ALES TOMAIER: AMBULANCE CHASER

Just months after the Mammoth Lakes Town Council heard from the police department about its funding woes, Mammoth Fire Protection District Chief Ales (pronounced Alesh) Tomaier made a mirror complaint Wednesday asking for more investment in Emergency Medical Services (EMS).

“Essentially, Mammoth Lakes has become too busy for one [Mono County] ambulance, one paramedic,” Tomaier told the council. “One of the challenges the county has had is that this is essentially their most expensive program. It’s not mandated, so they try to cut costs.”

To address the growing gap between demand and available resources, Tomaier proposed a four-party agreement between the Mammoth Lakes Fire Protection District, the Town of Mammoth Lakes, Mono County and the Southern Mono Healthcare District, which operates Mammoth Hospital. Under the agreement, each agency would contribute $100,000 annually for five years to expand emergency medical services.

The council unanimously approved the memorandum of understanding.

Tomaier said the proposal would increase advanced prehospital provider capacity by two to four times while preserving the county’s role as the primary ambulance provider.

The county’s EMS system dates to 1976, when a private ambulance company stopped operating in the area because it could no longer make money. Tomaier said a similar partnership among the county, town, fire district and hospital helped fund the system in its early years after that private company left.

“Nobody has to have emergency medical services,” he said. “A lot of things deal with economies of scale. We, as a small region with a few people, are challenged the most in trying to provide these services.”

While visitation has grown dramatically over the past two decades, Tomaier said the county’s deployment model has remained largely unchanged. Four Advanced Life Support ambulances are stationed along the U.S. 395 corridor in Walker, Bridgeport, June Lake and Mammoth Lakes, but roughly two-thirds of all EMS calls now occur in the Mammoth area.

At the same time, changes in healthcare have increased the number of patients transferred from Mammoth Hospital to specialty facilities outside the region. Those transfers require county ambulances to accompany patients to air transport or distant hospitals, temporarily leaving Mammoth without an Advanced Life Support ambulance.

“When I started here 20 or 25 years ago, they were running two paramedics on the ambulance,” Tomaier said. “Now they’re just running an EMT and a paramedic.”

On serious calls, he said, that reduction can make a significant difference.

He gave an example. During a fatal traffic collision on Highway 203 last winter, responders faced one fatality and three critically injured patients with only a single county paramedic available. While crews were still at that scene, another life-threatening medical emergency occurred during après-ski at Canyon Lodge, forcing responders to wait for an ambulance traveling from June Lake through a winter storm.

“I’m a dad,” Tomaier said. “I’ve been on three calls where I knew the families, and we couldn’t provide medication.”

Under the proposal, Mono County would continue operating ambulance transport while firefighter-paramedics stationed on fire engines would provide Advanced Life Support care immediately upon arriving at a scene. Firefighters could supplement county ambulance crews on critical incidents and, when necessary, staff the fire district’s backup ambulance without requiring the county to purchase another Advanced Life Support unit.

Tomaier estimated the county’s ambulance system costs roughly $6 million annually, while adding another Advanced Life Support ambulance would cost approximately $1.5 million. The four-agency partnership, he argued, would substantially increase emergency response capacity for a fraction of that cost.

He stressed that the proposal is intended to bring Mammoth’s emergency medical care up to the level visitors and residents expect elsewhere.

“If you go to any of our partner resorts, if you go to Southern California or the Bay Area, you’re going to have paramedics on the scene,” he said. “That’s the standard of care.”

Earlier in the evening, Tomaier made a similar argument during a presentation on Mono County’s emergency management system by consultants hired by the county.

The consulting team, led by former county administrator Don Ashton, concluded that Mono County’s Office of Emergency Management is “fragmented and under-resourced,” citing a vacant emergency manager position, reliance on a one-person office and limited staffing. The consultants recommended hiring a permanent emergency manager, adding staff to create redundancy, expanding disaster service worker training and conducting more regular emergency exercises with partner agencies.

Tomaier agreed with much of the report but argued it focused on symptoms rather than the underlying issue.

“I think they’re doing a pretty good job brushing around the edges,” he said. “They talked about leadership and accountability as the top two things we have to fix. Great. But the reality is this comes down to money.”

Funding quickly became the focus of the discussion.

Councilmember Chris Bubser asked whether the consultants’ recommendations were realistic given Mono County’s limited tax base and questioned how similarly sized counties afford additional staffing.

“Based on the size of our county and our resource constraints, does that change your recommendation in any way for the governance structure?” she asked. “How do other counties afford redundancies when it’s not in the sheriff’s department?”

Ashton acknowledged the challenge is common across rural California.

“Funding and capacity constraints… that’s not unique to Mono County,” he said. “It’s a struggle all small counties have up and down the state.”

His answer to Bubser’s question was straightforward.

“They take money out of their general fund, and they apply for grants.”

Ashton emphasized that the consultants were less concerned with where emergency management is housed than whether local governments are willing to invest in it.

“Whether it’s in the Sheriff’s Office or under the County Administrative Office, either model can work,” he said. “What matters is leadership, accountability and making sure the resources are there.”

Assistant County Administrative Officer Christine Bouchard noted that additional staffing could also unlock more outside funding.

“We do have grants that we apply for through emergency management,” Bouchard said. “Right now, we can only cover the position that is there. So if we bring on more positions, we can increase those grants.”

Councilmember John Wentworth asked who ultimately bears responsibility for emergency management. The consultants responded that while the county serves as the lead agency, effective emergency management depends on collaboration among local governments, fire districts, law enforcement, hospitals and state agencies.

For Ashton, that collaboration ultimately requires a willingness to invest before disaster strikes.

“We either pay now or we pay later,” he said.