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Northland, state EMS leaders discuss future of rural ambulance services

At a roundtable discussion with the Minnesota Ambulance Association and the Center for Rural Policy & Development, EMTs said rural ambulance departments are struggling with short staffing, underfunding and increased transfers outside their communities.

Hibbing bus crash
A crash between a school bus and a car in Hibbing in 2017 sent the bus driver and a student passenger to the hospital. The need for funding for rural EMS programs was highlighted during a discussion among regional and state leaders Wednesday.
Contributed / Hibbing Fire Department
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DULUTH — Area emergency medical services workers gathered with community members, lobbyists and rural health researchers Wednesday to host a roundtable discussion about rural ambulance services and their outlook.

The discussion, hosted by the Minnesota Ambulance Association and the Center for Rural Policy & Development, highlighted the need for changes, staffing and funding within rural EMS programs.

Featured panelists were John Fox, secretary and treasurer of the Minnesota Ambulance Association; Erik Jankila, chief of the Hibbing Fire Department; Mark Jones, executive director of the Minnesota Rural Health Association; and Kelly Asche from the Center for Rural Policy and Development.

The four panelists agreed the biggest challenges rural EMS face include:

  • Workforce shortages.
  • A lack of guaranteed funding.
  • A large volume of calls and transfers outside the immediate area.
  • An outdated model.
Emergency personnel and CN workers work the scene of a fatal train crash near Highway 8 in Culver Monday morning. A person walking along the tracks was fatally struck by the train. Bob King / rking@duluthnews.com
Emergency personnel and CN workers work the scene of a fatal train crash near Highway 8 in Culver in 2019. A person walking along the tracks was fatally struck by the train.
Bob King / File / Duluth News Tribune

Jankila said the Hibbing EMS providers are frequently called to assist in neighboring communities because other departments are short staffed. In addition, he said transfer calls requiring journeys to and from Duluth hospitals have increased nearly 300% in the last eight years because specialized care is only available in larger cities with primary health hubs.


"We know every fracture that comes into Hibbing hospital is going to go to Duluth — every single one — because they don't have ortho services (in Hibbing) anymore," Jankila said. "So that's four hours round trip and 156 miles round trip that we're going to do. We average, across the region, close to eight to 10 transfers a day, and we take three or four. And that's just from our primary hospitals."

Jones said the only guaranteed funding for ambulance services comes from fees for services, including Medicare's set rates of about $500 per call. With wages for employees and the cost of new ambulances — about $300,000, Jones said — fees for service alone aren't nearly enough to cover the costs EMS departments face. Some communities have tax levy dollars, donations or fundraisers to help bolster costs, but EMS departments across state struggle with too few staff and a shortage of rigs to respond to calls.

A Two Harbors ambulance heads back to the station after transporting a patient in 2017.
Clint Austin / File / Duluth News Tribune

Ashe said rural communities especially struggle, because they're expected to be ready 24/7 with equipment, vehicles and staff, but they have low call volumes, so they don't get the income to pay for the high overhead.

"Everyone in your community gets the same service with coverage 24/7, but only a few actually pay for it," Fox said.

Jankila said Hibbing heavily relies on revenue from transfers, despite the time strain it puts on EMTs. He said the coronavirus pandemic has spurred an increase in 911 calls to his department, which has then limited the amount of transfers Hibbing EMS can take to Duluth. He said they did about 200 fewer transfers this year, which meant their revenue was lower.

Hibbing Fire Chief Erik Jankila leaves a house at 212 42nd St. E. in 2017. A fire claimed the lives of two adults and a child and injured two other children.
Steve Kuchera / File / Duluth News Tribune

"These people being transferred to Duluth; they're people who are sick," Jones said. "They can't get that service at home. They need to go somewhere else. We can't board people in emergency rooms for six days anymore."

State Rep. John Huot, DFL-Rosemount, attended the discussion and said he's part of a bipartisan commitment in the Legislature to help rural EMS that should be announced in detail in the next month.

"Good things are going to happen," Huot said. "I can't announce them today, but I did meet with the speaker yesterday. There'll be no more task forces. There'll be no more studies."


Huot, who has worked for many years as an EMT, said the focus will be on rebuilding rural workforces for both EMS and other critical jobs.

State Rep. Roger Skraba, R-Ely, who narrowly won the Minnesota House District 3A election last week, attended the discussion and said many of the rural towns he represents are struggling with their EMS departments.

A patient is transported by Silver Bay Ambulance to Lake View Hospital in Two Harbors in 2017.
Mike Creger / File / Lake County News-Chronicle

"I'm not going to rest until this issue is somewhat resolved," Skraba said. "It's I-Falls (International Falls). It's Grand Marais, Ely, Silver Bay, Bigfork. They're all in my district — I could just keep going on and on — and every one of them is going through the same issue."

Roger Skraba.jpg
Roger Skraba

He asked the panelists how he can support them and help them secure funding, expressing interest in aiding in the work Huot and other legislators are doing to help rural EMS.

Jankila said he expects many rural EMS departments will eventually consolidate with other fire and ambulance services in the same area.

"You're no longer going to be able to sustain five different ambulance services within 20 miles like you did 20 years ago because of the different models," Jankila said.

Panelists expressed concerns about burnout among EMTs, especially as the workforce pool narrows and they fear turnover of employees.

Asche said a 2016 Minnesota Department of Health survey among rural EMS agencies found that extremely rural departments had positive responses because they were able to depend on volunteers to respond to low call volumes. However, as call volumes increased in rural areas, responses became significantly more negative.


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"Essentially, you're relying more on volunteers, you're still not making enough revenue from call volumes to pay your staff, but yet you're burdening them pretty heavily because you're getting a lot of calls," Asche said.

Jankila said relying on EMTs for 24-hour shifts puts a huge strain on them, since they only get about four or five nonconsecutive hours of downtime to rest. Because workers are so exhausted after a shift, there's really no amount of money departments are able to offer them to come in on their days off.

Fox said departments depend a lot on donated labor, and shared that he worked with a woman in her 70s who volunteered over 2,500 hours a year. He discussed compassion fatigue, which is exacerbated when EMTs are required to pay for and dedicate years to training, then aren't rewarded for that because they are either volunteers or paid a relatively low wage compared to other health care jobs.

The panelists said the Minnesota Ambulance Association, the Minnesota Rural Health Association and the Center for Rural Policy and Development are always looking for feedback from both EMS programs and the people served by rural ambulances to try to improve the situation. They said the system will have to change, one way or another, although Jones noted it will take a serious amount of money, time and collaboration.

"Without that investment, all I see is the reduction in the reliability of rural ambulances," Jones said. "So don't count on it being there if we're not willing to invest and really put everything we can into designing a system that's going to best serve our communities."

Laura Butterbrodt covers health for the Duluth News Tribune. She has a bachelor of arts in journalism from South Dakota State University and has been working as a reporter in Minnesota and South Dakota since 2014.
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