MADISON, Wis. — Rural communities in southern Wisconsin are facing growing pressure on emergency medical services as call volumes rise and fewer volunteers are available to staff ambulances. The strain was highlighted this week in Iowa County, where a medical call originating in Avoca had to be sent through four pages of departments before a staffed crew could respond. Agencies in Lone Rock and Spring Green were unable to field a crew at the time. Officials said the call was ultimately handled and the patient received care. Iowa County Sheriff Michael Peterson said the incident reflects a broader pattern in which the closest ambulance service is not always immediately available. Calls in the county have increased about 24% since 2020, he said, in part as the population ages. “When minutes matter, when seconds matter, we’re losing seconds,” Peterson said. “And it’s not to point blame at anyone or any agency. It’s just showing that we need to have those conversations.” Spring Green EMS Assistant Chief Derek Miller said his department has about 27 members, all volunteers except for small stipends paid to the chief, assistant chief and responding volunteers. Most members also have full-time jobs and family responsibilities. When Miller began volunteering about 20 years ago, Spring Green EMS handled roughly 280 calls annually. The department expects about 470 calls this year, compared with a previous high of 420 calls several years ago. The increased demand makes simultaneous emergencies more difficult to cover, he said. Plain EMS faces a similar challenge. EMS Director Trevor Strine said about 22 volunteers cover approximately 160 square miles and respond to about 200 calls a year. Although someone usually arrives, the department needs two licensed people to take an ambulance out — and one of them must be able to drive. “Having enough people available at the right time is the problem,” Strine said. Volunteer agencies also say expanded state training requirements have made recruitment harder. The EMT course has grown from one semester to two, adding a significant time commitment for people who already work and care for families. Miller said the added requirements are putting some volunteer services at risk, while Strine said it is increasingly difficult to ask prospective volunteers to devote that much time before they can begin responding. Departments in Arena, Spring Green, Lone Rock and Mazomanie have been meeting to discuss shared staffing challenges and possible solutions. Spring Green is exploring cross-credentialing, which could allow a licensed EMT or driver from one district to legally assist another department’s ambulance crew when it is short-staffed. Peterson said Iowa County officials are also considering whether the region needs more volunteers, multiple paid agencies or another model for providing emergency coverage. Moving toward paid services could improve availability but would also create additional costs for local taxpayers and communities with limited tax bases. For now, local departments say recruiting and retaining volunteers remains their most immediate priority. Miller said residents do not need prior medical experience to consider joining, and Strine emphasized the value of keeping responses local. “The biggest thing for us in the community right now is when you call an ambulance, knowing Plain Ambulance is going to show up for you,” Strine said. “These are your neighbors. These are your family members.”