EMS Crisis - Recruitment, retention are big issues

By Pam Reinig

Register Editor

The critical shortage of emergency medical responders in rural Iowa hasn’t impacted Clayton County—but that could happen if changes to staffing, training and budgeting aren’t made.

“Some of the biggest challenges in rural EMS are recruitment and retention,” said Chris Dahlstrom, newly hired director of emergency services for Central Ambulance Service in Elkader. Although retention hasn’t been an issue in this area, recruiting new volunteers has been difficult, something Dahlstrom attributes to state-mandated training requirements, which have become costly and time-intensive; continuing education mandates; and scheduling issues.

Mary Bissell, MFL Ambulance Crew Chief, concurs: “If we pay for someone to take the EMT class, they have to work two 8-hour shifts and then go on weekend rotation for two years,” she explained. “Some people want to help but they don’t want to commit to being on a schedule. But the schedule is what’s made us work for 46 years.”

Currently, Central Ambulance has eight drivers and three of those are taking classes to become an Emergency Medical Technician (EMT). They also have nine certified EMTs and five paramedics. The MFL ambulance crew consists of 27 volunteers (12 EMTs, 5 first responders and 10 drivers) but only 18 are on the schedule regularly.

And while that seems like strong staffing, especially for rural Iowa, consider the number of calls made by those two volunteer units. For the fiscal year ending June 30, 2017, Central Ambulance handled 390 calls and the MFL Ambulance crew, 310 calls. In addition, both Central and MFL handle transfers from area hospitals and care centers to other facilities, which, Bissell noted, takes resources away from the area for as much as four hours.

Both crews have personnel who have devoted decades to the service. For example, Monte Burns and Ken Pittman, two of the longer serving Central Ambulance volunteers, have given 23 and 16 years, respectively. Bissell has one volunteer who’s been with the service for 40 years, two for 34 years and three others for more than 20 years. Two volunteers with more than 25 years service each recently retired. And while this level of dedication is admirable, there’s a potential downside to it. As Pittman notes, the average age of volunteers in EMS is increasing and since the older age group outnumbers the younger age group, a staffing concern could arise.

Budgeting is also an issue for rural EMS crews. Rural departments typically cover the cost of training, which can range from about $2,500 for an EMT to considerably more for a full paramedic. The CCH Foundation has helped offset training costs with generous donations to the Central Ambulance Service, including one for more than $6,000 presented earlier this month. The manner in which day-to-day expenses are covered varies.

Presently, Central Ambulance is a partnership between the City of Elkader and Central Community Hospital. 

“The City of Elkader pays for the ambulance rigs, the building where they reside, insurance and half of the gas,” explained CCH Chief Executive Officer Brooke Kensinger. “Central Community Hospital employs the EMS staff, purchases equipment, supplies and half of the gas. The hospital pays the on-call staff a nominal rate per hour that they are on call. Then, when they actually go out on a call they are paid their normal rate for the jobs of driver, EMT and Paramedic.”

The MFL Ambulance Service relies on donations and revenue from calls. Both Dahlstrom and Bissell note than tax dollars are not used for EMS service. In fact, they can’t be used because the state of Iowa presently considers volunteer EMS a non-essential service.

Those involved in EMS are understandably proud of the service they’re providing their communities.

“I certainly didn’t get involved for the financial rewards or for personal recognition,” said Pittman. “Basically boils down to what can I contribute to the needs of the community.”

“It’s more of a passion than anything,” Burns added. “When I’m not working, I’m doing this. It’s what I want to do to help my community.”