Retirements shrinking ranks of Minn.'s rural medical responders

For 23 years, Joe Mercil stayed within earshot of an emergency radio as he lived and worked in tiny Brooks, Minn., ready to rush to the medical aid of anyone in his community who needed it. As a volunteer first responder, he tended to more than his share of bloody car crashes, heart attacks and other problems as he stabilized patients until the ambulance got there. It was stressful, physically demanding work.

So when Mercil turned 64 last year, he decided it was time for him and his wife to retire. Now the town of 140 has only one first responder left.

"We were the only ones in town that were on it, so that's why we kind of held on," Mercil said. "I decided it was time for me to quit and let the younger people take over, but you can't get anybody in these towns to take over. … The first question they ask is 'How much money do you make?' They don't realize you're [a] volunteer."

Emergency medical service in rural Minnesota is approaching a dangerous dearth of volunteers as baby boomers age out of the demanding work and into needing more care themselves, emergency service leaders say. The shortage is hitting patient-stabilizing first responder groups as well as volunteer ambulance workers who rush to transport patients.

An estimated 60 percent of emergency medical technicians (EMTs) and paramedics are volunteers in the state's approximately 200 rural ambulance services, industry analysts say. First responders are almost completely volunteer.

Already the shortage of recruits has shuttered some small emergency squads, lengthening response times as ambulances race to help from farther away. Emergency service leaders say the problem will only get worse and they will have to get creative with solutions, likely by mixing in some paid staff and figuring out a way to pay for them.

"I think we stand at a critical point," said Mark Schoenbaum, who directs the state health department's Office of Rural Health and Primary Care. "Given [baby boomers'] predominance in the rural EMS volunteer workforce, in 10 years few of them will still be on the scene."

'A scary situation'

Rural regions of the state have a disproportionately aging population, with 17 to 18.5 percent of residents in northwest, southwest and west central Minnesota now age 65 or older, compared to 11.5 percent in the Twin Cities. Those percentages will continue to grow. By 2020, at least 21 percent of residents in those rural regions will be older than 65, according to state estimates; by 2030, that figure should swell to more than 26 percent.

Ambulances charge for calls, but rural areas see so few calls that many struggle to maintain expensive equipment and training, let alone pay workers. In rural Minnesota, more than 70 percent of payments come from Medicare and Medi­caid, which sets its own price, according to the Minnesota Ambulance Association.

"That pays us below cost and it's a huge part of our population," said Buck McAlpin, the group's lead lobbyist.

Retirees also are spending more time at cabins in the lakes regions, stretching volunteer services to their limits there, service leaders say.

From Floodwood in northern Minnesota, Lori Schumacker directs an ambulance service that covers roughly 400 square miles in an area where more cabins have been built. The service has 10 volunteers handling two or three calls a week, down from 20 volunteers several years ago when they had slightly fewer calls, Schumacker said.

"It's the older population that we're getting the calls for," she said. "Heart issues, trouble breathing, they just don't feel right, falls within a home."

It would take 45 to 50 minutes to bring an ambulance in from elsewhere, so Schumacker, a 40-year-old financial analyst and mother of two teenagers, finds herself on call about 60 hours a week. She's missed family birthdays and Christmas and sometimes is gone in the middle of the night.

"You're giving back to people that need you," she said.

The state Emergency Medical Services Regulatory Board didn't have statewide statistics on the age of patients calling for help, though numbers are available for some specific areas.

The Le Sueur Ambulance Association, which answers about 400 calls a year, has seen its percentage of calls from patients 65 or older rise to 46 percent last year from 39 percent in 2011, President Pam Williams said.

The closing of rural nursing homes is also putting a strain on ambulance services, said Patrick Lee, executive director for Arrowhead EMS, which represents seven northeast counties. Instead of sending loved ones to care centers dozens of miles away, people are making use of 911, he said.

With so few volunteers "it's getting to be a scary situation," he said. "Knowing that a loved one could call 911 and unfortunately there's not a crew that can respond. It's a huge issue."

Expensive solutions

Business hours are the most difficult to staff with volunteers.

Most recruits have full-time jobs far away from their rural homes. In a difficult economy, many employers haven't been as flexible in allowing workers to leave when alarms go off, officials said.

Though some services pay small amounts, such as $2 an hour to be on call and stipends for each run made, that money mostly covers expenses such as ruined clothes at bloody accidents, volunteers say.

In Two Harbors, the ambulance service applied for equipment grants and trimmed its budget to hire paid staff about a year ago after struggling with volunteer shortages, Director Danielle Deneui said. They are considering a fundraising campaign this summer.

The ambulance service owned by townships surrounding Zumbrota has resorted to hiring, too, adding two paid daytime paramedics to a team of 24 volunteers. Last year, they covered more than 800 calls over 330 square miles, mostly in Goodhue County, which has seen its 65-and-older population rise from 15 percent to 18 percent over a 12-year span.

Managers there set up a training facility for the region as a way to earn revenue and draw more recruits.

Jamie Sommer, a 34-year-old hair stylist in Wanamingo, sat in a four-hour, twice-weekly class Thursday night, part of more than 100 hours of EMT instruction, learning the protocols for assessing a patient. She had always wanted to try being a medical responder, she said, and the class near her home was a good opportunity to sign up.

She hovered over a fellow student lying on the floor, practicing how to check someone for injuries as others watched. Even the practice was making her sweat with adrenaline.

When she finished, she raised her arms with relief and smiled: "Saved you! You are alive! Woo!"

Shutting down

Having to shut down a service isn't always a bad thing, though. In the southwest Minnesota town of Belview, when the ranks of volunteer EMTs dwindled to five, leaders closed the ambulance service more than a decade ago. Its vast territory is now covered by surrounding services, many of which use highly trained paramedics. Town leaders have found it easier to recruit local first responders because that role requires less training and commitment.

The Minnesota Ambulance Association is promoting legis­lation to put a $10-a-year assessment on auto insurance policies to help fund trauma training for ambulances, hospitals and other responders.

Some ambulance services with paid staff also are starting to train workers to be community paramedics, allowing them to make checks on residents while they wait for emergency calls and bring the service more income.

Near Brooks in northwest Minnesota, where Mercil and his wife are enjoying life without a squawking emergency radio, Mike Dessellier needs more volunteers. As president of the Oklee ambulance service 8 miles away, he covers 100 square miles with nine volunteer EMTs and five first responders, many of whom work 30 miles away in Thief River Falls. An assisted-living facility opened in Oklee a few years ago, he said. The usual 80-or-so service calls is now up to 140.

"Anything we can take as far as new members, we more than welcome them," he said.

Dessellier, 57, has been on the ambulance squad for 37 years. He's hoping to retire soon.

Pam Louwagie • 612-673-7102