JAMESTOWN (AP) It's been a tough five years for LaMoure resident Connie Willey.
She's served her community as an emergency medical technician for 20 years. But due to changing times, insufficient funds and not enough hours in the day, the number of emergency volunteers have shrunk in LaMoure, leaving Willey and two others to cover most of the 60 12-hour ambulance shifts each month for the last five years or so. Willey is president of the Community Volunteer EMS Service of LaMoure.
Of the 60 shifts per month, Willey said she covers 40 to 50 of them.
Jamestown (N.D.) Sun - - P.J. Hardy, basic life support coordinator for Ringdahl Ambulance, left, checks the lungs of a dummy used in medical training for emergency medical technicians and paramedics. Observing are Nancy Miller, business manager, center, and Randy Fisher, operations director, for Ringdahl Ambulance. Ringdahl travels to rural communities, training their ambulance services.
"I'm the only one available during the day, basically," she said, saying other volunteer EMTs work outside of LaMoure city limits, meaning they're too far away to respond to a call in time. "If I'm not here, it gets to be a big problem."
Staffing volunteer ambulance services is a problem statewide, said Curt Halmrast, president of the North Dakota EMS Association. Halmrast serves on the ambulance service in Oakes. Halmrast said several factors contribute to the problem, including reimbursement for volunteers and ambulance programs as well as training requirements, and aging and shrinking populations in rural areas.
"We've been dealing with this issue for a long time, but we're dealing with a crisis right now," Halmrast said.
Of the 143 ambulance services in North Dakota, 14 of them respond to 50,000 calls per year, Halmrast said, whereas 120 crews respond to a combined 10,000 calls per year.
Jamestown's ambulance service is one of the larger 14. It is operated by a private company, Ringdahl EMS and staffed with full-time crews as opposed to volunteer crews as in rural communities, said Nancy Miller, business manager for Jamestown Area Ambulance.
LaMoure's volunteer crew, for example, responds to about 100 calls per year, Willey said. But to break even financially, an ambulance service must respond to more than 650 calls per year, Halmrast said, saying it costs about $840 for each call, but the average reimbursement rate is about $650.
"Every time we roll out the door, we lose money," Halmrast said.
To recoup costs, ambulance services ask their local jurisdictions for subsidies and hold bake sales and other fundraisers, said Mike Sandy, manager of the ambulance service in Oakes.
A bake sale in LaMoure garnered about $1,000 for the crew there, Willey said, saying the town supports the service. Not everyone is willing to volunteer, but her employer, LaMoure Drug Store, allows her to leave for calls as needed.
"They (the community) are very good that way as far as donating to the ambulance ... but people is our biggest problem," Willey said. "People and money."
And people are hard to come by in rural communities where the population is both declining and aging. Willey, 53, said she's afraid of what will happen in LaMoure if she were to have her own medical emergency or for when she's unable to do the job.
"We get a lot of people that are eager and willing but physically or mentally not up to the challenge," Sandy said.
And although reducing ambulance services may save some costs, consolidation typically isn't a consideration. In rural areas, ambulance services are about 30 miles from each other and response times can vary. Sometimes they can take at least 30 minutes, and that's if roads are open and weather conditions are fair.
"In a heart attack, you're talking life and death. And in a car accident, you're talking a long time," Halmrast said.
Money woes extend into the pocketbooks of volunteers, who sometimes sacrifice their livelihoods for the ambulance service, Sandy said.
Volunteers are compensated in a variety of ways. LaMoure, for example, recently increased its stipends because the reimbursement volunteers received wasn't enough to cover the costs of leaving the office.
"If you left work, you lost money, that's just the way it was," Willey said.
As of July 1, volunteers in La-Moure are paid $2 an hour for on-call work, so $24 for each 12-hour shift. If the ambulance is called, volunteers are paid $50 for the run, Willey said. Most runs take at least two hours, because patients typically receive care in larger communities like Jamestown, Fargo and Bismarck. Plus, Willey said, after the call, responders must file paperwork, taking more time. So the increase in payments still doesn't always cover the cost of missing work, Willey said.
"(But) it's better than what it was," she said.
Even full-time paramedics (the highest trained on an ambulance crew) aren't compensated as much as many of their counterparts in the medical field. A typical salary for a paramedic is about $30,000 to $40,000, whereas a registered nurse earns about $50,000 or $60,000 annually.
Turnover is high, Halmrast said, saying medical professionals used their experience on ambulance crews as a stepping stone into other careers in medicine. Plus, the job is high-stress with odd hours.
"Most medics have a hard time raising families," he said.
Training isn't as extensive as the four or so years required for registered nurses, although EMTs and paramedics are required to complete 72 hours of refresher courses and continuing education each year.
That's in addition to the required coursework to become an EMT or paramedic.
"That's a long time for someone to commit to take a class, and then you have to pass," Sandy said.
Training is another battle for rural ambulance services.
Finding time can be a challenge, especially when they typically need to travel to larger communities like Fargo, Bismarck or Jamestown. Coursework and travel can quickly consume a day or even a weekend. And while some ambulance services will cover their volunteers' expenses, that isn't always the case. EMT courses can cost more than $600 plus the cost of books. Paramedic training can cost as much as $10,000.
Travel is nearly impossible for the ambulance crew in LaMoure. The few volunteers the community does have can't leave the town to attend training, Willey said, because without them, no one is available to drive the ambulance in the case of an emergency.
Ringdahl Ambulance in partnership with Emergency Training Associates is offering to train emergency response crews in their own communities, to reduce travel time and increase convenience to rural ambulance crews.
"You train them locally and maybe they'll stay there locally," said Randy Fischer, operations manager for Ringdahl EMS in Minnesota and North Dakota.
P.J. Hardy is one of the locally-grown EMTs at James-town Area Ambulance. Hardy originally went to a four-year college to earn a teaching degree, but changed her mind when she joined the ambulance service for part-time work. Today, she's the basic life support coordinator for Jamestown Area Ambulance.
"It's pretty powerful to know that someone is calling you for help," Hardy said. "(It's) a pretty good feeling. It kind of makes you want to come back for more."
The group has already trained ambulance crews in Gackle, Lisbon and Jamestown. A 13-month paramedic program is set for Jamestown in October.
Halmrast said he targets business owners and hospital employees when he looks to increase staffs at rural ambulances. Business owners can typically leave work if necessary and hospital employees many times already have much of the required training.
In addition to training, politicians have introduced bills to increase funding.
Sen. Kent Conrad, D-N.D., introduced the Medicare Ambulance Access Preservation Act in March. The legislation would raise Medicare payments to ambulances by 6 percent and extend a bonus payment for super-rural areas for five years.
Super-rural bonus payments apply to ambulance transports that originate in extremely rural areas.
The plan under national health insurance reform offers a different means for reimbursing ambulance services. Under that plan, ambulances would be reimbursed based on services rendered like medication or oxygen as well as outcomes.
Halmrast said he's unsure how that will affect rural ambulance services, aside from adding more pressure on crews to document.
"We'll see what happens," he said.
Gary Wingrove is a member of the National Rural Health Association. He was quoted by Medill News Service out of Northwestern University saying local communities may need to come up with their own solutions.
"If they want an ambulance service, then they're going to have to support it the same way they would support other city services like snow plows, police officers and other things that are important to them." he said.