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Rural ambulance services facing shortage of volunteers

When most people sign up to become volunteers, they usually agree to a certain number of hours a week or some set schedule. But volunteers for rural ambulance services get no such arrangement. They need to be available on a moment's notice, and t...

When most people sign up to become volunteers, they usually agree to a certain number of hours a week or some set schedule. But volunteers for rural ambulance services get no such arrangement. They need to be available on a moment's notice, and their volunteer job can take them on the road for hours, sometimes even a full day. It's a tough sell to recruit volunteers, and rural ambulance services across the state are feeling the pinch.
"We have a very heavy reliance in this state on volunteers," said Terry Hill, director of the Minnesota Center for Rural Health in Duluth. "In Duluth there are professional paramedics, but Grand Marais, Ely, they rely on folks who volunteer as a basic life support team. Volunteerism has diminished in a lot of areas, and now it's starting to show up in our ambulance services. We're not getting enough folks to volunteer."
Hill serves on a statewide work group studying the issues facing rural ambulance services. Hill says that recruiting volunteers is a big concern, especially when ambulance drivers not only volunteer their time, it sometimes even costs them money. When a patient is severely ill in Grand Marais, for example, a volunteer ambulance driver may need to take the day off of work for a drive to a hospital in Duluth or the Twin Cities.
"You're spending a full day transferring that patient down and going back," Hill said. "In rural areas, volunteering is not just going out and picking up someone. It takes a lot of time and effort. We have been leaning on volunteers for years."
Mike Peterson, training officer and operations manager for the Cromwell ambulance service, says he has noticed not only fewer volunteers, but those who do sign up are not staying as long as they used to.
"There's been a big change," Peterson said. "In the '70s and '80s when most people joined up, they were on for 20 years. Since the '90s, statistics are averaging from 4 to 6 years. A lot of people aren't staying on the service."
Peterson says many people who leave the service do so because they change jobs and move out of the area. He says the toughest people to recruit as volunteers are those raising a family.
"Our recruitment now has been before they were married or just married or after the children leave," Peterson said. "It seems like during the child rearing years it's very hard to get people to leave in the middle of the night, leave from the birthday party or the Christmas dinner."
Recognizing the challenges facing rural ambulance services, the 2001 Minnesota Legislature directed the Rural Health Advisory Committee, which had already identified emergency medical services as a significant rural health issue, to conduct a study and make recommendations. They charged the committee to look at and make recommendations on personnel shortages and staffing issues, funding for ambulance operations, the impact of the federal Balanced Budget Act of 1997 on ambulance reimbursement and the adequacy of volunteer incentive programs. In addition, the advisory committee will examine whether reimbursements for volunteer training are adequate to ensure ambulance service volunteers will be available in rural areas.
The committee is looking at staffing shortages as well as funding shortage caused mainly by the Balanced Budget Act of 1997. The reimbursement ambulances receive for medicare patients is expected to be cut in half because of the changes put in place in 1997. And since rural Minnesota has a higher percentage of Medicare patients, these same ambulance services will be hit doubly hard, some losing as much as a quarter of their total revenue over a year's time. As the changes mandated by the Balanced Budget Act are phased in over the next four years, Peterson expects the Cromwell ambulance service to lose 28 percent of its total revenue.
The demands are great. The hours are irregular. There's little or no money. But Peterson says being an ambulance driver has far greater rewards. "The patting of the hand," he said. "They look at you, and that look says, 'Thank you.'"
Jennifer Simonson covers health issues for the Budgeteer News. Reach her at jsimonson@duluth.com or 723-1207.

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