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Recruitment ongoing challenge for rural ambulance services

Holly Koebernick drives the main ambulance out of the Tri County EMS Station on Wednesday, April 1, 2015, in Karlstad, Minn. Tri County Medical Services is struggling to find volunteers to staff the station. (Logan Werlinger/Grand Forks Herald)1 / 4
Marcus Steien turns the main ambulance around to pull into the the Tri County EMS Station on Wednesday, April 1, 2015, in Karlstad, Minn. Tri County Medical Services is struggling to find volunteers to staff the station. (Logan Werlinger/Grand Forks Herald)2 / 4
Holly Koebernick holds their supply of common summer emergency allergy medication at the Tri County EMS Station on Wednesday, April 1, 2015, in Karlstad, Minn. Tri County Medical Services is struggling to find volunteers to staff the station. (Logan Werlinger/Grand Forks Herald)3 / 4
Holly Koebernick stands next to the main ambulance at the Tri County EMS Station on Wednesday, April 1, 2015, in Karlstad, Minn. Tri County Medical Services is struggling to find volunteers to staff the station. (Logan Werlinger/Grand Forks Herald)4 / 4

To Holly Koebernick, choosing to be a volunteer emergency medical technician was all about community service.

She's been the administrator of the Tri-County EMS District, which serves Kittson, Marshall and Roseau counties in northwest Minnesota, for about a year but a rural EMT for 11 years.

"I enjoy giving to my community," Kobernick said. "We're probably there helping a person on one of the worst days of their lives if they had to call an ambulance. Just knowing you can really help somebody is really good."

But community service isn't as enticing of a selling point as it used to be for a commitment that requires volunteers to be on call 24 hours a day, complete more than 100 hours of training and potentially leave jobs and family gatherings at a moment's notice.

A declining volunteer base has ambulance services in rural Minnesota and North Dakota rethinking how to recruit volunteers.

"I think what we're struggling with is using the same recruiting methods that we always have. I think we need to reinvent how we recruit," said Mark Jones, president of the Warren (Minn.) Volunteer Ambulance Service and president-elect of the Minnesota Ambulance Association.

Local and county government boards in Minnesota's northwest portion are offering cash incentives while the Minnesota Ambulance Association, an advocacy agency for emergency medical service personnel, is convening a summit this month to rouse recruiting ideas from members.

Nationwide issue

Alejandro Mayorkas, deputy secretary of the U.S. Department of Homeland Security visited Larimore, N.D., earlier this week to gather firsthand information in an effort to bolster volunteer recruitment and retention not just in North Dakota, but nationwide.

"The unique challenges of smaller rural communities in North Dakota are representative of the problems and challenges that small communities face all over the country," he said.

While volunteers comprise about 80 percent of first responders throughout the nation, in North Dakota the percentage is 96 percent.

Two local ambulance services in North Dakota — in Carson and Goodrich — have closed in the past two years because they did not have enough volunteers to sustain the minimum requirements to have the service available 24/7, according to Tom Nehring, division director for emergency medical services and trauma with the North Dakota Department of Health.

Others have merged or become substations of neighboring ambulance services, which decreases the requirements for volunteers at the substation. One example is Finley (N.D.), which now is a substation of West Traill Ambulance Service in nearby Mayville, N.D.

"There are a number of ambulance services in North Dakota that are on the brink of no longer being sustainable," he said.

Lakota (N.D.) Ambulance Service, for instance, has been struggling for several years.

"Lakota is still in business," Nehring said. "They were talking about becoming a substation. They have not. It's a brutal fight to stay open.

"The reason they have survived is because of the volunteers," Nehring said. "That's the volunteer subsidy."

The state agency estimates it would cost $31 million annually to pay all local ambulance services to provide wages to cover the minimum staffing requirements, he said.

In North Dakota, local governments can levy up to 5 mills to support ambulance services, with up to another 5 mills allowed, if approved through a public vote.

Lakota Ambulance Service had been receiving $4,000 to $5,000 annually from a 0.78-mill levy. Next year, that income will increase to about $45,000 annually, after the Lakota Ambulance District EMS board this week approved a request to raise the levy to 5 mills, according to Tami Bulik, the service's only paid employee.

"Hopefully that will allow us to pay volunteers per hour for carrying a pager, pay for some EMT classes and, someday, buy a new rig," she said.

Rising from need

Rural ambulance services have a storied history, rising out of a need for care — to the relief of other businesses.

In Warren, Minn., and other small towns, funeral homes became receivers of calls for help, Jones said.

"All of a sudden, people realized there was a service out there that if they were sick or injured, someone would come get them," Jones said. "Then the funeral home got too busy, so we started in our community ambulance services."

Since then, the services have become more regulated, requiring state licenses for operation and certification for emergency medical technicians and responders.

When it's all said and done, a potential EMT volunteer may participate in 120 to 190 hours of training to become certified depending on if they have a medical background, Koebernick said.

Once training is completed, it's time to be on-call.

Minnesota state law requires two EMTs to respond to each call no matter the time, unless the service has sought an emergency staff hardship variance to allow one EMT and one first responder to take the call instead.

North Dakota has comparable rules requiring at least two qualified attendants on every call.

EMT volunteers are on call 24 hours a day during their shifts, which have the potential to take them away from jobs.

It's sticky situation in many of the small towns in northwest Minnesota where residents commute to other communities for work, leaving those working in town to cover shifts.

"I'm really thankful for a lot of employers in the area that allow our people (to go) if their pagers go off," Koebernick said.

Right now, 12 people are going through Tri-County's EMT training class. The 10 individuals remaining in Tri-County's volunteer base following the course's conclusion will bring its roster up to about 65 volunteers.

They'll be expected to get to an ambulance garage in 10 minutes, be paid only for runs they make and potentially encounter friends and neighbors on their calls.

"It's a tough job to do, and it's hard to stay in it for a long time," Koebernick said. "It's an emotional job. You're dealing with people in small communities. We're dealing with people that we know, that we see every day on the street. They're not strangers."

Looking forward

Recruitment isn't a new issue for volunteer ambulance services.

In 2002, the Minnesota Department of Health published a report called "A Quiet Crisis: Minnesota's Rural Ambulance Services at Risk," which included recommendations for addressing staffing problems.

Fast forward more than decade later and recruiting remains a challenge statewide as people's lifestyles continue to shift.

"As we're finding out, it's getting more and more difficult to find people willing to volunteer," said Bob Orlen, interim executive director of the Minnesota Emergency Medical Services Regulatory Board. The board oversees and certifies ambulance services throughout the state.

Orlen said it's quite possible people don't feel they have the time to commit to dozens of hours of training and don't seek out the volunteering opportunity.

Incentive programs do exist at the state, regional and local levels to attract volunteers.

For example, Orlen points to credits earned for years of service that can be cashed out at age 50 and reimbursements for classes and training costs.

Any incentive that may get volunteers to look into becoming an EMT is a good idea, Jones said, though it's up to emergency service staff to follow through and get a commitment.

Jones and about 60 other emergency medical service leaders will tackle recruiting and other challenges facing Minnesota's EMS system during a two-day summit next week focusing on the sustainability of rural ambulance services.

"I think we're at that point where those of us who have been doing it for many, many years, we just do it because that's how we provide services to our community," said Jones, who has been a volunteer for 21 years.

Identifying recruiting problems and coming up with new methods of recruiting will be two topics of discussion. Jones said he hopes the summit produces tools communities can use to grow their volunteer bases.