Tom Nehring, director of the division of EMS and trauma at the North Dakota Department of Health, said the current model for EMS has been in place for a little more than 40 years, and said volunteers have always been the “backbone” of the state’s rural delivery system.
That model, he continued, is “not a sustainable mode either near-term or far-term.”
“We’re already starting to see failures,” Nehring said. “We are facing a growing, potentially dangerous, crisis.”
Experts from and allies of the state’s EMS community gathered at the Strom Center for an open forum hosted by the North Dakota Emergency Medical Services Association to discuss the status of ambulance services across the state.
The meeting consisted of a series of presentations delivered by stakeholders in addition to Nehring, including Senate Majority Leader Rich Wardner, R-Dickinson, and Ken Reed, EMS director at the Heart of America Medical Center in Rugby.
Nehring identified industry factors like declining volunteerism -- which he attributed to increasing employment of rural workers beyond their home area and decreasing willingness of employers to allow staff to leave to respond to calls -- as driving the need to find new adaptations.
While Nehring said the state isn’t alone in facing these trends, and that 12,000 of the nation’s 17,000 ambulance services are volunteer-based, he said the widespread nature of the weakening of the volunteer model “doesn’t make the problem any easier” and necessitates a change.
Of North Dakota’s 128 total ambulance services, Nehring said there are 17 known North Dakota ambulance services “on the verge of closing or transitioning to another type of license.”
Further, he said station closures or downgrades to substations represent an “obvious trend.”
“We have to make sure people no longer being adequately covered have some type of emergency medical services coming for the future,” Nehring said.
In addition to the issues presented by inadequate staffing, EMS -- which is not a mandated government service like police and fire protection -- may also experience funding-related troubles related.
Reed’s portion of the night’s presentations examined current and potential future financing mechanisms for EMS and possible system changes that may come down the road.
He described ambulance services as “very adaptable” in response to possible revenue streams, but said EMS can still be a “scary industry” when it comes to pricing structures.
While services can set their rates as they choose, Reed said, the payment outcome ultimately relies on what insurance companies will pay, which can result in service providers being forced to write off costs associated with answering EMS calls.
Declining volunteerism, coupled with higher transportation needs in rural services, provide a situation in which resources can be stretched thin and response times can be jeopardized.
Reed suggested the reliance on actual ambulances to respond to calls could hinder services that are already overdrawn and said one goal could be a more rapidly arriving, stripped-down unit, as opposed to a maximal response to every call.
Future ambulance services may provide “alternative” services to health care providers that focus more on wellness.
“Sitting in the station waiting for an emergency to happen -- why aren’t we out checking blood pressures, doing bed reconciliations, visiting patients, assisting with hospice programs and all the other things we could potentially be doing?” he asked.
In part, due to less-than-ideal conditions, including the possibility of being unable to “rely upon third-party reimbursements to fund local ambulance services,” Reed described the current situation as bearing “opportunities for innovation.”
“EMS may need to reinvent itself,” he said. “‘Emergency’ may no longer be a part of our word. We may need to become more of the health care system and provide more comprehensive health services.”
‘People do not do this for the money’
In the face of a system facing an influx of calls, Wardner said he “understood the urgency” of addressing the needs of North Dakota’s EMS community in the context of the realities created by the oil economy’s boom-and-bust cycle.
Wardner directed his presentation toward the next legislative session, which begins in January 2017, and its bearing on the future of state funding for EMS services, as well as the status of local and county financing tools.
The state budget shortfall and the future’s uncertainty leaves somewhat of a “blank page” in terms of state money that may be available to service providers, he said.
“It depends on the growth of the economy. It depends on a lot of things, whether we’re going to have any money in it or not, or are we going to have to cut some,” Wardner said. “We want to protect the dollars you have in the EMS currently, as we go forward. That will be the challenge.”
Penny Lewis, operations manager and paramedic at the Dickinson Ambulance Service, said the issues discussed at the meeting will have a wide effect throughout the state’s network of ambulance services.
The potentially large geographic spread in which EMS units operate can pose issues, she said, even at a service like Dickinson’s that is staffed by two response crews every day of the year.
Any decline in local services could create gaps in the ability to provide help to those in need, Lewis said, and the strenuous nature of the job, coupled with increasing difficulty to enter it as a volunteer, can compound structural difficulties in the wider system.
Still, Lewis said the necessity of the help EMS gives to communities creates both a desire for the services and a drive to providers as they go about their work.
“People do not do this for the money, and we certainly don’t do this because we think we’ll get a thank you and a pat on the back,” she said. “We’re seeing these people when they’re injured or ill, at the worst times in their life, so the last thing they’re thinking about is saying ‘thank you.’ It’s that letter that you get in the mail that says, ‘You picked up my loved one in a motor vehicle accident and we’re happy you were there.’ That’s the warm fuzzies that you get from doing this job.”
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©2016 the Dickinson Press (Dickinson, N.D.)
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