Jul. 29—Who do you call when you have a medical emergency?
For many South Dakotans, they call their local volunteer ambulance service. Those emergency medical service workers rush to the location of the call, provide medical assistance on site to those in need before transporting them, if necessary, by ambulance to a hospital or other facility to continue their care.
They have saved countless lives over the years, but the number of volunteers is beginning to dwindle, with an increasingly older corps of emergency medical technicians eyeing retirement and a shortage of new, young volunteers stepping up to take their place.
It's a difficult situation for a number of reasons, Eric Van Dusen, president of the South Dakota EMS Association, which represents about 1,100 emergency medical services personnel around the state, told the Mitchell Republic recently. Low pay, educational and training requirements and a faster-paced modern lifestyle has made it difficult to draw new volunteers to the fold.
"It's a 24/7 commitment to ensure communities are kept safe, but our potential workers are opting out of health care," Van Dusen said.
South Dakota has experienced a general exodus of educated, skilled residents over the years, losing them to states they feel better fits their lifestyle, careers or recreational goals. The impact of that flight can be felt in many aspects of South Dakota, and emergency medical services and volunteerism is definitely one of them.
Van Dusen said the problem goes beyond South Dakota — it's a growing nationwide both with volunteer and career path technicians. Bringing in younger volunteers can be difficult because of the changes in the way people live in the modern world, which can move faster than it did in decades past, making it seem as if there is less time for volunteerism.
"As the aging EMTs move on, there is less of a pull. It's just the way people live their lives. We've gotten very busy, and the priority is no longer serving the community, it's keeping up with the kids," Van Dusen said.
People who become emergency medical technicians don't get into the field for the money, Van Dusen said, but the relatively small stipend most volunteers make on their ambulance runs are less than what they could make part-time at a standard 9-to-5 job.
"Arby's is paying higher than what EMTs get paid," Van Dusen said.
Nicole Neugebauer, director for Douglas County Ambulance in Armour, knows well the difficulty that can come with trying to maintain a robust EMT staff. She is down to seven volunteers with her service, and of those five are regularly active. That's around half of what she would consider to be a comfortable number to have available for emergencies.
"Arby's is paying higher than what EMTs get paid."
— Eric Van Dusen, president of the South Dakota EMS Association
"We're actually struggling for staffing right now. Up to about a year ago we were doing OK, but we lost a few and we're not finding people to do it," Neugebauer said.
She said the average age of her staff is in their 40s, with most being in their 40s or older. Like Van Dusen, Neugebauer said many potential young emergency medical technicians have concerns about the constant on-call nature of the job and the uncertainty of scheduling. If they have children, they may prioritize family time when they're not working at their full-time job.
"They're (unsure of) being on call with having small children and how that works," Neugebauer said. "(The older EMTs) don't necessarily have little kids at home."
Paying their volunteers their stipend for ambulance runs — and paying the bills in general — can be tricky. Neugebauer said her service doesn't operate an ambulance district, meaning it doesn't draw its own tax dollars to support it. Instead, Douglas County provides support to it and a second ambulance service in the county. The service gets by on that county help, donations and fundraisers.
Neugebauer said she encourages potential recruits to explore training options and incentives. Some municipalities will offer to pay for EMT certification courses if they agree to serve with the local ambulance service for a set period of time. Other options include classes provided by groups like Avera and Sanford that can open the door to opportunities not only as an EMT, but other areas of the medical profession.
But bringing young people into the fold continues to be a challenge, she said. Some of the solution may be to increase awareness of the importance of rural services like an ambulance.
"I think that's a big part of it — awareness," Neugebauer said.
Josh Andersen, EMT captain and fire chief for the Freeman Fire Department, is in a slightly better position with 15 on staff with his ambulance service, with the youngest being 32 and an average age of about 50.
But scheduling is still difficult, and as new volunteers slowly stop stepping forward to take the place of retiring members, tougher days could lie ahead for many rural ambulance services.
"I think the writing is on the wall. Something has to change in the next four or five years or there won't be an ambulance service in a lot of small towns," Andersen said.
Andersen, 43, who also works as a firefighter in Sioux Falls, said he had been with the Freeman service for 13 years and is still the second-newest person on staff. That demonstrates how slowly new EMTs are coming into the fold, he said.
"I think the writing is on the wall. Something has to change in the next four or five years or there won't be an ambulance service in a lot of small towns."
— Josh Andersen, EMT captain and fire chief for the Freeman Fire Department
It can be stressful being a volunteer, Andersen said, even if it's something you like doing.
"We're not going to be immune to people retiring in the next few years. After that, I don't see a big influx of people coming in," Andersen said. "It's a volunteer service. We get paid for calls, but everyone has a full-time job and may not work in town, and when they come home from work they don't want to put in time doing this."
In a statement, the South Dakota Department of Health said there were several factors that are contributing to the shortage, including a change in the state's demographics, which shows younger people flocking towards cities for socioeconomic reasons, creating a disconnect between the needs of a particular community and the level of involvement many have with smaller towns. Many potential volunteers may work full-time in another community, leaving them unavailable during the day for emergency runs.
In addition to classes from groups like Sanford and Avera, Gov. Kristi Noem, the South Dakota Department of Health and the South Dakota legislature are considering the Recruitment Assistance for Healthcare Professionals program, which helps ensure the recruitment of EMTs in South Dakota to better serve the public needs and help smaller communities improve/retain EMT coverage. Highlights of the program include:
Reimbursing educational costs for EMTs and paramedics in South Dakota, if after training, they go on to serve a community of less than 3,000 residents.
This program has cleared the appropriation process with considerable support and the governor's office has backed it.
Daniel Bucheli, a spokesman for the SDDOH, said finding ways to bolster rural emergency services is crucial to the quality of life for South Dakota residents.
"The decrease of the EMT workforce is not only a challenge in South Dakota, but for all rural states nationwide. A decrease in this workforce could mean an increase in service call wait times, limited access to medical personnel in emergencies and many having to depend on medical care or services not within their immediate vicinity or community," Bucheli said. "(Becoming an EMT) is an amazing opportunity to serve your community and help others. We would encourage those interested in pursuing this career track to consider volunteering and getting to know what the profession entails by speaking with those who currently are involved in EMT."
Neugebauer agrees. She said she would do everything she could to keep her service up and running. Advice and guidance is available by contacting your local ambulance service and asking about options, she said.
She knows the importance of a rural ambulance service, and she hopes more young volunteers find it to be an attractive way to give back.
The future of her ambulance service, and others, may depend on it.
"We're bound and determined. Never say never. I hope we never close, but you really don't know," Neugebauer said.