Lack of volunteers puts survival of rural ambulance services in question
By Kevin Bonham / Grand Forks Herald
Lakota Ambulance and Quick Response is on life support.
The elixir for revival is volunteers. But they seem to be in short supply in the Nelson County governmental seat of 650 residents.
The local ambulance service has just seven active volunteers, with most of them on call 35 to 50 hours a week — in addition to their full-time jobs — just to maintain the state-required 24/7 schedule to keep its license.
“We’re one trip and fall or one back injury away from closing up,” said Tami Bulik, the ambulance service’s only employee. “You go to bed at night and you hope nobody’s family has a heart attack or some other emergency overnight.”
Lakota is not alone, according to Kenneth Reed, community paramedic coordinator for the North Dakota Department of Health’s Emergency Medical Services Division and EMS director at Heart of America Medical Center in Rugby, N.D.
“This is troublesome to all of us,” he said. “Lakota is just a symptom of what is happening all over the state right now. The money is not the issue. The problem is lack of volunteers.
“Unfortunately, it’s becoming more common,” he said. “Some may have larger rosters, but there’s just a small percentage who are active with the ambulance. It’s created an artificial sense of security.”
That security vanished earlier this year in Goodrich, N.D., a small town northeast of Bismarck, when the local ambulance service shut down.
“They were down to one EMT, and she was rather elderly.” Reed said. “She was trying to hang in there the best they can,” Reed said. “That’s what we’re seeing in a lot of these communities. They’re hanging on as long as they can, but it’s very difficult to attract new, young people to give the time commitment.”
Hundreds of hours
Doris Karas and Jack Davidson know all about time commitment.
Karas has been a volunteer with the service for 25 years, serving 150-plus hours monthly, plus her full-time job in town at Lakota Drug.
“It’s pretty much 24/7,” she said, sometimes forcing her to leave her job to answer a call. “I don’t like to leave work, but I don’t want to know what might happen if we can’t respond.”
Davidson, the Nelson County auditor, has been with Lakota Ambulance for 31 years, averaging 200 hours or more per month.
“He’s on call just about every day. We’d be lost without Jack,” Bulik said.
“The biggest thing is you have to be ready to go,” Davidson said. “You can’t go to the bar to have a drink. You can’t leave town. You’re very limited in what you can do. The thing is we don’t have a lot of calls. But when we do have a call, it’s sometimes pretty major.”
He said the current lack of volunteer drivers is forcing emergency responders (EMRs) and EMTs to take extra shifts.
“If we could get a few more people, we could schedule people for weekends, and we’d have some time off,” Karas said.
Erin Fossen is one new volunteer who has responded to Lakota’s emergency call. She just started training to become a driver and an EMT.
I’ve always had an interest and there’s a dire need for it,” Fossen said. “The majority of our community is 40 and over.”
She knows about the commitment, too. Her father, Stanley Schrupp, was a volunteer for more than 20 years, before retiring because of health reasons.
Bulik said they need more.
“The desperate need is for EMTs, but if we can attract volunteer drivers, we can train,” Bulik said. “The first goal is to get them started as volunteer drivers, then as EMR, then EMTs.”
Searching for answers
The Lakota Ambulance board currently is reorganizing, according to Bulik.
One of the options is to raise mill levy the service receives through property taxes to be raised from the current 0.73 percent to 5 percent, the maximum allowed without a separate public vote.
The current levy brings in about $5,500 annually, according to Davidson.
The board meets Oct. 1. If it decides to pursue a mill levy increase, the decision must be made by February. However, the extra money would not be available until 2016.
The money would be used to increase the small stipend volunteers receive for their service, said Bulik. Volunteer drivers and EMRs are paid $15 per run, while EMTs get $25 per trip.
“We’d like to get it to where they get paid $1 an hour just to carry a pager,” Bulik said.
The North Dakota Department of Health requires that any licensed ambulance service provide 24/7 availability, with at least two qualified personnel on duty for every ambulance call.
“The financial support is really good in Lakota,” Davidson said. “Money has not been an issue. It’s getting volunteers. Some of us are getting older.”
Mergers as remedies
One option to stay open in Lakota is to merge with Michigan Ambulance Service. Michigan, N.D., is 11 miles east of Lakota.
Under the substation arrangement, Michigan would assume ownership of all Lakota Ambulance assets, according to Jason Flom, EMT trainer in Michigan.
It would keep one ambulance at the Lakota station, he said. If a call comes in from the Lakota service area, Michigan would prepare to answer it. If two qualified people from Lakota are available, the Michigan crew would not respond.
If Lakota would close, its service area would be divided among several other ambulance services, including Michigan, McVille, Edmore and Lake Region in Devils Lake.
Michigan would get the majority of calls, because it is closest to Lakota, which is home to a Good Samaritan Nursing Home.
That’s the same route that was taken recently in Finley, N.D., when Finley Ambulance Service merged with West Traill Ambulance Service, headquartered in Mayville, N.D., about 25 miles away.
Another substation agreement is working between Mohall, N.D., and nearby towns in north central North Dakota.
If Michigan would absorb Lakota Ambulance operations, it would nearly double its service area. Michigan currently serves 432 square miles, while Lakota covers 378 square miles.
Michigan had some troubles with attracting new members a few years ago. However, they never got to the point of possible closure, according to Flom. Today, it has 22 members, with 18 considered active.
“We’re currently stable, but we have 3 to 5 people who would like to retire in the next couple of years. Some of them have been here for 35 or 36 years,” Flom said.
Michigan Ambulance, which operates on 4.5 mills, currently pays volunteers $30 for an ambulance run and $1 an hour for volunteers when their pagers are on. Holiday pay is $50 for a run, plus an increased hourly on-call wage.
Every minute counts
Bulik believes a merger should be a last resort.
Although Michigan is just 11 miles away, in reality, she said, it may take 20 to 25 minutes before an ambulance can respond to an emergency in or near Lakota.
“If you have a heart attack in Lakota, that’s too late,” she said. “Every minute counts.”
“I’m hoping the community takes them seriously,” Flom said. “Some say they’re crying wolf. They’re not.”
While mill levies and mergers provide some hope of relief, Reed said the dilemma is likely to spread to other small communities, especially in eastern North Dakota, where rural depopulation is continuing.
“There are funds available for grants,” Reed said. “We have some of the best-equipped ambulances in the country. There’s been funding available. All of the cost of training is covered by the state.
“The problem is lack of volunteers,” he said. “The only way funding will help is if we get funding to hire full-time people. Then you have to decide, Do we want to pay someone full-time to respond to 30 calls a year?”