NORTHWOOD, N.D. -- Lights flash. Sirens blare. Blood pounds in Tom Engen’s temples as he heads out on an ambulance run in Northwood, a small town 45 miles southwest of Grand Forks.

“When that pager goes off,” said Engen, “it’s pure adrenaline.”

As emergency medical services manager for Northwood Deaconess Health Center, the hospital that serves not only this town of 1,100 but several others nearby, Engen oversees Northwood’s ambulance service. Roughly 200 calls for service come in each year to the hospital, which serves about a 30-mile radius.

Even with the rush that accompanies the job, Engen says the most meaningful aspect is sitting in the back of the ambulance holding a patient’s hand, reassuring the patient that everything is going to be OK.

“You have to care for patients,” Engen said. “You need compassion.”

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Northwood seems to have plenty of it, as the ambulance service has 25 members -- enough, according to Engen, to take care of the needs of the community in the coming years. Other towns aren’t so lucky, as the number of emergency medical technicians declines statewide.

“We need an ambulance service,” Engen said.

Nearby Aneta lost its ambulance service about two years ago.

With other, smaller ambulance services closing, Engen said the number of calls the Northwood ambulance service gets could increase in the future. The loss of ambulance services can put a strain on existing services, in turn causing them to close. This is a rising problem in many parts of the state. Ten years ago, there were 135 ambulance services in North Dakota; today there are 111, according to Engen.

“I’m not sure what the answer will be down the road," Engen said. "With each squad closing, it creates a domino effect.”

The issue is not as dire in Northwood, but Engen knows it could be if more of these essential services close.

Engen’s daughter, Jenna Bumgardner, is a nurse at Northwood Deaconess and an advanced emergency medical technician (AEMT) on his squad. The department was staffed by just two people for many years, Engen said. Engen is the only paid emergency services employee.

“We are spoiled where other squads in the state tend to be struggling,” Engen said.

Engen found his calling late in life. After spending time running his parents’ grocery store, the Northwood native came into the emergency medical services as an adult.

His parents owned Engen’s Market, a long-time grocery store in the community. He took over in 1985.

He began taking emergency courses in 1979 and worked part time with the squad at Northwood, starting in 1980. He has been full-time with the ambulance service since 2011.

“I finally found what I want to do when I grow up,” Engen said.

Some patients used to be customers at the grocery store, Engen said.

“I think it helps when someone is having a medical emergency to see a familiar face,” Engen said. “Hopefully, it is reassuring.”