EMT Shortages Strain Rural Agencies In Central Illinois
Travis Wilson can make being an EMT sound like the coolest gig in the world.
“It’s not like anything else in the field of medicine,” Wilson said. “It’s different every single day. If you’re an adrenaline junkie, it’s an awesome job.”
It’s an awesome job that not enough people want to do. Many small fire departments are struggling to meet staffing needs, including those in rural McLean County. It’s a problem that threatens to lengthen wait times when someone calls for an ambulance.
“In a rural community, waiting 25 minutes for an ambulance is a long time,” said Wilson, manager of the McLean County Area EMS System. “When you’re having a stroke, every minute you go by without being treated, you lose over a million brain cells. So that’s a pretty significant thing to wait that long.”
Historically, rural fire departments have relied on volunteers. In fact, two-thirds of U.S. fire departments are still all-volunteer, according to the National Volunteer Fire Council (NVFC). But the number of volunteers has fallen nationwide, even as the number of emergency medical calls has spiked, the NVFC reports. Departments have begun augmenting their volunteers with paid help, but even that’s not enough.
There are many reasons for the staffing shortage—from low pay to the rigorous training requirements. The changing economy in rural communities is chief among them.
The Mount Hope-Funks Grove Fire Protection District is based in McLean. With 15 people on staff—mostly volunteers—the department provides fire and EMS (ambulance transport) services to around 1,450 people across 96 square miles.
Like many other small towns in central Illinois, McLean is largely a bedroom community, with many residents driving out of town every day to go to work—not exactly conducive to being on-call to jump in an ambulance at the drop of a hat.
“It used to be that one parent or the other would stay home, or one or the other wasn’t working. Or you only had one job,” said Fire Chief Eric Fulk. “It’s not like that now. Both parents have to work. Both parents have to have double jobs to make ends meet. That’s nationwide. That’s an ongoing problem.”
So his fire department pays two full-time EMTs to cover 6 a.m. to 6 p.m. weekdays. After-hours and on the weekends, they find part-timers or use their volunteers. (Its firefighting service remains all volunteer.)
The top priority is to insulate patients from the shortage, said Mount Hope-Funks Grove EMS coordinator Brenda McCallister. They’ve done it so far, she said, but it hasn’t been easy. She’s working 36 hours of paid time each week. But she’s regularly picking up 100+ hours of volunteer on-call time too. So is Fulk.
“It’s very difficult for those of us who are left behind,” McCallister said. “It could be my family. It could be (Fulk’s) family. I’m not gonna face that person at the post office tomorrow and answer that question on why our ambulance did not respond.”
Fulk, a 19-year veteran of the service, said the system will crash without volunteers. If departments can’t sustain their EMS service—with volunteers or paid help, or both—then those calling 911 may have to wait for another community’s ambulance to drive into town.
“It’s time consuming. It takes away from people’s lives. But somebody has to do it,” Fulk told GLT. “If you don’t have anybody there to do it, then your family is gonna suffer and these communities won’t have nothing.”
Part of the problem is budgetary. Fulk’s department is supported largely by property taxes, plus additional revenue from reimbursements for ambulance rides, grants, and charitable gifts. A shift to an all-paid EMT and firefighter service—like what’s offered in Bloomington-Normal—would drive taxes through the roof, Fulk said.
In fact, the time donated by volunteer firefighters saves localities across the U.S. an estimated $46.9 billion per year, according to the National Volunteer Fire Council.
Wilson said low reimbursement rates for Medicare (around 40% recovery rate) and Medicaid (10-15%) patients are a big problem for EMS agencies.
“They respond, and they’re losing money every single time,” Wilson said.
Those with private insurance do full provide reimbursement. But rural communities, with more low-income residents, tend to have disproportionately higher numbers of Medicaid patients, Wilson said.
Low Pay, High Stress
To maintain 24/7 service, the Mount Hope-Funks Grove Fire Protection District taps into a pool of paid, part-time, basic-level EMTs who work in and around McLean County. But many of them are working long hours for multiple departments to try and make ends meet. That’s because EMTs don’t make that much money. The average hourly wage is between $8.75 and $12, Wilson said.
Wilson himself worked for several departments when he first started: Heyworth, Lexington, and even Mount Hope-Funks Grove.
“I spent a lot of time at different agencies just trying to make enough money to live,” Wilson said.
It’s an important job to ask someone to do for just over minimum wage.
“When you show up and somebody’s asking you to save their loved one, and you’re getting minimum wage for that … that’s why they work multiple jobs, to make extra money to pay the bills,” Wilson said.
"We gotta start stepping up to the plate as citizens."
There is a lot of turnover among EMTs, he said. One reason is the stress of the job.
“If you constantly have to go out and see these horrific things over and over again, within a couple of years people get burned out. EMS has a high burnout rate,” he said.
More rigorous training requirements are a key reason for the nationwide staffing shortage, according to the National Volunteer Fire Council. You can earn your basic EMT license in about one college semester, Wilson said. Heartland Community College offers the training. The more advanced paramedic license takes around two years.
It takes a lot of work to maintain that license. CPR certification has to be renewed every two years, requiring a four-hour class. A four-year renewal of an EMT license requires 60 hours of continuing education. The Mount Hope-Funks Grove fire department has a mandatory two-hour training once a month, plus a weekly meeting.
“There’s nothing wrong with certification and training, especially with the EMS arena. You want the best care you can get,” said Steve Hirsch, NVFC chair and a volunteer firefighter in Kansas. “But in small communities, when you make it so difficult to comply with, what good is it if you don’t have any service?”
Simply put, there are a lot of volunteer opportunities that take up a lot less time.
“You have someone who lives in a rural community, they’re a farmer, they work all day. They work late into the evening, and then have to come to class all night,” Wilson said. “It’s a lot of work. A lot of stress. So we’re trying to make it a little easier.”
That means trying to move more of the training online or into hybrid online/in-person settings, Wilson said.
Efforts are also underway nationwide to recruit more volunteers, including the National Volunteer Fire Council’s Make Me A Firefighter initiative, funded in part by a FEMA grant. The website MakeMeAFirefighter.org can connect prospective recruits to needs in their area.
“People in their communities are really gonna have to step up here, because when my house is on fire, I want somebody to respond. And the community is not gonna have full-time firefighters,” Hirsch said. “I need somebody to show up. You need somebody to show up. We gotta start stepping up to the plate as citizens.”
National EMS Week is May 19-25. There are several events planned in McLean County.
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