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A lack of EMTs in Iowa leads to less stable care for rural residents

Shenandoah's ambulance services sits on a road in southwest Iowa. Its service area is growing as surrounding rural areas lose volunteer EMTs.
Courtesy of Shenandoah Medical Center
Shenandoah's ambulance services sits on a road in southwest Iowa. Its service area is growing as surrounding rural areas lose volunteer EMTs.

Iowa’s rural areas are seeing emergency services volunteers retire without enough new ones to replace them.

Nationwide, emergency medical services are seeing high rates of turnover for emergency service technicians and paramedics – with an average of 20 to 30 percent leaving annually. As more emergency service professionals disappear, it puts the state’s rural residents at greater risk.

At Shenandoah Medical Center in southwest Iowa, CEO Matt Sells said he’s worried about the rural populations in Fremont and Page counties. He said he’s seen smaller communities lose their volunteers, which translates to longer emergency response times.

“The average person believes that when they call 911, an EMS service is going to respond. And, at the end of the day, the truth of that statement is that there is no guarantee,” Sells said.

 Shenandoah emergency services is struggling to find on-call staff for its ambulances. At the same time, they're having to provide services to rural areas farther away who have lost their volunteer EMTs.
Shenandoah Medical Center
Shenandoah emergency services is struggling to find on-call staff for its ambulances. At the same time, they're having to provide services to rural areas farther away who have lost their volunteer EMTs.

As rural emergency services surrounding Shenandoah shutter, Sells said their service area continues to grow. Now, their small staff of two full-time and two on-call employees is straining to be able to respond to calls up to 10 miles away, he said.

“It's harder and harder, from a response time perspective, to be able to get there timely,” he said.

But, it’s hard for the small town’s emergency services to find the funding to retain on-call staff. Shenandoah Ambulance Service on-call employees are paid $2.25 an hour. Despite their funding being split between the hospital and the county, Sells said — even with the low wages — he estimates their ambulance services lose $700 per day.

Last year, the Iowa legislature made it possible for counties to deem ambulances an “essential service," which would allow towns to vote to fund emergency services by increasing property taxes. Emergency services need 60 percent of voter’s support.

But, Sells said, with limited time, it’s hard to find the time to rally their communities around the issue.

“It’s a tough sell,” he said. “ I've never seen anybody raise their hand and say ‘I'm excited’ or to pay more taxes.”

When rural hospitals aren’t properly funded, it has a domino effect, according to Dave Edgar, West Des Moines’ assistant chief of emergency services. He says the more communities rely on larger facilities, the bigger strain those ambulance services feel.

“It's about ready to potentially cause a pretty big collapse of the EMS system which will result in partial collapse of the healthcare system,” said Edgar, who sits on the board of the National Association of EMTs.

Edgar said in the most recent staffing search at West Des Moines Emergency Medical Service, they received applications from just three qualified candidates – only one of which accepted a position. Their team is still looking for 12 more full-time employees.

The shortage is coming at a time when ambulance services are dealing with an increased volume of calls. Edgar said their 911 calls increased by 20 percent last year.

“We don't have enough people coming in and call volumes and the dependence on ambulances is getting bigger,” he said. “It's just a recipe that can't function.”

“The average person believes that when they call 911, an EMS service is going to respond. And, at the end of the day, the truth of that statement is that there is no guarantee."
Matt Sells, president and CEO of Shenandoah Medical Center

One of the major issues for facilities is their ability to have enough staff for at least two full-time ambulances. They need to have the ability to drive patients who need to be transferred to larger facilities while still being prepared to service their local region.

But with fewer EMTs, facilities like Crawford County Memorial Hospital have had to cut down their tertiary team’s hours. Instead of having the second ambulance crew available all day, they’ve shifted to 9 a.m. to 9 p.m. – the busiest hours for transfers.

“We're going to do everything we can to try to see if we can't find more volunteers,” said Don Luensmann, director of marketing. “Because the stress that's put on our volunteer services in small communities is much greater than many people realize.”

Luensmann said even though many rural area populations are decreasing, their responsibility to provide emergency services has not. He said the hospital is working on partnering with local community colleges to bring more EMTs into their county.

“You can have an emergency service that literally goes away overnight,” he said.

 The Crawford County Memorial Hospital in Denison has changed its schedule for one of its ambulance services. It's one of many hospitals across the nation with a shortage of emergency service technicians.
Courtesy of Crawford County Memorial Hospital Facebook
The Crawford County Memorial Hospital in Denison has changed its schedule for one of its ambulance services. It's one of many hospitals across the nation with a shortage of emergency service technicians.

To stop that from happening, Sells said he believes ambulance services should be able to be deemed essential without having a supermajority of voter support. He said it should be up to county supervisors to find room in their budgets to support emergency services.

Sells said it’s challenging to get people concerned about a service that they won’t need every day. But, in the worst of medical emergencies, he said rural residents need assurance someone will be there.

“I just believe that those folks deserve that care as much as anybody,” he said.