Exploding tourism in rural Utah counties can be a boon for the hotel, restaurant and guiding industries, and by some estimates outdoor recreation employs 110,000 people in the Beehive State.

But when it comes to emergency medical services, high tourism numbers can be a drain on local coffers.

“We have a problem in the state — especially in rural counties — with EMS,” state Rep. Phil Lyman, R-Blanding, said at a recent hearing of the House Revenue and Taxation Committee. “The demand is high, the funds are low and costs of providing EMS continue to go up.”

San Juan County, where Lyman lives, had a $226,000 shortfall in its EMS fund last year. And financial reports show that in 2018 Millard County lost $201,000 on its EMS program while Sevier County barely managed to stay in the black.

“Training and the equipment is expensive,” Lyman said, “so the smaller counties especially are feeling a real pinch.”

Funding EMS isn’t easy anywhere, said Andy Smith, executive director for Grand County Emergency Medical Services that serves the area around Moab, but the issue can be compounded in places with far more visitors than residents.

“The real big challenge for rural EMS is we have to care for a much larger population than we have the tax base to support,” Smith said. “We run roughly 2.5 to 3 million visitors a year in Grand County [which has a population of around 10,000].”

Typically, a county of that size would average 500 emergency calls per year, Smith said, but the high volume of out-of-county visitors more than triples that number. Fees charged to patients and insurance companies usually don’t keep up with the cost of running an EMS program, even those staffed by volunteers.

In 2016, Grand County voters approved a 0.5% sales tax on hotels, restaurants and other visitor services, requiring tourists to help bear the cost of the trained first respondents and ambulance equipment.

Smith said the tax revenue, which is collected under a state provision known as the rural county health care facilities tax, has been a “huge support” for his department.

“We’re busy enough in our county that we’ve had to hire full-time staff, and that money pays for our full-time employees," he said. "It’s essentially taking care of a third of our budget.”

Other rural counties have eyed Grand County’s success but, under state law, the rural county health care facilities tax can be used only to fund EMS programs in counties with fewer than 11,000 residents.

Lyman’s proposed amendment to the law, HB174, would increase the population cutoff to 31,000, giving 19 of Utah’s 29 counties the option to impose up to a 1% sales tax and use that money for EMS in addition to health care facilities. “[My bill] puts the discretion in the hands of the commissioners,” Lyman said.

Sevier County Commissioner Garth “Tooter” Ogden and San Juan County Commissioner Bruce Adams have both spoken out in favor of the measure.

“People come to San Juan County just to get lost,” Adams joked. “And I think some of them not only come there to get lost, but they get lost and then they get injured.” Adams said EMS, along with search and rescue, is a service visitors expect to be available when something goes wrong, and it’s something that visitors should help fund.

San Juan has been forced to use property taxes from its already strained general fund to cover losses in the EMS account in recent years. But with nearly $40 million in taxable sales of hotel and restaurant services in San Juan County in 2018, a 1% tax on those services alone could bring in close to $400,000, more than enough to cover the $226,000 EMS fund shortfall last year.

Smith hopes the bill passes and other counties are able to follow Grand County’s footsteps if they so choose. “I’m grateful that Rep. Lyman wanted to run this bill — that it’s something that he cares about and is passionate about,” Smith said. “Rural EMS specifically is an issue that’s not getting enough attention.”

Lyman’s bill received unanimous approval from the House Revenue and Taxation Committee and awaits a vote by the full House.

Zak Podmore is a Report for America corps member and writes about conflict and change in San Juan County for The Salt Lake Tribune. Your donation to match our RFA grant helps keep him writing stories like this one; please consider making a tax-deductible gift of any amount today by clicking here.