Letter to the Editor: Rising costs crushing rural ambulance services

To the editor:
Many of you have probably read or heard about the articles that have been posted in the Des Moines Register over the past year. While Des Moines is four hours away, we too have some of the same challenges here facing rural EMS, in every one of our communities, now and in the coming years.
Operating an ambulance service can be very expensive. Rising equipment costs, advances in technology and lack of funding are making it difficult for many ambulance services to stay afloat.
For many years, much of the rural EMS has relied on donations and fundraising to support their ambulance service. But those dollars are no longer enough to pay for the increasing costs associated with running an ambulance. And, contrary to what many believe, most ambulance services receive no funding from federal or state government. In Allamakee County they do receive a portion from local governments, but taxes don’t increase the same as expenses.
The fixed costs required to operate an ambulance are numerous and they continue to escalate. Plus, rural EMS agencies in Allamakee County have the additional problem of dealing with the same fixed costs as busier EMS agencies but operate much lower volumes, and therefore, less income to pay these fixed expenses.
One of the largest expenses is equipment and supplies. Consider this, an ambulance vehicle can cost between $125,000 to $225,000. That doesn’t include the costs associated with equipping it with medical equipment, fuel, and expenses related to maintaining the equipment, repairs and replacement.
EMS squads cannot pick and choose which types of medical equipment they are going to use and purchase. Much of their equipment is required and federally regulated and varies depending on whether they are equipping a basic life support (BLS) ambulance or an advanced life support (ALS) ambulance.
Equipment required of a basic life support (BLS) ambulance includes ventilation and airway equipment, automatic defibrillator devices, stair chair and cot, immobilization ambulance devices, bandages, communication devices, obstetrical kits, infection control equipment, injury prevention equipment and many other miscellaneous supplies. Equipping and supplying a BLS ambulance typically costs $40,000 -$50,000.
Along with items listed above, an advanced life support (ALS) squad is even more costly. These costs are for items like specialized vascular access equipment, intravenous infusion pumps, cardiac devices like 12-lead ECG with transmitting to a local facility, electrical cardioversion, transcutaneous  pacemaker, automatic compression devices and other advanced equipment like CPAP, enhanced ventilators and nitrous oxide for pain control. Services in Allamakee county that provide this ALS coverage are Postville, Waterville and Waukon.
Keeping up with the greatest and latest medical technology is very often cost prohibitive for the rural EMS services. But as you can see for even a modestly equipped ambulance, the average costs for the vehicle, equipment and supplies easily approaches or exceeds$250,000.
We all have stations that must be maintained as well. Workers Compensation is another increasing expense in a field considered by the insurers as high risk. The number of underinsured and those on Medicare and Medicaid also continues to go up, making it difficult to get fair compensation. The amount that Medicare and Medicaid reimburse often doesn’t cover direct expenses, and in many cases, doesn’t help pay for salaries should they be paid workers. As a result the services must adjust their rates to help compensate for these additional expenses.
Then there is the money needed in investing in education and ongoing training. The expectations placed on volunteer EMTs and paramedics are greater today than ever before. As medical technology has advanced, the level of care provided by EMS has also increased and that requires rigorous education and ongoing training.
The minimum training to become an EMT is usually around 140-180 hours and is typically done over four to six months with an investment of approximately $1200-$1500, an expense that sometimes comes out of the volunteer’s own pocket. Ongoing training requires at least an additional 24 hours of training every two years for a BLS provider.
Training to become a paramedic is even more rigorous and may cost in the $7,000 – $12,000 range. Ongoing training for a paramedic requires up to 72 hours every two years to maintain one’s certification.
So, the next time you receive a bill for services rendered, or see that your local ambulance service is having a fund raiser, or have a little extra on-hand cash at the end of year, remember what it takes to keep the local EMS services operating. In many instances, the EMT or paramedic who came to your assistance was probably a volunteer receiving little or nothing for his or her time and service. Instead of complaining, be thankful that you still have an EMS squad operating in your community that can save the life of you or a loved one.
For more information, call Jeff Mitchell, EMT-P, EMS Coordinator at Veterans Memorial Hospital at 563-568-3411.

Jeff Mitchell, PM, EMS/Paramedic Supervisor
Veterans Memorial
Hospital Ambulance