In 1966, the National Academy of Sciences published “Accidental Death and Disability: The Neglected Disease of Modern Society.” The purpose of this article was to draw attention to emergency medical services (EMS) which, at the time, were neglected.
One of the factors discussed in this article was that “the general public is insensitive to the scale of accidental death and injury”. In 2022, 55 years after the publication of this article, it still rings true today, in my opinion.
I’ve been a paramedic for 27 years and people still ask me, “Are you still driving the ambulance?” Not only do I drive, but I also treat patients and make sure they get the advanced care they need. Consequently, the public is not educated in EMS. The public only wants to know about EMS when they call 911 and most people think, “I’ll never need an ambulance.
When I became an Emergency Medical Technician (EMT) in 1991, the class was 120 hours; I had to drive 16 hours with an ambulance service and spend eight hours in the emergency room. Today, the class consists of 120 to 150 hours and costs several thousand dollars to complete.
There are other options such as Emergency Medical Responder (EMR) which takes less time to complete. So where am I going with this?
EMS in Minnesota, as well as the United States, urgently needs funding, staffing, and training in rural areas. Most rural areas have ambulance services staffed by volunteers. These volunteers are not paid and if they are, it is very minimal. Most volunteers work and live in the communities they serve.
Years ago, people could volunteer their services to staff these ambulances. Companies allowed employees to leave work to respond to emergency calls. This has not been the case nowadays. Families, jobs and other commitments are forcing ambulance services to close in Minnesota.
According to the Minnesota Department of Health, approximately 60% of rural EMS agencies have insufficient staff to cover their call schedule, 59% of agencies do not have all of their shifts covered at least 24 hours a day. progress and 88% of agencies provide basic life-saving assistance. (non-paramedical services) to their communities. Most Minnesota ambulance services are in rural areas (231 versus 41 in urban areas).
In Minnesota, since 2010, seven rural volunteer ambulance services have closed primarily due to staffing and funding. Most people do not know this due to lack of education. Most don’t care either.
What do many Minnesotans do in the summer? They go to their cabins, go camping, hiking or by a lake. Most of these activities take place in rural areas. When you dial 911 in rural areas, the response times are not what you see in urban areas. Depending on the day, response times can double, triple or even quadruple.
According to the National Rural Health Association, in the face of this glaring disparity in health care, rural emergency medical services often become the only guaranteed access to health services and ultimately the safety net for communities. underserved rural areas.
However, declining population, loss of volunteer labor and declining reimbursements threaten continued access to these services. Nearly a third of rural emergency medical services are in immediate operational danger. Therefore, steps must be taken to ensure access and quality of this vital service for rural Americans. Not only are we losing ambulance services, but rural hospitals are also closing.
Since 2005, six rural hospitals have closed in Minnesota, and that will certainly continue. The total number of lost beds was 230. When hospitals close in rural areas, transport times for EMS are longer.
A University of Minnesota study in May 2021 found that the closure of rural hospitals was straining municipal emergency medical service providers as they attempted to route patients to other hospitals. The average ambulance ride time for municipal emergency medical services agencies has increased by 22%. For private EMS agencies, the duration increased by 10%. Private companies are free to leave once their contracts expire.
Minnesota’s average ambulance service has seen a 58% reduction in Medicare payments since 2002. In the Balanced Budget Act of 1997, Congress required Medicare to put ambulance services on a fee schedule. Prior to 2002, when the fee schedule was enacted, ambulance services in Minnesota received higher payments than those in other states. When the fee schedule was fully implemented on January 1, 2006, it nationalized payments, hitting Minnesota vendors especially hard.
What can we do? We have to educate ourselves. Find out what ambulance service personnel do and what training is needed to care for people. Find out what type of service is available in your area when you go camping, hiking or at the cabin. We can learn basic first aid and CPR.
The state of Minnesota has a $9 billion surplus and another $1 billion in federal coronavirus aid that needs to be spent. Politicians, if you are reading this, it is time to step in and alleviate this crisis. As politicians, let’s set an example for other states that we can be a leader in solving the problems facing rural EMS.
Spend money for these rural ambulance services. Pay for anyone who wants to take an EMR or EMT course. Fund the staff of these services. Allocate funds for better equipment and reimbursements. Give companies a tax break if they allow employees to leave work to answer calls.
People, we all face the challenge of better serving those who live in rural areas.
Michael Jernander, of Chaska, has been a volunteer firefighter/paramedic for 25 years and a paramedic for 27 years.