The Economist
Copyright 2006 The Economist Newspapers Ltd.
Garber, Okla. — Driving through tiny Garber, a once-thriving town in central Oklahoma, is thoroughly depressing. Most of the shops on Main Street, save for Billy Bobs Bar and a fitness centre, are boarded up. In a large shed next to the City Hall, a beautiful white ambulance — the newest-looking thing in town, complete with a defibrillator — sits alongside an old pick-up, a tractor and some trailers. Alas, the vehicle has not made a run for about eight months. This is not because it is unwanted but because there is no one to staff it.
The Garber ambulance used to make 80 or 90 runs a years. But stricken residents must now wait 25 minutes (instead of six minutes) for help. The town is not alone in its plight. Shawn Rogers, head of Oklahoma’s emergency medical services, says that ten rural ambulance services have come to a stop over the past five years. Nor is Oklahoma alone. The struggles extend from the Texas Panhandle all the way to North Dakota, where two ambulance services have shut down in the past year. Air ambulances are no answer since they have trouble flying in bad weather and have had several crashes in recent years.
In cities, professionals man the ambulances but most rural ambulances are staffed by volunteers: local people who devote hundreds of hours to training. Basic EMTs (emergency medical technicians) do over 100 hours; paramedics, a rare species in rural areas, do more than 1,000. But as people get busier and rural America shrinks, volunteers become harder to find. In Garber, one of the volunteers went to work for the telephone company so is not around enough. Another moved away. “We had a death here recently in our town that I think would have been saved,” says Hal Long, the treasurer for the ambulance service. He hopes to revive the service with the help of a schoolteacher currently having medical training.
Even as rural services are struggling, demand is increasing. Baby-boomers are reaching their 60s, which means more strokes and heart attacks. In Oklahoma City, says Mr Rogers, one ambulance service is braced for a doubling of yearly runs. In rural communities — where the young tend to leave and the old to stay behind — the need will be even greater.
Another worry is reimbursement. Though much of the burden falls on Medicare, the insurance programme for the aged, transport by ambulance may not be covered. Sometimes a hospital stay is paid for but getting there by ambulance is not. In any event, worries Mr Rogers, ambulance reimbursement is not keeping pace with inflation. Another problem is the rising cost of petrol, especially out west where villages may be 100 miles from the nearest hospital.
Can anything be done? Last week, Craig Thomas, a Republican senator from Wyoming, introduced a bill that would make it easier for rural ambulance services to get money (by coming up with a better definition of “rural” and by boosting reimbursement for small hospitals’ ambulances). But even if Congress does not act, experts on coping with emergencies are hoping to bring more efficiency to the business. “We’re promoting regional systems,” says Mr Rogers. He adds that sometimes, when towns have played against each other in football, “we don’t see the kind of collaboration you would like.”