Studying options key to future EMS, fire protection staffing

By Reed Anfinson

Publisher

Publisher’s note: This is the second part of a two-part story on providing emergency services to the residents of Grant County.

As they look to the future of providing emergency medical services to the residents and businesses of Grant County, fire chiefs, emergency medical providers, and Emergency Management Director Tina Lindquist are studying the options.

Though the rosters are full today across the county, they are concerned as they see few people signing up to fill out those rosters as the current volunteers retire.

Last November, Grant County Fire Chiefs Association sent out a letter to all the cities and townships that fund volunteer services. It was a letter to make them aware of the challenges that potentially lie ahead.

Lindquist acts as the secretary for the Grant County Fire Chiefs Association. It is made up of the fire chiefs and their assistants, along with ambulance directors and their assistants, and law enforcement. As part of her job, she helps coordinate their efforts.

It was a message to tell local leaders at the city and township level to talk to their fire chiefs, ambulance and EMS directors, Lindquist said. “Make sure you understand where they are at and ask them how it is going. Then, maybe, cities can start working together.”

Rather than waiting for a crisis to develop, Lindquist and the fire chiefs association are proactively looking at alternatives to fill the gaps should they be necessary.

“Exploring all options and learning as much as possible is super important,” Lindquist said. It is important for the public to know that in a worst-case scenario what might need to be done to provide emergency services to county residents.

“The perception is that you call 911, and within 5 to 10 minutes, you are going to have people at your house to help you,” Lindquist said. “In the event that we struggle to get people to volunteer and become a part of our agencies, there will be longer wait times.”

Some small towns in Minnesota have had to give up their volunteer fire departments and EMS service. “Now its residents are waiting for paid ambulance service from a hospital from a long distance,” she said.

Some communities in the state levy a tax to pay the salaries of paid emergency response personnel. It can’t be used for equipment, Lindquist said. 

State law allows for the establishment of taxing districts to support EMS and fire protection services.

“I think we are going to have to be creative moving forward if we struggle to fill our departments with volunteers,” she said.

If only two of Grant County’s cities see issues during the daytime, maybe they could work together to find a solution. Meanwhile, everyone continues to talk about the big picture for the county.

“You find out what works best for you and how can we all make it work together,” is her approach, she said.

In researching the options, Lindquist has looked into how other counties are trying to overcome the hurdles with EMS services that are county-line collaborations between counties. 

Stevens County has a countywide fire department operation. That idea has been discussed but there has been some resistance, Lindquist said. Each community wants its individual identity. 

She added that some of the cities in the county have had work sessions to talk about the future of EMS and firefighter services since the letter was sent out in November. 

Responders don’t have to live within the city limits, Lindquist said.

Communities are legislatively required to provide law enforcement and fire protection to their residents, she said. That doesn’t mean they have to provide it directly since they can contract with other entities to provide the service. EMS, on the other hand, is considered a non- essential service, Lindquist said. 

Flexible certification p0ssibilities

There are currently three levels of training to respond to emergency medical situations. A person can become an emergency medical responder (EMR) through a course that takes about eight weeks to complete. 

While an EMR can drive an ambulance and assist during a medical emergency, they can’t ride in the back of an ambulance alone with a patient.

These first responders are local and generally can get to the scene before the ambulance arrives. They can provide CPR and first aid. They are also the eyes and ears of the ambulance crew, summing up what it will deal with when they get to the scene.

One step up is an emergency medical technician, or EMT, which requires 16 weeks of training. An EMT can ride with a patient in the back of an ambulance and have an EMR with them.

To become a paramedic, a person goes through 1,200 to 1,800 hours of training over six to 12 months. For all three, there is testing that must be passed before certification. There are continuing education requirements as well.

One way of helping out may be looking at how volunteers for emergency service positions get certified, she said. Requirements could be lowered or modified, where a retired nurse could assist as a volunteer on a call giving not-fully-certified responders “a little guidance.”

She said there could be different training levels based on the call type, she said. This would reduce the number of hours required for training. However, at the same time, it would likely increase liability exposure for the organizations.

Volunteer firefighters, EMRs, and EMTs do get paid when they are on duty. 

The job is changing

As in all areas of emergency response, from law enforcement to medical response, the job has changed in recent decades.

“Calls now, even compared to five years ago, are very different when you look at mental health and what people are dealing with,” she said. The pandemic played a role in increasing the mental health dynamics of the calls. “We haven’t even seen all the consequences from that,” Lindquist said.

Another change involves declining familiarity with those who are calling for help.

“The way people have to respond has changed so much, because 25 years ago, when a call came in, they knew the people they were going to help. Everybody in the community knew who everybody was. I do believe that has changed some,” she said. 

Recognizing and caring for volunteers

“We need to take care of our responders,” Lindquist said.

Those who volunteer see added stress in their lives at work and home, making it critical to show them understanding and support if they are to continue to volunteer. Appreciation is also crucial to attracting new volunteers. Lindquist says.

Volunteer firefighters can be at a fire in the middle of the night for four hours. “It’s not like they can go home, lie down, and fall asleep right away. Now the alarm is going off at 6:30, and they have to get up and go to work.”

If local businesses can work with their employees who have to answer a call at night, she said it would be one way of showing appreciation for those who serve. Some already do.

It’s not just the responders who need support and appreciation, but so do the responders’ families. 

“The family sacrifices as much as the responder. It could be Christmas dinner, a birthday dinner, or the first night they are home as a family and the pager goes off. Celebrating the families of the responders is important,” she said.

Both volunteers and their families can get burned out by the demands of their roles, making it essential to recognize their sacrifice, Lindquist says.

Suppose local businesses who have employees who are volunteers would keep them on the clock when they have to answer an EMS or fire call. In that case, it could help recruitment and retention efforts, Lindquist said.

“Giving them a special parking space or finding some other way to recognize their service because they are giving back to their community would be a way to reward them,” she said.

Each year, Grant County does a hero day to recognize responders for their years of service. “We really have the best of the best,” Lindquist said. “Whether it is 30 below or 106 degrees, they are on duty.”

Seeking legislative help

Last month, EMS leaders from around the state gathered at the Capitol in St. Paul to tell lawmakers that rural agencies are facing shortages threatening the level of care they can provide. At the same time, they are seeing a demand for their services.

Dylan Ferguson, executive director of Minnesota’s Emergency Medical Services Regulatory Board, points out the following statistics to illustrate the challenges communities face in retaining and attracting EMS personnel:

– Of EMTs not renewing their license and leaving the profession, nearly 65% are under 40.

– In 2021, 4,474 certifications expired while 1,558 certifications were issued – a deficit of 2,916 EMS providers.

– 39% of EMS providers leaving the profession said their decision was influenced by low pay.

“This is probably one of the most important things coming up in the next 10 to 20 years as our population gets older and older,” Dr. Aaron Burnett, who practices emergency medicine at Regions Hospital in St. Paul and Lakeview Hospital in Stillwater, told legislators.

“As a state, we shouldn’t wait until there’s a public outcry because people can’t get an ambulance in a timely manner. Every day citizens in Minnesota rely on EMS services for emergency care. We owe it to those patients to ensure our EMS system is appropriately supported and funded at the state level,” he said.

While in St. Paul, EMS leaders asked for the following support from lawmakers, according to the ambulance association:

– Increased reimbursement levels from the federal and state governments by realizing opportunities to leverage more federal dollars for governmental payers.

– A focus on improving retention of the current EMS workforce, such as the income tax subtractions for volunteer fire and rescue workers through legislation proposed in House File 98.

It would allow EMS and firefighter volunteers a $10,000 tax deduction and married volunteers a $20,000 tax deduction if both are volunteers.

– Development and support for future EMS workforce, including establishing a Paramedic Scholarship Program and funding for current and new EMTs. The scholarship program would fund training for 600 volunteers seeking EMS training. It would also provide $100,000 for student recruitment and program promotion.