If you are considering a move to North Idaho, access to emergency medical care matters just as much as schools, neighborhoods, and outdoor recreation. In this episode of North Idaho Experience, the team sat down with Jay Wojnowski, chief of Kootenai County EMS, to talk through how the system works, how it is funded, and what makes it different from many EMS models in larger metro areas.

For many people moving from states like California, the structure of emergency medical services here can feel unfamiliar. But one thing came through clearly in this conversation: Kootenai County EMS is a thoughtful, well-organized system that is adapting to growth while keeping patient care at the center.

What Is Kootenai County EMS?

One of the most interesting takeaways from the conversation is that Kootenai County EMS is its own entity. While it works closely with the county and local fire agencies, it is not simply a county department in the traditional sense.

The organization operates with its own budget, receives tax-supported funding through the county commissioners, and partners with local fire districts to provide ambulance service across the county.

That system supports a county population of roughly 187,000 people and works with 11 fire departments, nine of which transport patients. The three largest agencies—Northern Lakes, Coeur d’Alene, and Kootenai County Fire and Rescue—have ALS capability, meaning they operate with paramedics and advanced life support equipment.

In simple terms, Kootenai County EMS owns the ambulances and medical equipment, then provides those resources to the fire districts, which staff and operate them. That means residents benefit from a model where responders are not only trained firefighters, but also EMTs, advanced EMTs, or paramedics.

Why This System Is Different

In many parts of the country, ambulance service is fragmented. Some communities rely on private providers. Others have separate municipal systems. In this case, Kootenai County EMS offers something of a hybrid model that gives local agencies flexibility while maintaining countywide oversight on equipment, standards, and coordination.

That matters because it helps create consistency.

Every piece of medical equipment on the ambulances and fire engines is purchased and supplied through the EMS system. That includes the monitors, airway devices, CPR equipment, and transport resources crews rely on every day.

It also means the county can make strategic decisions about upgrades and replacements based on what field personnel actually need.

Call Volume and the Types of Emergencies Seen Here

Countywide, Kootenai County EMS handles roughly 19,000 calls per year. That is a substantial number, especially for a county that still feels smaller and less congested than many large urban areas.

But the nature of the calls is notably different from what many responders see in bigger California systems.

Instead of heavy volume driven by homelessness, violent crime, or dense urban stressors, much of the demand here comes from medical calls involving older adults. According to the discussion, about 62% of calls involve Medicare-age patients, with another significant percentage involving Medicaid.

The chief also noted that strokes are currently one of the most common call types.

North Idaho still sees trauma, especially because of outdoor recreation, motorcycles, ATVs, and rural travel. But compared to larger metro areas, responders are seeing fewer shootings, stabbings, and violence-related calls.

That says a lot about the area itself. It also means EMS crews here are dealing with a very different set of community needs.

Rural Care Means Broader Scope

Another important point from the conversation is that rural EMS often has to do more, not less.

In a city where a hospital is only minutes away, transport times are short and the patient can be handed off quickly. In North Idaho, depending on where the emergency happens, transport can take much longer. That means field providers need strong protocols, the right equipment, and broader capabilities.

Kootenai County EMS appears to take that seriously.

The county uses advanced tools like Lucas devices for automatic CPR, supports advanced airway training, operates a critical care transport program, and allows providers to perform a broad range of interventions depending on certification level and need.

The CCT team handles higher-acuity patients, including those on ventilators or requiring critical medications during transport to larger regional hospitals. That kind of capability is a major asset for a growing county.

It also reflects a system that is not stuck in the past. From the conversation, it is clear that the leadership is focused on keeping protocols modern and training relevant.

Budget Realities and Why Funding Is Complicated

One of the most eye-opening parts of the discussion was the EMS budget.

Kootenai County EMS operates on about $12.6 million per year, but only about $4 million of that comes from county tax funding. The rest has to be made up through ambulance billing and reimbursements.

That sounds workable until you hear the reimbursement numbers.

Medicare and Medicaid do not pay back the full cost of service. The agency reportedly receives around 54% reimbursement on Medicare billing and even less on Medicaid in many cases. That creates a major gap between what emergency medical care costs and what the system actually gets paid.

At the same time, Idaho law limits annual growth in tax revenue, even while the cost of ambulances, medical supplies, and apparatus continues rising much faster.

That is why levy discussions sometimes come up—not because the system is failing, but because maintaining service quality during rapid growth becomes harder every year.

Growth, Tourism, and Summer Demand

Another challenge is something many locals already understand well: North Idaho gets busy in the summer.

Tourism, lake traffic, recreation, and out-of-state visitors all increase call demand. More boats, more traffic, and more seasonal activity naturally mean more accidents and more medical responses.

Yet local taxpayers often shoulder the burden.

One idea raised in the conversation was the possibility of a local option tax or tourism-based funding mechanism, similar to what other states or resort communities use. That kind of structure could help offset seasonal demand created by visitors without putting the entire burden on full-time residents.

Why This Matters for People Moving Here

When people relocate, they often ask about schools, crime, politics, and housing. But emergency services should be part of that conversation too.

This episode offered a strong reminder that North Idaho is not just beautiful—it is supported by professionals who are actively building systems to keep up with growth.

Kootenai County EMS appears to be investing in equipment, replacing aging apparatus, improving inventory systems, involving field personnel in purchasing decisions, and planning for future needs instead of simply reacting to them.

That should give newcomers confidence.

If you are thinking about relocating and want help finding the right area, acreage, or community fit, you can connect with the North Idaho Experience team to start the conversation.

Final Thoughts

The biggest takeaway from this conversation is that Kootenai County EMS is a modern, collaborative system built around local fire partnerships, strong medical oversight, and practical adaptation to rural realities.

It is not a copy of a California metro model, and that is part of what makes it work here.

For residents and future residents alike, that is reassuring news. North Idaho continues to grow, but the people leading critical services like EMS are clearly thinking ahead.