When A Rural Ambulance Service Closes Now What? Moderated By: Tom Nehring Director of Emergency Medical Systems ND Dept. of Health Speakers: Kenneth Reed, MS, NRP, CCP-C, CP-C Director of EMS & Disaster Services Heart of America Medical Center – Rugby EMS Sherm Syverson, MS, NRP Sr. Director, F-M Ambulance Service, Inc. Sanford Health - Fargo

Why are rural ambulance services failing? Lack of Leadership Social vs. Business Staffing requirements 24/7 coverage Minimal personnel licensure Initial training Continuing education requirements Regulatory…..

Why are rural ambulance services failing? Economics Lack of tax base funding Low 3rd party reimbursement Volume-based Decreasing donations

Why are rural ambulance services failing? Social Decreased pool of volunteer labor Work out of the response area Employers reluctant to release for calls Less time to commit to community Rural Community Trends Decreasing population base Rural/Frontier towns getter smaller

And Now, A Brief Overview From A “Real Life” EMS Regulator

Why ambulance services are not prepared or do not want to change. Loss of identity Loss of local control Fear of failure Living in the present – not anticipating the future Not anticipating staffing need until it is too late to recover No strategic planning Reluctance to work toward county or local financial assistance No accountability or reluctance of regulatory agency to force compliance with minimum standards

Why ambulance services are not prepared or do not want to change. Frequency of missed or late calls – not reporting - anecdotal Some services want to be part-time ambulances – protecting public safety Working in silos – not with other elements of the continuum, no thoughts to system development, reluctance to work with other ambulance services Decreased state funding or little state funding to begin with Fire and EMS tensions

What is the Impact on the Community/Region When an Ambulance Service Closes?

Immediate Delayed response to medical emergencies Delays in transport from rural healthcare facilities

Delayed Public apathy Another reason to move away “Wake Effect” on Region Stresses other regional EMS providers

Real-World Case Studies Nearly-dead services (I call them Zombie Ambulance Services) Can they be more dangerous than nothing at all?

Potential Mitigation Solutions & Alternatives “Follow the Science” 10 Minute Conditions Time-Sensitive Conditions All The Rest

Quick Response systems Organizational Quick response units EMRs vs. EMTs Public-based Community-based responders CPR, AED & Hemorrhage Control

Partnering with Others Regional Response systems Services combine and rotate staffing Critical Access Hospitals Shared staffing costs Dual role personnel Rural Health Clinics Non-emergency home care services MIH/Community Paramedic Other Public Safety Agencies Fire Law Enforcement Others?