EMS director outlines vision to modernize emergency service in Eureka County

Don’t call Eureka County’s health care system “rural medicine.”

This is the frontier, and providing emergency medical services (EMS) to a small population spread over thousands of square miles comes with obstacles.

A report from the National Rural Health Association (NRHA) noted, “The large coverage areas, travel distances, and increased demand for time spent with the patient can lead to significant impacts on patient outcomes and survival rates. For example, the fatality rate from a vehicular accident in a rural area is almost twice as high when compared to an urban area.”

Volunteering trends in small communities amplify these challenges. The same report said 69% of rural EMS programs struggle to recruit volunteers and more than half said the problem is getting worse.

Eureka County EMS director Nichole Cooley knows these trends well and has spent much of her career on the front lines of frontier emergency response. Over the next five to 10 years, Cooley wants to transform the county’s operation from a volunteer organization supplemented by full-time employees to a full-time service supplemented by volunteers. 

“I just wanted to help expand the service and be part of, you know, changing the service for the good,” she said. “Not that they weren’t doing great before, but just it’s always been a passion of mine.” 

That passion began in Cooley’s hometown of Round Mountain, where she joined a mine rescue team at age 20. Such teams specialize in industrial rescue training, including underground and surface hazards and pre-hospital trauma care for mining operations.

“I absolutely loved the mine rescue side of things just because all the different modalities you had to be certified in, you know, hazmat, rope rescue, you had to be at least a [emergency medical responder] or higher,” Cooley said. “We had to do 40 hours of confined space training. Just so many different things.”

After her husband’s job transfer brought them to Eureka, Cooley was the postmaster for five years before being hired as the county EMS director. She said she is driven by both a desire to help those in need and her personal experiences with healthcare. Cooley’s 16-year-old twins have grown up with special medical needs, so her family is always learning how to best care for them. 

“We’re constantly advancing and progressing in our household,” Cooley said.

She draws inspiration from her own experiences when EMS professionals came through for her. 

“I love helping other people and, you know, being a part of the worst day of their life, but being a positive for them.”

She added, “I’ve been there. I’ve been on the other end of it, and it sucks. And if I can just help one person and ease their minds, or, you know, just be there to hold their hand, it makes all the difference.”

Eureka’s EMS program has three paid, full-time EMTs: Cooley, Griffin Bussian in Eureka and Brent Jones in Crescent Valley. This puts the community in a stronger position than many other frontier regions, but the director said more is needed. She wants 12 career EMS professionals servicing both Crescent Valley and Eureka. 

“Essentially, that’s what we need,” Cooley said. “Twelve full-time EMTs, paramedics, AEMTs, in order to fully staff one rig in Eureka and one rig in Crescent Valley with rotating shifts 24/7.” 

Achieving this requires funding, recruiting and housing. The director said Eureka has grant opportunities to pursue, including the Rural Health Transformation (RHT) Program. Established under the federal One Big Beautiful Bill Act, it includes over $10 billion in annual rural health funding through state-level sub-awards to modernize rural health care. These funds could support EMS staffing and retention, but like all federal grants, there is paperwork, and the county lacks a grant writer to manage it. 

“You actually have a ton more steps that could take years after the grant is awarded in order to see when it’s actually finalized,” Cooley said.

Senator Jacky Rosen recently visited Eureka County and discussed this challenge with the community, including exploring hiring a grant writer. With that in place, they could go after that funding. 

“It’s going to be kind of the waiting game right now,” Cooley said.  

Then there is housing. Professional EMTs are willing to move here, so long as they have a reasonable place to live.

“We can’t hire people if we don’t have anywhere to put them,” Cooley said. She added EMS shares the challenge with the sheriff’s office and noted their two departments “are working together to try and come up with some ideas on how to fix the housing.”

These needs are poised to increase as mining operations pick up steam. Cooley said her team responds to 30 to 40 calls per month, and that is likely to rise. The director is hearing projections of 600 employees at the i-80 mine within three years, with the possibility of other nearby mines expanding operations as well. Cooley said EMS has had productive conversations with i-80’s community outreach team and characterized them as “phenomenal and supportive” as they’ve discussed these challenges.

“They really want to help us establish some homes,” Cooley said.

Meanwhile, Intermountain Health (formerly MedX) provides supplemental EMS services in Crescent Valley to ensure 24/7 coverage as Cooley seeks to train more local EMTs to serve that area.  

“We haven’t had any issues with them,” Cooley said. “It’s been a great service, and it allows our new EMTs in Crescent Valley to still utilize a second rig.” 

As modernization progresses, volunteerism remains an important element of the program. Eureka is not immune to national trends that paint a picture of dwindling volunteers. 

“The biggest challenge that we have is volunteerism as a nation is dying,” Cooley said. “It’s dying all over. We’re not the only town, community or state that is having real trouble keeping volunteers engaged and, you know, trained and having them want to show up.” 

There are multiple ways to volunteer. Becoming a certified EMT requires a weeks-long training course and an exam. Other options include becoming an ambulance driver, which requires a four-hour class. The director said she is working to streamline the volunteer onboarding process and schedule. She is encouraged by recent trends, as a new crop of volunteers completed training. 

“I really feel like the word is getting out there with our new protocols and all of our new volunteers and people that are getting trained up,” Cooley said. 

It is a critical development out here on the healthcare frontier.