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Rural EMS providers fill many roles, face tough financial picture

EMTs and paramedics often go to smaller communities for training and then relocate to other communities; doctors, dentists and nurses are also difficult to keep

By Laura Camper
The Anniston Star

HEFLIN, Ala. — An open work truck sat Friday, parked next to a Cleburne County ambulance. Behind it, drywall, taped and mudded with white plaster, rose to the ceiling of the garage.

The Cleburne County Emergency Medical Service building is getting a $64,000 makeover including four new bedrooms, a weight room, a new kitchen, a training room and lots of storage.

It's being funded with "found money," thatturned up after a bookkeeping error was discovered, said Tracy Lambert, interim director of the service.

The renovation is a much-anticipated project in a building constructed several years with the intent that it be expanded. However, the money to accomplish the work hasn't been available until now. In fact, say directors of local rural emergency medical service providers, money is tight at most rural services, a consequence of the widespread populations they serve.

"We'll never make a profit," Lambert said. "You just can't in a rural area."

The Jacksonville Ambulance Service, managed by that city's Fire Department, covers an area of about 140 square miles, said Jacksonville Fire Chief Wade Buckner. Cleburne EMS covers 530 square miles, Lambert said. Phillip Winkles, director of Piedmont Rescue, the ambulance service and search and rescue agency in that city, said the service covers about 400 square miles.

The wider coverage area means picking up a patient and taking them to the hospital takes longer — an average of two hours for Cleburne County EMS and an average of an hour and a half for Piedmont EMS. In contrast Jacksonville, which covers both urban and rural calls, averages 30 minutes for calls in town and an hour and a half for calls in rural areas.

In addition, although EMS stations in less-populated areas have to be staffed 24 hours a day just as those in urban areas, their service-call volume is lower, giving them fewer opportunities to fund their operations with fees, Winkles said. Rural counties like Cleburne also often have higher poverty rates and more uninsured people than urban areas, making it more likely the fees that are generated won't be paid, Lambert said.

But funding is just one of the challenges that rural services face, said Severo Rodriguez, executive director of the National Registry of Emergency Medical Technicians.

Rodriguez, a paramedic who spent a number of years teaching in rural southern Texas, said rural services often have a harder time recruiting and retaining certified personnel.

EMTs and paramedics often go to smaller communities for training and then relocate to other communities, Rodriguez said. That is a problem throughout healthcare as a whole; rural areas often have a hard time recruiting doctors, dentists and nurses as well, he added.

The lower call volume in rural areas also creates a need for more skill maintenance, Rodriguez said. For instance, some calls can be simple to answer while others are more challenging. If the challenging calls are done less frequently, the skills needed to handle those calls can become rusty, Rodriguez said.

In addition, just the fact that transports can take longer means rural EMTs and paramedics often do more diverse treatments with their patients, Rodriguez said. A medical technician or a paramedic can brush up on the skills and pick up new ones with continuing education. But that hands-on training can be expensive, he said.

Emergency medical personnel are passionate about and committed to their profession, Rodriguez said.

"We look for educational opportunities," he said. "But at some point, the resources need to be provided."

That can be a problem in rural areas where the smaller population base can have a harder time generating the amount of money needed to provide those resources, Rodriguez said.

But there are also rewards to working in more rural communities. In such places, paramedics and EMTs may be the only healthcare workers around for 30 or 40 miles, Rodriguez said. The people in those communities tend to view the EMS service differently than people in more urban areas.

In urban areas the perception of EMS may be "lights, sirens and dramatic rescues," Rodriguez said. But in rural areas, EMS workers often provide much more routine care, such as blood-pressure checks and walk-in clients asking for help.

In Cleburne County, where there is no hospital, the EMS service has people walk in three or four times a week for blood pressure checks, said paramedic Heather Fink. But they also come for other reasons.

"We took a fish hook out of a kid two weeks ago," Fink said.

Piedmont, which also has no hospital and no medical clinic nearby, sees the same type of requests, Winkle said.

"We have a huge amount of walk-ins," Winkle said. "About eight a week."

The people come in for blood pressure checks, or to complain of chest pains, difficulty breathing, broken bones. The EMTs and paramedics treat them all whether or not they need to go to a hospital. Meanwhile, they only charge the clients if they take them to a hospital, Winkle and Lambert said.

Cleburne EMS is turning one of the old bedrooms being replaced in the renovation project into an exam room, Lambert said. It will be more private and more comfortable for the clients, he said.

"We see it as a community service, a way to give back to the community," Winkle said.

Copyright 2013 The Anniston Star

McClatchy-Tribune News Service

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