Oct. 28—No one wants to call 911, but when we do, we expect someone to answer our call promptly. We expect help to arrive quickly. We expect the first responders to be well-trained, experienced and steel-nerved in the face of fire, a car accident or a medical crisis.
That's their job, right?
Well, yes and no.
In large cities, firefighters and paramedics are paid professionals. They clock in and clock out. They get medical benefits, paid vacations and retirement plans.
But residents of small towns and rural areas across the nation — including southeast Minnesota — depend on a patchwork network of barely-paid volunteers to answer the call when disaster strikes.
These volunteers have other gigs. They are teachers. They are auto mechanics. They are farmers, accountants and business owners. And when, for whatever reason, some of them decide to stop moonlighting as emergency responders, alarm bells start ringing.
Sadly, most of us don't hear those alarms unless they affect us directly. Perhaps that's why, back in 2002, the Minnesota Department of Health issued this report to the Legislature: "A Quiet Crisis: Minnesota's Rural Ambulance Services at Risk."
The report described statewide problems in recruitment and retention of EMS volunteers. Among the problems it cited were high stress, low compensation, substantial training requirements and employers' unwillingness to release workers to answer emergency calls.
More than two decades after that report came out, the crisis is no longer "quiet" in Altura, a small town nestled in the blufflands region east of Whitewater State Park in Winona County. On Oct. 9, 50 people attended a public meeting about staffing woes affecting the Altura Ambulance Service. (That's more than 10 percent of the town's population, so in Rochester, that would translate to about 10,000 concerned citizens.)
In other words, this is a big deal.
The crisis actually began in February, when one Altura Ambulance volunteer moved away and two retired. With no replacements ready to step in, the dozen remaining volunteers were hard-pressed to cover 24 hours, seven days a week, 365 days per year.
The system works like this: At any given moment, Altura Ambulance (and all such services in Minnesota) must have at least two people "on call," and one of them must be a fully trained EMT. Being on call has certain restrictions — you can't attend a football game in Dodge Center on Friday night if you're on call in Altura — but in most cases these volunteers aren't paid unless they actually respond to a call. Even then, in Altura they receive just $20 per hour, and just $10 per hour when they undergo training.
Think about that. People being trained to save lives are paid less than fast-food workers. No wonder it's increasingly difficult to recruit new volunteers.
Being short-staffed has legal ramifications. According to Minnesota law, an ambulance service that has no on-call coverage for 12 consecutive hours can have its Basic Life Service license revoked. Altura Ambulance has had several such gaps this year, but so far the state hasn't taken action — a fact which points to the continuing, widespread nature of this problem.
If such a revocation did occur (or if the remaining volunteers simply gave up), then neighboring ambulance services would have to take over Altura Ambulance's coverage area. That would translate into longer response times and, almost certainly, worse outcomes.
What's the answer?
More money would be a good start. Jessica Romine, director of Altura Ambulance Service, has floated the idea of paying on-call volunteers $2 an hour on weekdays, $5 an hour on weekends. By our math, that would add up to about $50,000 per year — a small sum to ensure that a stroke victim gets help in 10 or 15 minutes, not 30. We'd also support higher pay for training hours and call responses.
Still, that money would have to come from somewhere, and Medicare (which pays for the bulk of ambulance calls in rural Minnesota) and private insurance companies won't pay a higher rate just because an ambulance service asks for it.
That means property taxes might need to increase. In 2021, the Legislature approved a new, higher cap on how much additional property tax a county can levy to support EMS, but so far, no county has pursued such a funding stream. County commissioners in rural Minnesota have expressed a reluctance to raise taxes for ambulance services — especially if they have to ask voters' permission to do so. Without a new source of state funding for rural EMS, county leaders might need to overcome that hesitance.
We'd argue that the Legislature has a role here, too — and a responsibility to help preserve ambulance service across the state. This problem was identified in a report to the Legislature two decades ago, and lawmakers only passed legislation in 2021 raising the cap for counties to collect money. The Legislature has taken action to help hospitals and schools. We think ambulance service should be next.
Of course, if you live in Rochester or another city that has full-time EMS personnel, you might be tempted to shrug your shoulders and say "Not my problem."
Almost all of us travel. We drive 30 miles to see our grandchildren in Wanamingo. We visit our in-laws in Winona or Austin. We take vacations "up north." We drop off college students in Duluth or Mankato.
Keep in mind that when you have an accident on an icy highway in Blue Earth County, or when you suffer a heart attack while trout fishing near Altura, your big-city ambulance service didn't travel with you. You get the ambulance service that serves your current location, and the outcome of your crisis could hinge on the availability, expertise and proximity of volunteer first responders.
When you call 911, minutes matter. Dollars don't.