Skagit County’s medical services are too fragmented and should be managed by the county’s public-health department for better performance accountability, Oregon-based consultants say.

The 141-page report released last week also recommends that the Central Valley Ambulance Authority share its jurisdiction with city fire departments that also can deploy paramedics to an emergency if other ambulances in the area are tied up.

Skagit County’s first responders anticipate a growing workload. While the total population is expected to grow 39 percent by 2040, the 50-plus population is projected to grow by 88 percent.

Emergency Services Consulting International (ESCI), of Wilsonville, Ore., contracted with Skagit EMS in July for $88,000.

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ESCI first recommended that the EMS levy rate be put on the ballot, which led to the 12.5-cent levy rate increase that voters approved in August. Property owners now pay 37.5 cents per assessed $1,000 for emergency medical response.

Then, EMS asked the group to analyze its operations and provide recommendations for changes, which led to the report.

The commission intends to discuss in coming months how to enact changes over time.