The average response time for rural agencies (excluding Bloomington and Normal fire departments) was 5.4 minutes in 2019. It’s jumped this year to 8.4 minutes, said Travis Wilson, manager of the Normal-based McLean County Area EMS System.
“Every additional minute could be problematic depending on what the call is,” Wilson said. “For a stroke, every minute that goes by untreated is about 1.8 million neurons lost in that timeframe. A couple minutes can be a significant difference.”
Rural EMS agencies in McLean County, and around the country, are struggling to find volunteers and paid EMTs. It’s not a new problem, but it's getting worse, Wilson said.
“The pandemic expedited that process,” he said, noting that class sizes for EMT paramedic programs were limited due to COVID-19, causing a training bottleneck. Increases to the state minimum wage also have been a challenge, he said, creating compression issues for EMTs.
"If two people end up leaving here, it could totally just shut the doors. And that’s scary."Eric Fulk, Mount Hope-Funks Grove Fire Protection District
“And we saw a lot of older health care providers in the EMS field walk away (due to COVID-19 concerns), and understandably so. I don’t fault them,” Wilson said. “They’re at the higher risk categories of contracting COVID.”
Rural ambulance services rely heavily on volunteers. About 53% of rural EMS agencies in the U.S. are staffed by volunteers, compared with 14% in urban areas, according to a National Rural Health Association report. More than 70% of those rural agencies report difficulty finding volunteers.
Eric Fulk is right in the middle of it.
Fulk is chief of the Mount Hope-Funks Grove Fire Protection District, a small department based in McLean. Fulk’s department responds to all those crashes and other calamities along Interstate 55 southwest of Bloomington-Normal—only half-jokingly called the Bermuda Triangle.
Fulk is one of three primary team members who go out on ambulance runs.
“If two people end up leaving here, it could totally just shut the doors. And that’s scary,” Fulk said. “And then (residents) are looking at 15- or 20-minute response times. And I know (from experience) … sometimes you don’t have 15 or 20 minutes to respond.”
The importance of agencies like Fulk’s was prominently on display July 28, when a series of crashes (including one fatal) in one afternoon shut down Interstate 55 for 14 hours.
Mount Hopes-Funks Grove wasn’t alone that day. They called in mutual aid—their lifeline during a mass casualty incident. Seven patients were transported from the first wreck that day alone.
The hardest part, Fulk said, was getting emergency responders to the right place and quickly. I-55 was a parking lot, and nearby Route 66 also was under construction.
“There was always a curveball,” Fulk said. “We had all sorts of stuff thrown our way on that day.”
It was a long day.
“Sometimes it’s taxing. You come back, when it’s time to unwind, you’re the ones cleaning everything up. It’s still going until you go home. And the next day you’ve got paperwork,” Fulk said. “But for me personally, I wouldn’t give it up for anything. Yes, I put myself through hell. But that’s what I like to do.”
Those July 28 crashes happened just a few weeks after the historic June flooding that sent Mount Hope-Funks Grove personnel out on a water rescue.
“There’s only a handful of people from these agencies who respond to all these calls, all the time,” Wilson said. “They dedicate their lives to serving their communities in this way. They’re really relying on four or five providers to run the ambulance continuously. They’re so vital for the community, and sometimes I think a lot of communities don’t recognize the importance of EMS until they need them.”
Broken funding model?
And it’s not like these rural agencies are swimming in money to hire a bunch of paid help, even if that paid help was available. In addition to personnel shortages, about a third of rural EMS agencies in the U.S. are in immediate operational jeopardy because they can't cover their costs, according to the National Rural Health Association.
That largely stems from insufficient Medicaid and Medicare reimbursements, Kaiser Health News reported last month. Those reimbursements cover, on average, about a third of the actual costs to maintain equipment, stock medications and pay for insurance and other fixed expenses.
“It’s hard to go after a person individually for that money, so agencies are in this tight spot. ‘What do we do?’ A lot of time they just eat it up as a loss for that agency,” Wilson said.
Fulk said they need a new funding model. Agencies like his rely on local tax dollars, but those levies are generally limited and often maxed out.
“(My community members) only have so much to give. We can’t keep taxing these folks. I’m not a big proponent of that. But at some point, we have to figure something out on who’s going to pay for these services so that they stay,” Fulk said. (He spoke about the issue briefly with Lt. Gov. Juliana Stratton, whose transport got stuck in traffic near McLean during the July 28 wrecks. She heads up the Governor’s Rural Affairs Council.)
Rural EMS needs to evolve into something else, Wilson said. The best option may be consolidation of services—whereby a couple fire protection districts or ambulance services merge. That would at least guarantee a response, rather than just hoping a mutual aid partner will show up in a pinch, Wilson said.
“We’ve had a few instances in the past few months where a service was unable to staff an ambulance. And their mutual aid partners were unable to staff an ambulance,” Wilson said. “So there was a significantly delayed response for those services.”
The Mount Hope-Funks Grove Fire Protection District will host a mobile blood drive from 1-6 p.m. Sept. 14 at its headquarters in McLean. You can sign up online.
