Last year two states lowered their ambulance staffing standards, Wisconsin and South Dakota, due to EMS personnel shortages and recruitment issues. An Associated Press story that ran in both The Tribune and The Charlotte Observer notes that the lowered standards have not solved the staffing and recruitment problems in South Dakota. That story is based off The Daily Republic story detailing how state officials are asking for patience despite three services being on the verge of shutting down within two years.
Here are my favorite quotes from The Daily Republic article:
Following state legislation that went into effect in late 2016 that reduced the number of emergency medical technicians (EMT) required to respond to ambulance calls, Deputy Secretary for the South Dakota Department of Health Tom Martinec said it will likely take more time for people to realize the benefits.
It is important to note that the article does not mention what the current rate of pay is or what these supposed benefits are. More importantly further down in the article is this little gem:
But with a statewide workforce shortage in the medical field, finding volunteers who can balance responsibilities at work, home and for the ambulance service is a problem that’s not unique to Gregory County, South Dakota Emergency Medical Services Director Marty Link said. But he’s hopeful for the future of Gregory County’s services and ambulances across South Dakota.
Smack. My. Head.
This is absolutely tragic. An entire state lowered their standards and STILL have volunteer agencies unable to fulfill the mission. Gee… could it be because they are VOLUNTEERS? What benefits are there actually to draw people in? If there’s a paycheck or a stipend involved, then you aren’t a true volunteer agency.
In the latest episode of the Inside EMS Podcast, the episode titled Giving volunteer EMTs meaningful incentives, hosts Kelly Grayson and Chris Cebollero touch on a number of different ways to incentivize EMS volunteerism. While the discussion revolves around property tax rebates, there are a number of other things that they briefly touch on items such as car registration, water bills, and end-of-the-year stipends that could help with getting the volunteers involved.
The second half of the podcast also deals with a topic that is related, namely the cost of providing EMS services. While discussing the millions of dollars being written off by agencies as unreimbursable, the true cost of providing the service is often hidden behind seemingly outrageous ambulance bills. There is a cost to coverage and readiness that often is not calculated, instead agencies hope to recoup the cost through billing the actual transports. A true EMS “fee-for-service” will include the coverage and readiness costs, not just considering the service as transportation and making that the only viable billing option. Part of that readiness cost is in fact salaries.
Volunteer agencies have a HUGE cost savings over other agencies thanks to not having to cover the overhead of paying personnel. I originally said that if you want to provide your community a consistent and reliable service, maybe you should start by paying your personnel. Of course then comes the issue about funding and how rural communities can’t necessarily afford a paid EMS services, hence why they continue to rely on volunteers.
It’s ironic to note that in the most recent Presidential Election the voters of South Dakota indicated that healthcare is a choice, not a right, through their overwhelming support of the Republican Candidate who steadfastly insists he was elected to repeal and replace the Affordable Care Act. Based on that logic, if you can’t afford a paid EMS service then you probably shouldn’t have a consistent and reliable EMS service. EMS is like health insurance, it isn’t for everyone according to the political platform of the South Dakota voting statistics.
The sad truth is it is easier to lower standards than it is to fiscally invest in the services your community wants and this truth is not specific to South Dakota. I’m going to stress the word wants, because without knowing the call volume/types that go on it is impossible to determine the actual needs. The fact there are still agencies struggling with recruitment after lowering the standards illustrates that there is an acute lack of understanding of what the actual problem and challenges are from the bureaucratic establishment. This is neither a surprise or unheard of, it is a challenge many people have faced and overcome… and they did it without lowering their standards.
It will be interesting to see what happens in the near future regarding this issue in South Dakota and other places that have taken similar steps.