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International Falls Fire Department Budget Strained by Ambulance Service and Staffing Challenges

The International Falls Fire Department is grappling with significant budget challenges driven by the costs of operating its ambulance service and maintaining adequate staffing levels. In recent years, a growing deficit in the city’s ambulance fund has put pressure on the department’s finances, prompting city officials to seek new funding solutions and consider structural changes. Local leaders have openly addressed the issue – from consultants’ reports and council deliberations to town hall meetings – as they work to preserve vital emergency services without overburdening taxpayers. This article examines the history behind the Fire/EMS budget problems, how the department’s budget is structured today, the policies and decisions that led to the current strain, and possible paths toward financial stability.

Background: A Growing Budget Problem

The fire department’s fiscal troubles became evident in the late 2010s when the City of International Falls began seeing recurring shortfalls in its ambulance operations. By 2018, city officials recognized that the ambulance service was “deficit spending” – expenses were outpacing revenue in the dedicated Ambulance Fund (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). In response, the City Council approved a “recent revenue increase” (such as higher ambulance fees) to offset some of the mounting losses (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). This stopgap measure helped but did not resolve the core problem: the ambulance service continued to run in the red.

In December 2018, the city commissioned an outside assessment of the Fire/Rescue/EMS Department (known as the “Mike Metro Phase Two Report”) to diagnose the issues (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). The report highlighted several challenges. One was a staffing and scheduling dilemma: the ambulance crew’s work schedule did not comply with federal labor rules, leading to potential overtime liabilities (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota) (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). At the time, the city employed a small team of full-time paramedics working 12-hour shifts in a rotation. Under the Fair Labor Standards Act (FLSA), these EMS personnel were subject to a 40-hour workweek maximum before overtime, unlike firefighters who can have a longer work period (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). The consultant recommended hiring additional full-time EMTs and adjusting schedules to curb overtime costs (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). Paramedics themselves proposed creating new firefighter/paramedic hybrid positions so they could remain on their 12-hour rotation without violating labor rules (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). This plan aimed to integrate ambulance staff into the fire department’s framework, which might allow more flexible scheduling and share personnel across fire and EMS duties.

City leaders were receptive to these ideas but also cautious about the obstacles. Fire Chief Adam Mannausau raised questions about Civil Service Commission rules and union implications for reclassifying jobs, noting that new firefighter/paramedic positions might have to be opened to the public and could face resistance from existing fire staff (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). Despite these hurdles, officials agreed the ambulance service is a “valued service” and that they needed to find a way “to make it work” within the city’s means (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). The City Council did not immediately adopt the paramedic integration plan in 2019, but the discussion underscored the financial and structural headwinds the department was facing.

Through 2020 and 2021, the ambulance fund’s deficits persisted, compounded by the high fixed costs of providing 24/7 emergency medical response. By mid-2022, city officials recognized that the situation could not be solved by internal belt-tightening alone. In June 2022, the City Council took the notable step of formally asking Koochiching County for help. The Council approved sending a budget request letter to the County to help fund the International Falls Ambulance Service during 2023, while a county steering committee researched long-term financing options (International Falls City Council Meeting 6-20-22 – R & J Broadcasting Inc.). This move acknowledged that the ambulance service – which covers not only the city but also a broad rural area – was a regional asset in need of regional support.

Despite these efforts, the financial strain only grew more urgent. By the fall of 2023, city leaders set a firm deadline to confront the ambulance funding crisis. On October 16, 2023, the City Council unanimously passed a motion “to have a plan in place by March 1, 2024, to alleviate the growing deficit of the ambulance fund,” directing the Ambulance Director (Fire Chief) and City Administrator to develop recommendations (October 16, 2023 City Council Minutes – City of International Falls, Minnesota). Mayor Harley Droba and the council underscored the importance of preserving the city’s Advanced Life Support (ALS) ambulance capability during these discussions (October 16, 2023 City Council Minutes – City of International Falls, Minnesota). Community members and ambulance staff also voiced concerns – for example, one long-serving Emergency Medical Technician questioned how the service could hire needed personnel while running a deficit, emphasizing that “Paramedics are needed, they save lives” (October 16, 2023 City Council Minutes – City of International Falls, Minnesota). The message was clear: cutting back on ambulance service quality was not a desirable option, so new funding had to be found.

The city opened this conversation to the public. A town hall meeting on November 30, 2023, gathered residents to discuss “current ambulance funding issues” and possible changes (NOTICE- Town Hall Meeting – Thursday, November 30, 2023 – City of International Falls, Minnesota). According to Mayor Droba, that meeting “went well” in educating the public and gathering input (December 4, 2023 City Council Minutes – City of International Falls, Minnesota). Citizens learned that the ambulance fund’s deficit was a structural problem – largely due to insufficient reimbursements and lack of outside support – rather than simple mismanagement. City officials assured residents that, for the 2024 budget, property taxes would not be raised to plug the ambulance deficit (December 4, 2023 City Council Truth-in-Taxation Public Hearing and Input Minutes – City of International Falls, Minnesota). In other words, the city did not plan to simply transfer the shortfall onto local taxpayers through a levy increase, at least in the short term. This put even more pressure on finding an alternative fix before the March 2024 deadline.

As that deadline approached, there were signs of progress. The city and county began earnest negotiations on sharing ambulance costs, and state lawmakers started paying attention to the plight of rural EMS services. In December 2023, Mayor Droba and Chief Mannausau testified at a legislative hearing in Mountain Iron about the “statewide ambulance funding, staffing and capacity crisis”, making the case that places like International Falls need help (December 4, 2023 City Council Minutes – City of International Falls, Minnesota). A few months later, in March 2024, they met with U.S. Senator Tina Smith’s staff to discuss federal support for local emergency services “in arrears” (March 18, 2024 City Council Minutes – City of International Falls, Minnesota). These advocacy efforts coincided with statewide action: Minnesota’s governor and Legislature approved a one-time infusion of funds for ambulance services. In May 2024, Governor Tim Walz signed a bill providing $30 million in emergency aid to bolster rural EMS providers (As Walz signs $30 million for rural EMS, providers worry it’s not enough | MPR News). Of that, $24 million was slated to be distributed as short-term operating aid across greater Minnesota ambulance services (with International Falls expected to receive roughly $200,000) (State funding to help EMS) (As Walz signs $30 million for rural EMS, providers worry it’s not enough | MPR News). The remaining $6 million created a pilot program to test new EMS delivery models in rural areas (As Walz signs $30 million for rural EMS, providers worry it’s not enough | MPR News). Local officials welcomed this funding boost as a “shot in the arm”, but they understood it was only a temporary remedy (As Walz signs $30 million for rural EMS, providers worry it’s not enough | MPR News) (As Walz signs $30 million for rural EMS, providers worry it’s not enough | MPR News). Statewide, ambulance providers had identified about $122 million in annual costs not covered by existing revenues (As Walz signs $30 million for rural EMS, providers worry it’s not enough | MPR News) – highlighting that the EMS funding gap is far larger than one round of aid could fill.

On the local front, Koochiching County took decisive action in early 2024. In April, the County Board voted unanimously to “pursue a subordinate taxing district to support the City of International Falls Ambulance Service” (). This meant the county would begin the process of creating a special tax district specifically to fund ambulance operations, ensuring that residents in the ambulance service area (which extends well beyond city limits) contribute to its cost. The subordinate service district, once established, can levy a tax to provide ongoing funding for ambulance service in the region. This structural change – essentially a partnership between the city and county – is aimed at stabilizing the ambulance fund after years of deficit spending. As of mid-2025, the city is working with the county to implement this new funding mechanism, alongside continuing to seek state grants and other support. These steps have bought the fire department some breathing room, but the underlying budget challenges remain a concern until longer-term fixes fully take effect.

How the Fire/EMS Budget Is Structured

To understand the strain on International Falls’ fire and ambulance services, it helps to examine how the department’s budget is set up. The City of International Falls operates a combined Fire/Rescue/EMS Department, but its funding comes from two primary sources: local tax levy (for fire protection) and user fees (for ambulance services). In the city’s budgeting, fire department expenditures are part of the general fund public safety budget, while the ambulance is run through a separate enterprise fund.

Fire Department Budget: The fire division is funded mainly by city property taxes and covers traditional firefighting and rescue services. According to the city’s 2025 budget presentation, the Fire Department accounts for about 26% of International Falls’ public safety operating budget (with the Police Department taking about 64%, and the remainder for code enforcement and animal control) ([PDF] budget & tax levy – City of International Falls, Minnesota). This reflects the resources needed to staff and equip the fire department. The International Falls Fire Department is a “combination” department, employing 30 firefighters in total, only six of whom are full-time (including the Fire Chief, Fire Marshal, and four Fire Engineer firefighters) (EMS & Fire – City of International Falls, Minnesota). The rest are paid on-call firefighters who respond as needed. This model helps contain salary costs, as most firefighters are not full-time staff, but it also requires recruiting and retaining a robust roster of on-call personnel to ensure adequate response to fires and other emergencies.

The fire department’s budget pays for personnel, training, and equipment maintenance. The city must maintain a fleet of fire apparatus to protect the community and its contract areas. Currently, the department’s equipment includes a 75-foot aerial ladder truck, engines, a heavy rescue vehicle, a brush rig, and other specialized trailers and boats (EMS & Fire – City of International Falls, Minnesota). Keeping this equipment in service (and eventually replacing it on schedule) is a significant ongoing expense. For example, one discussion in 2024 revolved around plans for purchasing new ambulances and radios to update aging equipment (March 18, 2024 City Council Minutes – City of International Falls, Minnesota) – a reminder that capital costs can spike the budget in certain years. The city also contracts with the Rural Fire Protection Association (RFPA) to provide fire coverage to surrounding townships (covering an additional 175 square miles outside city limits) (EMS & Fire – City of International Falls, Minnesota), for which the RFPA pays a fee. Those contract fees and an annual state fire aid (which was about $79,700 in 2024) help support fire operations ([PDF] 2024 Fire State Aid Amounts from the Department of Revenue), but local taxpayers still bear most of the fire department’s cost through the levy.

Ambulance Service Budget: Funding the ambulance side of the department is more complex – and is the crux of the budget challenge. The International Falls Ambulance Service is operated as an enterprise fund by the city, meaning it is expected to be largely self-sustaining through the revenues it generates. City code stipulates that “all receipts from the operation of the ambulance service shall be placed in the ambulance fund… and used for the operation of the ambulance service” (State funding to help EMS). In practice, this means patient billing (payments from insurers, Medicare/Medicaid, or individuals) is supposed to cover the costs of running the ambulances. If those payments fall short, the ambulance fund incurs a deficit unless other steps are taken.

The ambulance service covers an enormous area – roughly 989 square miles of Koochiching County (EMS & Fire – City of International Falls, Minnesota) – and provides 24/7 emergency medical response and patient transport at both Basic Life Support (BLS) and Advanced Life Support (ALS) levels. To deliver this service, the city currently staffs four full-time paramedics and about twenty part-time EMTs who rotate shifts to ensure two ambulance crews are on duty around the clock (EMS & Fire – City of International Falls, Minnesota). The service operates four fully equipped ALS ambulances (Horton models) to respond to 911 calls and inter-facility transfers (EMS & Fire – City of International Falls, Minnesota). This staffing and apparatus allow International Falls to offer a high level of emergency care for a rural area – but they also carry high operating costs. Salaries, overtime, benefits, medical supplies, vehicle fuel and maintenance, and training all must be paid out of the Ambulance Fund.

A key point is that until now, no dedicated tax levy has routinely supported the ambulance service. City officials deliberately did not use general fund tax dollars to subsidize the ambulance deficit in the 2023–2024 budgets (December 4, 2023 City Council Truth-in-Taxation Public Hearing and Input Minutes – City of International Falls, Minnesota), hoping instead to find external funding and efficiencies. Essentially, the ambulance service’s expenses have outstripped its income, creating an accumulating deficit within that enterprise fund (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). Each year that the gap persists, the city faces tough choices: either allocate tax dollars to cover the shortfall, cut ambulance services, or find new revenue. Mayor Droba confirmed at a public hearing that the 2024 city levy would not be increased to bail out the ambulance fund (December 4, 2023 City Council Truth-in-Taxation Public Hearing and Input Minutes – City of International Falls, Minnesota), reflecting the Council’s reluctance to shift the burden onto city property owners alone.

Why is the ambulance fund in the red? The core problem is inadequate reimbursements and uncompensated costs. A large share of ambulance calls in International Falls are reimbursed by federal programs like Medicare and Medicaid, which pay only a portion of each transport’s actual cost. According to testimony at the Minnesota Legislature, some rural ambulance services are “reimbursed at less than 25 cents on the dollar” for transporting patients (Proposed grant program aims to prevent rural ambulance services from going further into red – Session Daily – Minnesota House of Representatives). In other words, for every $1.00 it costs the city ambulance to respond and transport a patient, they might receive under $0.25 in payment from Medicare or Medicaid. Private insurance and patient self-payments can also fall short or go uncollected. This systemic reimbursement shortfall means the ambulance service essentially operates at a loss on many calls – a loss that in the past was not being fully offset by higher volume or other funding.

International Falls has tried to mitigate this by adjusting its billing rates upward where it can. The City Council-approved fee increases (referenced in 2018–2019) were an attempt to bring in more revenue (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). However, there is a practical ceiling to how much they can charge; Medicare and Medicaid payments are fixed by the government, and setting very high rates for other runs may just lead to more unpaid bills. Compounding the issue is the fact that the ambulance service must be ready to cover a huge, sparsely populated territory with relatively few calls per capita. As state officials noted, rural services have **“larger areas to cover” but fewer billable runs to spread out the overhead costs (Proposed grant program aims to prevent rural ambulance services from going further into red – Session Daily – Minnesota House of Representatives). International Falls might send two ambulances out at the same time to far-flung corners of its area (for example, to Rainier, Pelland, or other communities it serves), which requires staffing and equipment, but on a quiet day those crews still must be paid even if few calls come in. This high-readiness, low-utilization dilemma is common in rural EMS and contributes to the financial strain (Proposed grant program aims to prevent rural ambulance services from going further into red – Session Daily – Minnesota House of Representatives).

The staffing model also plays into the budget. Relying on part-time EMTs and on-call volunteers saves money compared to an all-full-time force, but it has limits. Volunteers and part-timers can only cover so many hours, and vacancies or lack of available on-call staff can lead to full-timers logging overtime. The city discovered that its ambulance personnel had been working schedules beyond the 40-hour workweek without overtime pay (under an assumption they fell under firefighter rules), which had to be corrected (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). Now, if full-time paramedics work more than 40 hours in a week, overtime pay is incurred – increasing costs. The ambulance service experimented with adding a third crew on a “peak” 10:00 a.m. to 10:00 p.m. shift in addition to the two 24-hour rotating crews (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota), in order to handle high call volumes at certain times without forcing overtime. While operationally helpful, this also means paying more personnel hours. Every staffing adjustment to improve service or compliance (whether hiring more EMTs or adding shifts) has a direct impact on the budget.

In summary, the fire/EMS budget is squeezed from both sides: expenses have risen (to meet labor standards, cover equipment needs, and maintain service levels), while revenues have not kept up (due to limited reimbursements and the lack of a dedicated funding stream). By early 2025, the city’s solution has been to pursue external support – namely, county and state funding – rather than drastically cut the service or impose a big tax hike locally. The current budget includes the expectation of county help via the new ambulance tax district and hopes of state aid, in lieu of using city general funds to shore up the ambulance department. This approach reflects a structural shift in how the community will fund emergency medical services going forward.

Policies and Decisions Behind the Strain

Several policy decisions and structural factors at the city and state level led to International Falls’ current budgetary strain for Fire/EMS:

  • Running a Regional Ambulance as a City Service: Historically, International Falls chose to operate its own ambulance service to ensure prompt emergency care for its residents and neighbors. However, there was no formal cost-sharing agreement with Koochiching County or surrounding townships for ambulance operations for many years. City taxpayers essentially subsidized the readiness of ambulances that served the entire region, while the only outside contributions were user fees from patients. A 2015 audit noted that Koochiching County provided only a token contribution – a one-time $10,000 allocation (plus small payments for inmate transports) – to the International Falls Ambulance Service, and even that had no clear statutory authorization (Koochiching County Financial Statements and Management Letter – 12/31/15). In short, the funding structure did not require county residents outside the city to pay into the system, even though they benefited from it. This structural choice left International Falls shouldering most ambulance costs on its own. The decision to create a subordinate taxing district in 2024 is a direct response to this long-standing imbalance ().
  • Ambulance Fund Isolation: By city ordinance, the ambulance fund is separate from the general fund (State funding to help EMS). This financial silo means ambulance revenues cannot easily be redirected to other uses – but conversely, it also meant the city was hesitant to inject general tax dollars into the ambulance fund. While this ensures transparency (so one can see if the ambulance service itself is self-supporting or not), it contributed to the problem by delaying subsidy decisions. For years, as deficits grew, the city avoided inter-fund transfers to cover them, effectively betting that a solution would emerge (such as raising fees or finding new revenue) rather than making an immediate policy to use general funds. The Council’s stance in late 2023 – explicitly not levying taxes to cover the ambulance shortfall (December 4, 2023 City Council Truth-in-Taxation Public Hearing and Input Minutes – City of International Falls, Minnesota) – exemplified this policy. The upside is that city resources were preserved for other services; the downside is that the ambulance deficit ballooned and became a crisis that required external intervention.
  • Labor and Staffing Rules: Federal labor regulations (FLSA) and state public employment rules influenced how the department could manage staffing. The need to comply with the 40-hour workweek overtime threshold for EMS staff forced the city to reconsider its scheduling and possibly hire more people (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). Hiring more full-time EMTs or paramedics, however, increases salary and benefit costs, putting pressure on the budget unless new funding is found. Additionally, any attempt to merge firefighter and paramedic roles runs into Minnesota’s public sector employment laws – such as civil service hiring requirements and existing union agreements (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). In 2019, officials noted that creating combined firefighter/paramedic positions might require opening those jobs through a civil service exam process and could raise concerns among current firefighters (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). These structural rules slowed down potential staffing reforms that might have improved efficiency. The city has navigated these constraints carefully, but often at the cost of time and flexibility.
  • State Policy and Reimbursements: At the state level, Minnesota historically did not have a dedicated program to fund ambulance services’ operating costs (aside from modest ambulance service reimbursements and occasional grants). Ambulance services are also heavily affected by federal Medicare/Medicaid reimbursement policies, which the city cannot control. The combination of high Medicare dependence in an older population and flat reimbursement rates essentially guaranteed a shortfall. As of 2023, the Minnesota EMS Regulatory Board identified a statewide ambulance operating deficit of $122 million per year – meaning that’s how much more ambulance services are collectively spending than they receive (As Walz signs $30 million for rural EMS, providers worry it’s not enough | MPR News). International Falls’ experience reflects this gap. It took lobbying by coalitions of “EMS providers, paramedics and mayors” at the Capitol to draw attention to the issue (As Walz signs $30 million for rural EMS, providers worry it’s not enough | MPR News). The result was the one-time $30 million EMS aid package in 2023, and discussions of more lasting solutions. One proposal introduced in the legislature (HF337 in 2024-25) would establish an “ambulance operating deficit grant program” to help services like International Falls on a recurring basis (Proposed grant program aims to prevent rural ambulance services from going further into red – Session Daily – Minnesota House of Representatives) (Proposed grant program aims to prevent rural ambulance services from going further into red – Session Daily – Minnesota House of Representatives). That bill initially considered a surcharge on cell phone lines as a funding source (Proposed grant program aims to prevent rural ambulance services from going further into red – Session Daily – Minnesota House of Representatives), though it is still being debated. The fact that state policymakers are considering such measures underscores that the problem is partly systemic – small cities and rural areas have been left with an unsustainable formula for EMS funding. International Falls’ budget woes are a case study of this larger policy failure, where essential services ended up “hemorrhaging dollars” without a stable funding model (Proposed grant program aims to prevent rural ambulance services from going further into red – Session Daily – Minnesota House of Representatives).
  • Local Political Decisions: Local leadership has had to make tough calls amid this crisis. By setting a hard deadline for a solution (March 1, 2024) (October 16, 2023 City Council Minutes – City of International Falls, Minnesota), the City Council essentially forced action and kept the issue in focus. This move, along with public outreach like the November 2023 town hall, created urgency and public awareness. It also put pressure on the county and state to collaborate. Another key decision was prioritizing service continuity – the city never seriously considered cutting the ambulance service or reducing from ALS to Basic Life Support only, even though ALS (paramedic-level service) is more expensive. Council discussions repeatedly emphasized keeping the ALS level of service for the community (October 16, 2023 City Council Minutes – City of International Falls, Minnesota). This policy choice comes from a public safety perspective (lives come first), but it does mean the city chose the more expensive route in budget terms. In the long run, however, maintaining ALS capability may prove wise if it prevents poor outcomes or loss of the service entirely. Finally, city officials demonstrated a policy of transparency and seeking help: rather than quietly accumulating debt, they openly reached out for county assistance and appealed to legislators. That collaborative approach is now yielding some results in the form of shared funding responsibility.

In sum, the budget strain is the product of a perfect storm of structural issues: a regional service funded at the local level, reimbursement systems that don’t cover rural costs, labor rules that increase expenses, and cautious fiscal policies that delayed subsidy interventions. Recognizing these root causes is essential to crafting effective solutions.

Path Forward: Toward a Sustainable Fire/EMS Funding Model

Despite the challenges, International Falls is now charting a path toward financial stability for its fire and ambulance services. Several reasonable and actionable steps are either in motion or under consideration to improve the department’s fiscal situation:

1. Implement the Regional Ambulance Taxing District. The top solution on the table is for Koochiching County to finalize the subordinate service district dedicated to ambulance funding (). This new structure will spread the cost of ambulance service across the broader community that benefits from it, rather than concentrating it solely on city hall. Once in effect, property owners in the ambulance service area (inside and outside the city) will pay a small tax specifically for EMS. Those revenues can be channeled into the ambulance fund to eliminate the deficit and fund operations going forward. Essentially, it creates a stable local funding stream to match the regional nature of the service. City and county officials should continue working closely to set the right levy amount for this district and get it up and running as soon as legally possible. This approach has precedent in other Minnesota counties and is arguably a long-term fix, as it aligns the funding base with the service area. For International Falls, ensuring this district is efficiently administered and transparently managed will be key. The city will want to show taxpayers exactly how these funds improve ambulance readiness and response. In return, the ambulance service should become more financially self-sufficient, easing the strain on the city budget.

2. Pursue Ongoing State Support and Policy Changes. While the one-time state EMS aid was helpful, local leaders know that permanent solutions are needed at the state level. The city should continue to actively support legislation like HF337 that would create an ambulance operating deficit grant program (Proposed grant program aims to prevent rural ambulance services from going further into red – Session Daily – Minnesota House of Representatives). If enacted, such a program could provide annual state funding to cover the gap between ambulance costs and revenues for places like International Falls. City officials – along with other rural cities and ambulance directors – can advocate for a reliable funding source (for example, a small statewide fee or dedicated budget line) to sustain this grant program. Additionally, the city can back policy measures to improve reimbursements and reduce costs. For instance, Minnesota’s recent EMS bill not only provided money but also established an Office of EMS and expanded the roles of who can staff rural ambulances (As Walz signs $30 million for rural EMS, providers worry it’s not enough | MPR News). Those changes could help with staffing flexibility and training support. International Falls should engage with the new Office of EMS to tap into any technical assistance or pilot programs (such as the “Sprint Medic” concept of roving paramedics) that could enhance service delivery in a cost-effective way (As Walz signs $30 million for rural EMS, providers worry it’s not enough | MPR News). On the federal side, the city can support efforts in Congress to boost Medicare reimbursement rates for ambulance transports and to fund rural EMS infrastructure. U.S. Senator Tina Smith and others have shown interest in the rural EMS crisis (March 18, 2024 City Council Minutes – City of International Falls, Minnesota), so maintaining communication with federal representatives might yield additional grant opportunities or policy fixes (for example, treating ambulance services more like essential rural healthcare providers). In summary, leveraging state and federal policy is crucial – International Falls should not have to solve this alone when the problem is widespread. Continued lobbying and participation in statewide EMS coalitions will keep the momentum for higher-level funding solutions.

3. Optimize Staffing and Reduce Overtime Costs. On the operational front, the fire department can look inward to find efficiencies in staffing. One idea is to cross-train and integrate roles between the fire and ambulance crews. Revisiting the firefighter/paramedic dual-role concept could pay dividends: if some of the full-time staff are certified to handle both fire and EMS duties, the department might cover two needs with the same personnel on shift. This could improve coverage (paramedics could assist in firefighting when not on medical calls, and firefighters could assist on medical calls when needed) and potentially allow the city to use the more lenient firefighter overtime threshold for those dual-role staff (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). Implementing this will require negotiating details with the firefighters’ union and Civil Service Commission, as noted earlier, but it may be worth piloting. Many cities have successfully created firefighter/paramedic positions that strengthen their emergency services overall. In the meantime, the department should analyze call data to fine-tune scheduling. If certain times of day or seasons see more call volume, staffing could be concentrated there to avoid overtime. The city has already tried a 10am–10pm peak ambulance crew (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota); it could formalize such adjustments if they prove to reduce strain on the core crews. Additionally, recruiting a few more part-time EMTs (or keeping a larger paid-on-call EMS pool) might help fill gaps without incurring full-time costs. The Council has approved new EMT hires in the past year (October 16, 2023 City Council Minutes – City of International Falls, Minnesota), and continuing to bolster the roster will distribute the workload. The key is to balance coverage with cost: too few staff leads to burnout and OT expenses, while too many full-timers without funding leads to deficits. Careful workforce planning, possibly with the help of the consultant or state EMS experts, can find the sweet spot. The city might also explore creative staffing models such as partnering a full-time paramedic with an on-call EMT for certain shifts, or sharing personnel with neighboring ambulance services if any exist (though International Falls is rather isolated in that regard). Every hour of overtime saved is money back in the budget, so these efforts, while operational, have financial importance.

4. Adjust User Fees and Explore Additional Revenue. Although raising ambulance service fees is not a complete solution, the city should ensure it is maximizing all possible revenue short of overburdening patients. This could include regularly updating transport fees to the upper limit allowed by Medicare and competitive rates for inter-facility transfers. The city can also look at subscription programs or membership plans for ambulance service, which some communities use: households pay an annual fee to cover any out-of-pocket costs for ambulance use, which provides the ambulance fund with a predictable revenue stream. Another idea is pursuing revenue through agreements with large local stakeholders – for example, the local hospital or clinic might contribute funding or equipment in exchange for guaranteed patient transport services, since the ambulance service is crucial for bringing patients to the hospital. Grants for equipment can also alleviate capital costs: the fire/EMS department can aggressively seek grants (from FEMA’s Assistance to Firefighters Grants for ambulances and equipment, or USDA rural development grants for public safety) to pay for big-ticket items like defibrillators, stretchers, or vehicle upgrades. By securing grants, the city frees up operating funds that would otherwise go toward equipment. Similarly, continuing community-driven fundraising for specific needs – such as the firefighters’ charitable “Fill the Boot” drives – can engage the public and generate a modest local contribution (while these are not huge dollar amounts, they build good will and can offset certain smaller expenses like public education materials or auxiliary equipment). The overarching principle is to leave no stone unturned for revenue: billing insurance properly (the city uses an expert billing service already) (March 18, 2024 City Council Minutes – City of International Falls, Minnesota), following up on collections within what’s ethical, and tapping any special funding pools (for instance, pandemic relief funds were used by some EMS services to cover COVID-related costs). Each of these measures can help inch the ambulance fund closer to break-even.

5. Strengthen Regional Cooperation and Mutual Aid. The city should also consider the broader regional EMS system for efficiencies. International Falls is the primary ambulance provider in Koochiching County, but ensuring robust mutual aid agreements with neighboring counties or services is important. For example, if a major incident exceeds local capacity, having nearby ambulances respond (and vice versa) can prevent the need for maintaining expensive excess capacity at all times. While this doesn’t directly bring in money, it improves service reliability without additional cost. In terms of fire services, the city already contracts with the RFPA for rural fire coverage (EMS & Fire – City of International Falls, Minnesota) – perhaps a similar model could be formalized for EMS with outlying communities (though the new tax district may cover this). The city and county might eventually explore a joint powers authority for EMS, where the service is governed and funded regionally rather than being a city department. This could potentially qualify the ambulance service for more state or federal rural health funding if it’s seen as a county-wide service. It could also allow cost-sharing on things like dispatch, training, or bulk purchasing of medical supplies. These structural collaborations take time to develop, but starting the conversation with regional partners (neighboring fire departments, first responder squads in small towns, etc.) could reveal opportunities to save money or improve coverage collectively. At the very least, the goodwill generated by jointly addressing EMS challenges can lead to more political support for funding measures at the county and state levels.

6. Maintain Public Engagement and Transparency. Finally, an important but sometimes overlooked strategy is keeping the public informed and involved. The 2023 town hall meeting set a good precedent for this (December 4, 2023 City Council Minutes – City of International Falls, Minnesota). When taxpayers understand exactly what the problem is – for instance, that ambulance billing doesn’t cover costs and without action the service could be in jeopardy – they are more likely to support solutions like the new ambulance district or state funding requests. The city should continue to report on the ambulance fund’s status in council meetings and local media, including how new funds (county tax or state aid) are being used to improve the service (e.g. hiring needed staff to reduce response times, upgrading an old ambulance, etc.). Demonstrating tangible benefits builds trust. It’s also wise to celebrate the department’s successes publicly: every life saved or fire contained is a reminder of why this investment is important. By keeping the community on board, city officials ensure that if additional local measures become necessary – say, a modest levy increase or bond for a new fire station or ambulance base in the future – residents will recognize it as part of a broader plan to secure emergency services for the long haul.

In conclusion, the budget challenges facing the International Falls Fire Department are the result of years of structural imbalance, particularly in funding the ambulance service that so many rely on. The problem began in earnest when rising costs and flat revenues created an ambulance fund deficit that could no longer be ignored (January 24, 2019 Committee-of-the-Whole Meeting Minutes – City of International Falls, Minnesota). It worsened due to rules and decisions that limited quick fixes – from federal labor laws to the absence of county aid (Koochiching County Financial Statements and Management Letter – 12/31/15). Today, however, the city is confronting the issue head-on with a multifaceted response. By creating a regional taxing district (), lobbying for state and federal assistance (December 4, 2023 City Council Minutes – City of International Falls, Minnesota) (As Walz signs $30 million for rural EMS, providers worry it’s not enough | MPR News), and implementing smarter staffing and budgeting practices, International Falls is working to ensure its Fire/Rescue/EMS Department remains financially viable. These efforts aim to preserve the high level of service residents expect – round-the-clock paramedics, skilled firefighters, and fast emergency response – without lurching from one budget crisis to the next. Achieving long-term stability will require follow-through on the plans set in motion and adaptability as conditions change. Yet the progress to date offers a roadmap for other small cities facing similar predicaments. With cooperation and prudent policy changes, International Falls can emerge from this challenge with a stronger, more sustainable model for funding public safety, securing both the lifesaving services and the fiscal health of the community for years to come. (October 16, 2023 City Council Minutes – City of International Falls, Minnesota) (Proposed grant program aims to prevent rural ambulance services from going further into red – Session Daily – Minnesota House of Representatives)

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