Marion County is far from alone in searching for better ways to provide emergency medical services to county residents
“Rural health care is at a true crossroads,” Newton fire chief Mark Willis said in an email. “Not just EMS but rural hospitals and health care access in general are facing an unprecedented crisis.”
In Newton, EMS is a branch of the fire department. All personnel are trained both as firefighters and EMTs or paramedics.
“Of our allocated 50 full-time positions, currently we have 26 paramedics, three advanced EMTs, and the remainder of our personnel are basic EMTs,” Willis said. “The ambulance dispatched on every EMS call has a minimum of one paramedic and one EMT.”
Marion County relies heavily on volunteers paid $2 per hour to be on call and a higher pay for ambulance runs, but the formula for payment on a run is complex.
Since January, the Marion ambulance crew has lost three members and replaced one, leaving five to cover the city. One who left for retirement was Gene Winkler, who put in 500 to 600 hours monthly and last year was paid $13,069.50. Of the other two who resigned, Brandy McCarty was paid $8,795.65 last year and Shannon James was paid $14,018.52 last year.
County commissioners are contemplating hiring six full-time and two part-time EMS crew members in 2017. Debesis said they would be assigned to Marion but that will require housing arrangements so they can stay overnight while on duty.
Hillsboro has 11 EMTs, paramedics, and first responders. Still, even there, the bulk of the work is done by a few.
Terry David, whom commissioners hired as a consultant in November, told commissioners in January that the county’s system of using paid volunteers in five stations is not sustainable.
“The number of volunteers that are on the roster versus the number who actually cover call is quite different, and given the new educational requirements of EMS personnel, there will be continued struggles to find and keep qualified people,” David wrote to commissioners.
Transfers to out-of-town hospitals take a lot of time for EMS and are technically not required, since federal law puts the responsibility for transfers on hospitals. Terry said if EMS discontinued handling transfers, the decision would have “significant financial impact to the business of EMS, as transfers can be a major portion of revenue for an EMS budget.”
Debesis agreed the service would lose a lot of money if it made the hospitals find their own transport services.
Hospitals in Hillsboro and Marion were supportive of using off-duty nurses to assist with transfers.
Another issue in providing EMS in rural counties is the cost of training, he said.
“What is being encountered there is happening all over rural Kansas,” Willis said. “Initial certification and ongoing re-certification processes are expensive and time-consuming; the demands on the EMS providers are greater than ever.
“Volunteerism in general is on the decline, not just in emergency services. The mandate of governing bodies to ‘do more with less’ is difficult to accomplish as our population gets older and demands for service are ever-increasing.”
Marion County recently agreed to help with training costs for two employees and looks to develop a standard policy on helping with training.