1. 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

2. 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…..

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

4. 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

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

6. 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

7. 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

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

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

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

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

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

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

14. 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?