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Lack of EMTs and first responders in rural areas creates concern in communities

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Squads are looking for volunteers every day. Ride-along programs give people the opportunity to see exactly what goes on when an EMT goes out.

By Addison Mumm

When you call 911, emergency medical technicians (EMTs) or first responders are one of the first groups to help you in a time of great need. What would happen if these brave souls weren’t available?

 

“If you’re not part of the solution, you might be the problem,” expressed West Grant EMT Denny Cathman. “About six years ago, we started seeing our numbers drop, and it has continued ever since.”

 

Denny has been with the West Grant rescue squad approximately 12 years; he drove for five years first, then became an EMT. He was a firefighter for 35 years prior to dedicating most of his time to the EMS.

 

Over the past 10 years, rescue squads and first responders like Eastman, West Grant, Bagley, Cassville, Wauzeka, North Crawford and other small towns have had decreasing numbers in EMT and first responder volunteers. According to Wisconsin Emergency Medical Service (EMS) Association, 60 percent of all EMTs are unpaid volunteers.

 

The different levels of EMTs—basic, intermediate, intermediate-technician, advanced, paramedic and clinical paramedic—and first responders all have different duties they can and cannot perform due to their level in the system, but all are equipped with the knowledge to stabilize a victim and help calm the victim’s nerves. 

 

History

 

The history of the EMS can show the public just how advanced technology and the EMS in general has evolved. In 1965, accidental deaths and injuries cost the U.S. about $18 million, according to the National Academy of Sciences. 

 

Prior to the organized EMS, people took accidental injuries into their own hands without any knowledge of the medical field; sometimes local doctors would be transported to the site, with limited equipment. Later on, hearses were provided by funeral homes as the original ambulance to transport traveling medical providers to accidents, but lacked equipment needed to save lives.

 

“I remember watching John Gage and Roy DeSoto on the TV show ‘Emergency,’” Denny said. “That’s what I think really got rural area EMSs started. It inspired me.”

 

In 2007, Richard Yokley and Rozane Sutherland published ‘Emergency!’: Behind the Scene, a book that highlighted the changes in the medical field  and pre-hospital care thanks to the hit show. According to the book, the show aired in 1972. By 1982, more than half of all Americans were approximately 10 minutes from ambulance rescue care.

 

The response time continues to stay in the 10 to 15 minute range as long as squads have the means and numbers to continue.

 

Rising Requirements

In recent years, the requirements for EMTs have increased. Volunteers and employees alike have to complete large amounts of work to learn procedures, techniques and proper safety precautions to help injured victims. 

 

When the rescue squads began in the 1970s, education and training requirements for EMTs took about 80 hours. In 2002, training and schooling hours for an EMT-basic were about 140 hours. Now, it has risen to 180 hours. In 2016, numbers are expected to increase even more. Every two years, EMTs have to attend a refresher course to stay updated on all the latest medications, procedures and equipment education. Today, first responders have to complete 80 hours of training and education.

 

“Training is important to keep you current with the ever-changing medical field,” said West Grant EMT retiree Bev Cathman. “When at the scene, you put what is happening in the back of your mind and worry only about the care for the victim and use what you have learned in training.”

 

Yet, the standards for training and education could be a bit extreme for small town squads in need of members.

 

“It is just a pain now,” said Sue Knutson, a 37-year EMT for the Eastman First Responders. “There are too many requirements for volunteers. In 1978, we had a lot of volunteers, but now volunteers, like EMTs, need to be licensed and have computer access for everything.”

 

The increase in training and education also accommodates the shift from hard copies to digital.

 

“The older members are uncomfortable with the computer work,” Bev stated. “We still have to fill out forms and do our bills though.”

 

The training hits rural communities hard, but doesn’t cause as much damage for the full-time paid squads in larger communities.

 

“People need to be trained to do the job,” said Tom Tornstrom, executive director of Tri-State Ambulance. “Yet, you can’t really have two different levels—paid and volunteer—of an EMT-basic, for example. Considering the paid and volunteer EMTs have the same duties they can perform, they have to have the same amount and type of training. There’s a balance between training and safely and proficiently treating victims.”

 

Tri-State Regional Ambulance Services came to Prairie du Chien in 2012. The non-profit company has just enough ambulance calls to maintain their paid employees.

 

“It is still a struggle in the rural areas, especially to even find paid EMTs. They get paid well, but most move to have a full-time job,” Tornstrom said. “EMTs and ambulances are essential to a community, and there isn’t a magic bullet fix to this growing problem.”

 

Funding

Most community rescue squads pay for aspiring EMTs training expenses, which cost about $1,000.

 

“We pay for the training, and you repay us with your time and dedication,” said Bev.

 

To get money in their accounts, squads put on fundraisers and also get some funds from townships.

 

“The community funds us to protect them,” said Knutson. “But if our squad does not have enough members and we dissolve and the community has to pay for a service to be available, taxes would go up.”

 

Denny mentioned all the equipment used in the ambulances is paid for by the squad and its insurance.

 

“If someone needs an EPI pen injection, we will perform the task, but we also have to pay for and replace that used medicine,” Bev said.

 

Victims also have to pay a fee for the use of the ambulance. These fees help keep the different squads running and available.

 

“The reimbursment and funding for EMS groups is also a growing problem,” Tornstrom said. “Medicaid and Medicare rates have not gone up, but fuel, medicine and other costs for the squads have.”

 

Volunteers needed

Even though numbers are low, accidents still happen. 

 

“We hear multiple calls go out for some places, and we get frustrated that they aren’t answered right away,” Tornstrom said. “But we know it is harder to get a full group together to go out when numbers are so low.”

 

Squads are looking for volunteers every day. Ride-along programs give people the opportunity to see exactly what goes on when an EMT goes out.

 

“We get a lot of people who say they aren’t sure about it or they couldn’t do it,” Bev said. 

 

“Don’t say ‘no’ until you’ve done a ride-along,” Denny added. “It’s hard work being an EMT, but it is very rewarding helping your community and all the members.”

 

Denny mentioned the most common calls are falls, breathing problems and cardiac issues. He also said the West Grant Rescue Squad receives about 160 to 200 calls a year.

 

“Even if people think they are okay, we still need to follow procedure,” Bev said.

 

“I remember one time, this man got in an accident and said he felt fine. We had to follow procedure and the man was a bit hesitant, considering he didn’t feel injured,” Denny chimed in. “That same man thanked us for making him follow protocol; he later found out he had broken his back in the accident and if he had continued on as normal he could have been paralyzed.”

 

Most EMTs and first responders don’t work for much of anything except the thank yous and small rewards.

 

“A little girl that lives next door smashed her hand. She would come over every day and I would wrap her hand so it wouldn’t get infected,” Knutson said. “Her family couldn’t afford to pay me, but just the other day the little girl had brought a rose to me, thanking me for all I did.”

 

Denny recalled receiving cards with people’s gratitude. Others get a “how are you doing?” every time he sees them, years after their accidents.

 

“When they go out of their way, you know they appreciate your work,” Denny said. “Our duty is to treat you, take you to the hospital and make sure you are doing okay until then.”

 

Possible solution

A possible solution for the declining amount of EMTs is incentives.

 

“In Minnesota, they have a program which offers a retirement incentive to EMTs who have served for 20 to 30 years,” Tornstrom said.

 

As part of the Professional Ambulance Association of Wisconsin, Tornstrom noted they have been working on the growing dilemma and different incentives are possible solutions. 

 

“National-, state- and local-level funding could also help EMS squads give some pay to their volunteers, just to show how much they appreciate their members’ time,” he said. “It is a big commitment and some financial support could show what their time is worth.

 

Unfortunate Consequences

If volunteerism continues to decrease, squads will disappear left and right and response times to accidents would take much longer. This devastating possibility could result in an increase in deaths. “If someone has cardiac arrest and there isn’t a service able to start CPR and defibrillate the victim, there is a higher chance they’ll die,” said Tornstrom.

 

According to the Sudden Cardiac Arrest Foundation, CPR should be exhibited as soon as three to five minutes after the victim has collapsed this increases their chances of survival enormously.

 

“We do the best we can for our community,” Knutson said. “We appreciate the community’s support all these years.”

 

Bev called EMTs an elite, tight-knit group that is a vital source to the community.

 

“We have to support one another to help treat the victims,” she said. “You have to have support when you have lives on the line.”

 

To learn more about ride-along programs or to find out how to become a first responder or EMT, please contact your local squad.

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