“You couldn’t do this job every day if you didn’t love what you did,” says Michele Madsen, reflected in the driver’s side mirror of an ambulance. As director of Greene County Ambulance, Madsen is taking the ambulance service from a quasi-public operation to one fully owned by taxpayers. ANDREW McGINN | JEFFERSON HERALD PHOTOSMadsen and EMT Mike Heinz (center) crack up last week at the ability of EMT Mark Renslow to not smile.“You go home and hug your kids a lot,” says Michele Madsen, a mother of four. A paramedic and a Greene County native, Madsen is the first director of the county’s new ambulance service, which launched March 1. ANDREW McGINN | JEFFERSON HERALD


Michele Madsen in the driver’s seat of new county ambulance service



If Michele Madsen’s classmates in the Paton-Churdan High School Class of 1987 had all just listened to themselves as kindergartners, the world would have a few more spacemen, stunt drivers and clowns in it.

Madsen, whose name back then was Michele Stream, ended up attending two colleges, never graduating because she was never sure what she wanted to do or who she wanted to be.

“I just didn’t have a passion for anything,” she confessed recently.

Eventually, a family member’s serious illness spurred an interest in health care, and Madsen took a basic EMT class.

She followed that by becoming a paramedic.

That was 20 years ago, and Madsen has since saved lives in multiple locations around the state, in cities big and small.

As director of the newly formed Greene County Ambulance — the county’s month-old ambulance service — she will now work to save the lives of people she’s known her entire life.

“I’m excited to be able to serve my home community,” explained Madsen, who returned to Greene County several years ago to be closer to family. “I’m taking care of my friends and family who’ve taken care of me my whole life.”

That’s a long way of saying that Madsen’s 5-year-old self may have been onto something.

On a piece of paper topped with the words Class Prophecy of 1987, done 12 years before, it’s right there in purple ink: “Michele Stream wants to be a nurse.”

“I should’ve listened to me in kindergarten,” she said. 

“By nature,” she added, “I’m a caretaker.”

Now 50, Madsen’s care and devotion to Greene County could be just what the doctor ordered as the county continues the transition from a quasi-public ambulance service to one fully owned by taxpayers.

That EMT class she took back in 1997 was taught by Dennis Morlan, who operated Greene County EMS for more than three decades with wife Marcia.

“The man has a plethora of medical knowledge,” Madsen said. “He was an excellent EMT instructor.”

Both Jefferson natives, the Morlans returned home in 1986, introducing emergency medical care to Greene County and making it such a routine part of life that it’s now impossible to imagine a time when an ambulance couldn’t be beckoned with just one simple call.

With the Morlans wanting to retire, the county board of supervisors couldn’t imagine it either, and officially assumed the service on March 1 after attempts to find a private buyer were DOA.

Under Iowa law, EMS still isn’t a service that counties are mandated to provide.

“It ranks up there with law enforcement,” board chairman John Muir said. “I’d never thought about it before, and never worried about it. I didn’t need to. It was taken care of.”

In talks last year with the supervisors, Morlan painted a grim picture of the service’s private-public operating model. 

Even with $50,000 annually in county assistance — the county owned the three ambulances and maintained the Greene County EMS building on Grimmell Road — the Morlans couldn’t pay enough to keep staff and had to fight for scraps from Medicaid, Medicare and private insurance companies.

Morlan estimated that insurers paid the full billed amount less than 5 percent of the time. Medicare and insurance companies are known to chop as much as 50 percent off patient bills.

Morlan saved his harshest criticism for Medicaid, which was privatized by Iowa Republicans in 2016, resulting in a sludge-like system of delayed, reduced and nonexistent payments.

Morlan called it a “fiasco.” Not to mention a “total disaster.”

County Supervisor Tom Contner, speaking last fall at a voter forum before his re-election, vowed to keep the ambulances running.

“If we can save one life,” Contner said, “I don’t care what it costs.”

Muir said he believes Greene County Ambulance will likely cost between $300,000 and $400,000 annually to operate as a county department.

A third-party company will be responsible for billing services.

During the election, Contner said he hoped to see the county partner with the city of Jefferson and the Greene County Medical Center to continue the service.

While the county has so far gone it alone, the medical center has informally agreed to help with some amount of cash and classes for staff, according to Muir.

“We’re on the same page,” he said.

Admittedly, getting the county’s municipalities to buy in will be more difficult.

“Everybody’s budgets are tight,” he said.

But letting the Morlans close the bay doors wasn’t an option.

“Any community that’s trying to grow, you need to have that service,” Muir said.

Of the amenities people consider before making a move, “I’d have to think an ambulance service is something they feel is a comfort and essential,” he said.

Greene County EMS was doing about 900 runs annually before the Morlans retired.

When it came time to select a director, Madsen was the one best suited to take what the Morlans started “and build on that,” according to Muir.

“Those are big shoes to fill,” said Madsen, who on this morning had just completed run number 64 for the month.

Greene County Ambulance is averaging three runs a day, she said.

What kept the Morlans going for nearly 33 years, Madsen said, was a “sheer passion for their community.”

“It’s really cool that a lot of my staff is passionate about coming back and taking care of friends and family,” Madsen said.

Like Madsen, full-time Greene County Ambulance EMT Mark Renslow worked for a time in Des Moines.

There, dead people never had names.

“It affects you more here,” said Renslow, a lifelong resident of Grand Junction, “because you know everyone.”

Madsen described working in Des Moines as a “mental disconnect.”

“Here,” she said, “your passion is stronger.”

Working at home, on people you know and love, the rewards are that much greater, they said.

But any losses have the potential to hurt that much harder as well.

“Not everything goes the way you want it to,” Madsen explained.

The staff is mindful of their mental health, emphasized Madsen, a mother of four.

“We all have our ghosts,” she said. “That’s normal. I have my faces. You always will. Those are the people who motivate me to keep going.”

“You go home and hug your kids a lot,” she added.

With five of six full-time positions filled, Madsen can turn now to finding more part-time help.

“That (part-time) pool can’t be full enough,” she said.

Anyone with an interest in an EMS career is encouraged to give her a call at 515-386-3101.

“Come talk to us,” she said. “We need people in the community who are willing to do this.”

Twenty years ago, when Madsen completed paramedic training at DMACC, she had one goal.

“I want to be the paramedic that I would want taking care of my mom,” she said.

Now that she’s home, she could be.

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