Madison and Ruby Valley Rural Ambulance District renewal on May 5 ballots

A measure asking Madison County voters whether to renew the Madison and Ruby Valley Rural Ambulance District, which provides dedicated funding for EMS services based at Ruby Valley Medical Center in Sheridan and Madison Valley Medical Center in Ennis, is on the May 5 ballots.  The special district election is an entirely mail-in ballot, with ballots hitting mailboxes this week.

The Madisonian reached out to local hospital CEO’s, Allen Rohrback and Jim Gillhouse for their perspectives on the impact of renewing this funding.

Madison Valley Medical Center transitioned Ennis’ longtime volunteer ambulance service to a hospital-based model in May 2021.  Shortly after, Madison Valley Medical Center and Ruby Valley Medical Center partnered to create the Madison and Ruby Valley Rural Ambulance District.

“Since then, emergency medical services in our community have improved in meaningful and measurable ways. Today, our EMTs and paramedics deliver advanced life support (ALS) care on 911 calls, during transfers to regional hospitals, and alongside our medical providers and nurses in the Emergency Department. We staff two ambulance crews around the clock to ensure help is always available when it’s needed.

That investment is making a real difference. Within two years, our ambulance service was recognized as the 2024 EMS Service of the Year by the Montana Department of Health and Human Services. That recognition reflects the strength of a fully integrated model where EMTs and paramedics can stabilize patients in the field, continue care in the Emergency Department, and safely transport them to higher levels of care when necessary. It also highlights our expansion into Community Integrated Health, which allows our crews to support patients at home through education, vaccinations, blood draws, and home safety checks,” said Allen Rohrback, Jr., Madison Valley Medical Center CEO.

“Our rural ambulance district has been a vital lifeline for the Ruby and Madison valleys.  Covering a wide geographic area with limited resources, our team has remained committed to delivering timely, high-quality emergency medical care whenever and wherever it is needed,” Jim Gillhouse, Ruby Valley Medical Center CEO added. 

The district also enables both hospitals to better coordinate training, share resources, and provide backup coverage across a large rural area. For example, crews are often staged in Virginia City during periods of high call volume or when one side of the district is committed to a transfer they explained.  

“In a region as large and rural as ours, that level of coordination is essential to ensuring timely, reliable care,” said Rohrback.

The current four-year levy is due to expire in 2026, and renewing the district for another four years is crucial to protecting emergency services, according to both Rohrback and Gillhouse.   

“Our paramedics and EMTs respond to a wide range of emergencies—from medical crises and traumatic injuries to accidents on remote roadways and calls in isolated homes and ranches. Despite the challenges that come with distance, weather, and terrain, we consistently work to ensure that no call for help goes unanswered,” said Gillhouse.

There has been an increase of approximately 46% in call volume in the ambulance services since the districts were established in 2022.  “This includes medical emergencies on highways, county roads, ranches, and homes throughout both Madison and Ruby valleys, and we also provide standby services for fire department and law enforcement, and are present at school events, rodeos, and other gatherings.  In 2025, the EMS crews from both hospitals responded to over 1,000 calls,” explained Rohrback.  

When asked what would happen to emergency medical services if the renewal does not pass, Rohrback responded,

“That’s a difficult question, but an important one. Operating an ambulance service at the advanced life support (ALS) level, capable of responding to 911 emergencies, transferring patients to regional hospitals, and providing back up to our partners in the Ruby Valley, requires a significant and constant investment. Much of that cost is tied to readiness. We may go a day or two without a call and then respond to as many as eight calls in a single day. Because of that unpredictability, we staff two ambulance crews day and night.

Maintaining that level of service means having trained staff, equipped ambulances, and necessary supplies available at all times, whether a call comes in or not.  Like most hospitals, our ability to provide services depends on a combination of revenue sources, including patient care payments, hospital district support, our Foundation, grants, and the ambulance district. Those additional funding sources directly impact what services we can sustain.

Emergency medical services will remain a priority because of their importance to community safety. However, without renewal of the district, maintaining the current level of readiness and service would become more challenging. EMS plays a critical role, not only in responding to emergencies, but also in stabilizing patients, supporting care in our emergency department, and ensuring safe patient transport to higher levels of care when needed.”

“Continued taxpayer support helps ensure we can keep ambulances staffed and ready, invest in life-saving equipment and training, and maintain reasonable response times across long distances. Without this support, the level of service our community depends on could be significantly reduced, putting lives at risk when minutes matter most,” concluded Gillhouse.