing training, better and updated equipment throughout the County, protocols and methods will benefit not only our EMS Responders, but the quality of services going forward.

The City is looking forward to working with the County and all other stakeholders in this important project.

What do you feel will be the most important message to convey between now and a potential ballot referendum in the upcoming election?

Cross: In all messaging, we must be transparent to the citizens in all areas. It will be crucial to explain the system as it currently exists and why we need to create something new. Building consensus and partnership with all communities in the county is extremely important, as we won’t be able to build out the project without them. We need to have a clear “ask” and have an articulable plan with what we’re going to do with their dollars on behalf of them. We must, in the clearest and most transparent way possible, convey the urgency of this project and then demonstrate how we’re prepared to build them a system that is of the people, by the people, and for the people.

Elder: Learn about what the EMS system is and could be, knowledge is power. Get involved, there is a place for everyone to improve our county’s EMS system. Ultimately the taskforce is working for you, the taxpayers and the people expecting EMS (ambulances) to arrive when you call for them, we want to hear from you!

Ladehoff: N/A.