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Shortage of EMTs a Rural Dilemma

Unlike fire protection, ambulance service in Iowa isn’t considered an essential service.

(TNS) - When Kip Ladage found his cancer-stricken mother near death in January, the local ambulance service found itself short staffed.

Family members phoned 911, but Tripoli medics weren’t available, and time was running out.

“We needed an ambulance to transport her and get her stabilized so we could get her up to Mayo to save her life, and we had no crew, other than me,” Ladage said.

Luckily, Ladage is the director of that very emergency medical service, and he had keys to the ambulance garage. He could tend to his mother, but he still needed a driver.

In another stroke of luck, a retired crew member had heard something was amiss — likely with the help of a radio scanner — and showed up to see if he could help.

“I said, ‘Jump in and drive,’ and I worked the back. We didn’t have any other crew there,” Ladage said. “It was pretty touch and go for awhile, but she made it.”

Ladage said similar scenes — minus access to the ambulance barn and the experienced passerby — play out often in rural Iowa, and it usually means deferring the call to another community, which increases response time.

Unlike fire protection, ambulance service in Iowa isn’t considered an essential service.

“There is no requirement that ambulance services exist, absolutely no requirement,” he said.

And the service is reaching a breaking point as small-town agencies are stretched for volunteers, many of whom are approaching retirement age.

Ladage, who is also Bremer County’s Emergency Management Coordinator, and Jim Schutte, the EMS association’s president, took their message about the state’s EMS crisis to a crowd of more than 100 Wednesday night during a town hall meeting at Wartburg College’s lyceum.

“Where you live shouldn’t determine if you live,” Ladage told attendees.

Ladage said state EMS groups have been lobbying lawmakers to make changes to ensure ambulance coverage and devise a funding mechanism. He asked Wednesday’s attendees to call their legislators so they can hear concerns from the public.

Rural departments usually pick up the cost of the training — about $2,500 for emergency medical technician and $10,000 for full paramedic. But the main issue is recruiting volunteers who obtain the certification and keeping them around to serve the community.

Even after certification, volunteers require ongoing training and must be available for calls.

“It’s all a big commitment,” Ladage said. “The number of people volunteering is critically low.”

The majority of those volunteering are in the 55 to 65 age bracket.

“When they start retiring, there are very few people to fill those spots. We think we are in a world of hurt now. What is going to happen when people start retiring?” Ladage said.

A secondary issue plaguing small-town ambulance services is Medicare and Medicaid reimbursement, which hasn’t been able to keep up with costs.

“Some of the drugs, it costs us more than we are reimbursed. … If we bill at $22 a mile, we are lucky to get a dollar or two reimbursement on that,” Ladage said. “As soon as that garage door opens up, you are losing money.” And that’s just considering equipment and supplies, since personnel are volunteers.

Ladage and Schutte have been traveling the state bringing the message to lawmakers, community members and anyone else who will listen.

During Wednesday’s meeting, residents discussed possible solutions like funding EMS services through sales or property taxes.

“If we have equitable, sustainable funding, that will help to make this system work. And that’s the only thing that will keep this system afloat, especially if we eventually have to start hiring staff to cover these places where we don’t have people there anymore,” Ladage said.


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