Rural hospital closures force patients in affected communities to travel longer distances for specialized or emergency care. A new study from the University of Minnesota School of Public Health shows that such closures place similar strain on emergency medical service (EMS) providers trying to get patients to the hospital or another facility as quickly as possible.
The study was led by Associate Professor Sayeh Nikpay and recently published in the journal Academic Emergency Medicine.
…
The study found:
The average length of ambulance trips for municipal EMS agencies went up 22% in locations of recent rural hospital closures.
The average length of ambulance trips for private EMS agencies increased 10% in those areas.
Interfacility transfers and non-emergency EMS trips fell by 31% for all agencies.
The total number of trips did not change, likely because many agencies are already operating at full capacity and must prioritize emergency calls over transfers and non-emergency transportation after hospitals close.
HRSA | Federal Office of Rural Health Policy Update | May 13, 2021
What’s New
CDC and USDA Team Up for Vaccine Education Effort. The Centers for Disease Control and Prevention (CDC) is providing $9.95 million in funding to the U.S. Department of Agriculture’s USDA) National Institute of Food and Agriculture (NIFA) to improve vaccine confidence in rural areas. NIFA will work with local partners through the Land Grant University System and its Cooperative Extension System, a nationwide educational network that provides non-formal higher education and learning to farming communities.
HRSA COVID-19 Coverage Assistance Fund. The Health Resources and Services Administration (HRSA) will provide claims reimbursement at the national Medicare rate for eligible health care providers administering vaccines to underinsured individuals. This may be particularly helpful in rural communities given higher rates of uninsured and underinsured.
HHS/DoD National Emergency Tele-Critical Care Network. A joint program of the U.S. Department of Health & Human Services (HHS) and the U.S. Department of Defense (DoD) is available at no cost to hospitals caring for COVID-19 patients and struggling with access to enough critical care physicians, nurses, respiratory therapists and other specialized clinical experts. Teams of critical care clinicians are available to deliver virtual care through lightweight telemedicine platforms, such as an app on a mobile device. Hear from participating clinicians and email to learn more and sign up.
HHS Coordinates New Effort to Vaccinate Migratory/Seasonal Workers in Agriculture. The U.S. Department of Health & Human Services (HHS) is working with several divisions, including the Food and Drug Administration and the Health Resources and Services Administration to boost vaccination rates in a workforce often at heightened risk of COVID-19 infection.
RAND/RWJF Report: COVID-19 and the Experiences of Populations at Greater Risk. The RAND Corporation joined with the Robert Wood Johnson Foundation (RWJF) to examine the way people view health issues. Researchers asked people in the United States about their experiences related to the pandemic, and their views on issues such as freedom, racism, and the role of government.
COVID-19 Resources
New:FCC Emergency Broadband Benefit Program. The Federal Communications Commission (FCC) created this temporary program to help eligible individuals and households afford internet service during the pandemic. Eligible households can enroll through an approved broadband service provider or by visiting GetEmergencyBroadband.org. The program will end when the fund runs out of money, or six months after the U.S. Department of Health and Human Services declares an end to the COVID-19 health emergency, whichever is sooner.
Volunteer to Administer COVID-19 Vaccines. The U.S. Department of Health & Human Services has expanded its definition of persons authorized to give the vaccine. These include, among others, current and retired traditional and non-traditional health care professionals, and students in health care programs.
HHS Facts About COVID Care for the Uninsured. The U.S. Department of Health & Human Services (HHS) helps uninsured individuals find no-cost COVID-19 testing, treatment and vaccines. The HRSA Uninsured Program provides claims reimbursement to health care providers generally at Medicare rates for testing, treating, and administering vaccines to uninsured individuals, including undocumented immigrants. There are at-a-glance fact sheets for providers and for patients in English and Spanish.
COVID-19 FAQs and Funding for HRSA Programs. Find COVID-19-related funding and frequently asked questions for programs administered by the Health Resources and Services Administration (HRSA).
CARES Act Provider Relief Fund Frequently Asked Questions. Includes information on terms and conditions, attestation, reporting and auditing requirements, general and targeted distributions, and how to report capital equipment purchases.
CMS Coronavirus Partner Resources. The Centers for Medicare & Medicaid Services (CMS) provides information for providers, health plans, state Medicaid programs, and Children’s Health Insurance Programs and holds regular stakeholder calls to provide updates.
HHS Coronavirus Data Hub. The U.S. Department of Health & Human Services (HHS) website includes estimated and reported hospital capacity by state, with numbers updated daily.
NIH Community Engagement Alliance Against COVID-19 Disparities. The National Institutes of Health (NIH) created a collection of online resources with information for communities hit hardest by the pandemic, such as African Americans, Hispanics/Latinos, and American Indian/Alaska Natives.
COVID-19 Data from the U.S. Census Bureau. The site provides access to demographic and economic data, including state and local data on at-risk populations, poverty, health insurance coverage, and employment.
ATTC Network COVID-19 Resources for Addictions Treatment. The Addiction Technology Transfer Center (ATTC) Network was established in 1993 by the Substance Abuse and Mental Health Services Administration. The online catalog of COVID-related resources includes regularly-updated guidance and trainings for professionals in the field.
Mobilizing Health Care Workforce via Telehealth. ProviderBridge.org was created by the Federation of State Medical Boards through the CARES Act and the FORHP-supported Licensure Portability Program. The site provides up-to-date information on emergency regulation and licensing by state as well as a provider portal to connect volunteer health care professionals to state agencies and health care entities.
Online Resource for Licensure of Health Professionals. Created by the Association of State and Provincial Psychology Boards, the site provides up-to-date information on emergency regulation and licensing in each state for psychologists, occupational therapists, physical therapists assistants, and social workers.
Funding and Opportunities
Nurse Corps Scholarship Program – extended to May 26. The Nurse Corps Scholarship Program provides financial support to students enrolled in nursing degree programs in exchange for a commitment to serve in high-need areas across the country. This year, Nurse Corps has additional funding for qualified nursing students that includes tuition, fees, other reasonable educational costs, and a monthly living stipend.
DOJ National Tribal Clearinghouse on Sexual Assault – June 3. The U.S. Department of Justice (DOJ) will make one award for $980,000 to an organization that can provide nationwide training and technical assistance for response to sexual assault crimes and services for victims in American Indian/Alaska Native communities.
DOJ Comprehensive Opioid, Stimulant, and Substance Abuse Site-Based Program – June 7. The U.S. Department of Justice (DOJ) will make 110 awards with total funding of $163 million to support state, local, tribal, and territorial response to use of illicit substances. A subcategory of the program will award up to $600,000 each for projects in rural areas, small counties, and tribal areas with a population of fewer than 100,000 for a federally recognized tribe.
DOJ Second Chance Act Youth Offender Reentry Program – June 15. The U.S. Department of Justice (DOJ) will make 13 awards of up to $750,000 each to support youth returning to their communities from correctional facilities. The program encourages collaboration between state agencies, local government, and community- and faith-based organizations. Separately, the DOJ will make approximately 15 awards of up to $750,000 each for the Juvenile Drug Treatment Court Program – June 15.
USDA Local Food Promotion Program – June 21. The U.S. Department of Agriculture (USDA) will make grants of up to $200,000 each for planning grants, and up to $750,000 for implementation grants. Grant recipients will create or expand projects that increase the availability of locally produced food.
DOJ Strategies to Support Children Exposed to Violence – June 22. The U.S. Department of Justice (DOJ) estimates eight awards with total investment of $7 million to support community-level strategies for children exposed to violence. Priority consideration will be given to applications promoting civil rights, building trust between law enforcement and the community, and that are intended to benefit high poverty areas.
HUD Housing Opportunities for Persons with AIDS – July 6. The U.S. Department of Housing and Urban Development (HUD) will make 18 awards of up to $2.25 million each for community projects that provide housing for people with HIV/AIDS in underserved areas. Rural populations are among those of interest for ensuring health equity. Also known as Housing as an Intervention to Fight AIDS, the program aims to create housing and service models that can be replicated in other similar localities.
Rural Health Research
Research in this section is provided by the HRSA/FORHP-supported Rural Health Research Gateway. Sign up to receive alerts when new publications become available.
Medicare-Paid Naloxone: Trends in Nonmetropolitan and Metropolitan Areas. Previous research has found that Medicare paid for an increasing share of naloxone prescriptions from 2016 to 2018 and pays for 1/3 of all naloxone dispensed from retail pharmacies as of 2018. This brief from the Rural and Underserved Health Research Center examines trends in Medicare-paid naloxone dispensing rates in nonmetropolitan versus metropolitan areas from 2014 to 2018.
Request for Information on Advancing Equity and Support for Underserved Communities – Comments due July 6. The Office of Management and Budget (OMB) seeks input from a broad array of stakeholders in the public, private, advocacy, not-for-profit, and philanthropic sectors, including State, local, Tribal, and territorial areas, on available methods, approaches, and tools that the Government can use to promote equity and support underserved communities.
Increased Medicare payment for COVID-19 monoclonal antibody infusions. The Centers and Medicare & Medicaid Service (CMS) announced last week an increase in the national average payment rate for administering monoclonal antibody treatments for COVID-19 from $310 to $450 for most health care settings. Additionally, they have established a higher national payment rate of $750 for monoclonal antibody treatments administered in a beneficiary’s home, including the beneficiary’s permanent residence or temporary lodging. CMS is updating its COVID-19 toolkits for providers, states, and insurers to reflect this change.
Medicare Guidance on Interoperability Rule Requirements for Hospitals. This interpretive guidance from the Centers for Medicare & Medicaid Services (CMS) outlines the Conditions of Participation (CoPs) requiring hospitals, psychiatric hospitals, and Critical Access Hospitals (CAHs) to send electronic patient event notifications of a patient’s admission, discharge, and/or transfer to another healthcare facility or to another community provider or practitioner, which are effective as of May 1, 2021. These CoPs were finalized in the May 2020 Interoperability and Patient Access Final Rule and are addressed in the recently released Interoperability Final Rule FAQs.
Medicare Waiver for Ambulance Treatment in Place. This Fact Sheet describes the circumstances in which ground ambulance services may be reimbursed by Medicare for treatment provided in place because a patient was not able to be transported to a destination permitted under Medicare regulations due to community-wide emergency medical service (EMS) protocols due to the COVID-19 PHE. This waiver is retroactively effective to March 1, 2020.
Learning Events and Technical Assistance
ONDCP Workshop for SUD: Rural Faith-Based Leaders – Thursday, May 13 at 1:00 pm ET. The Office of National Drug Control Policy (ONDCP) will hold a second session (90 minutes) in its series for faith leaders in rural areas. The workshops are meant to increase understanding of substance use disorder (SUD) and provide guidance on connecting faith to prevention, treatment, and recovery. If you would like to attend, please RSVP to Betty-Ann Bryce, Special Advisor for Rural Affairs at MBX.ONDCP.RuralAffairs@ondcp.eop.gov with your name, title, organization, state/county, and contact information/email address. The Rural Health Information Hub has a recording of the first workshop for faith leaders in its Community Toolbox for SUD.
HRSA Telehealth Series: Learn About Licensure Compacts – Monday, May 17 at 12:30 pm ET. Experts from the National Center for Interstate Compacts will discuss agreements for doctors, nurses, psychologists and other clinicians to see patients across state lines via telehealth.
SBIRT for SUD Native American Communities – Tuesday, May 18 at 11:00 am ET. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a process to quickly assess substance use disorder (SUD) in a person and move them toward more extensive treatment. This hour-long session is hosted by the National American Indian & Alaska Native Prevention Technology Transfer Center.
AgriSafe: Zoonotic Disease and Pregnancy – Wednesday, May 19 at 1:00 pm ET. The AgriSafe Network will hold a one-hour session to explain the risk that diseases transmitted between farm animals and humans pose to pregnant women.
Overcoming Mental Health Stigma in Rural Communities – Wednesday, May 19 at 2:00 pm ET. The Mental Health Technology Transfer Center Network will host a one-hour workshop to discuss what influences negative attitudes toward mental health and techniques to overcome various forms of stigma.
SAMHSA Connecting Prevention Specialists to Native Communities – Friday, May 21 at 1:00 pm ET. The Tribal Training and Technical Assistance Center at the Substance Abuse and Mental Health Services Administration (SAMHSA) holds virtual trainings to cover topics such as crisis response, youth engagement, and sexual assault awareness. Trainings will take place on the third Friday of each month.
DEADLINE REMINDER: Apply now for rural EMS training and recruiting grants
Eligible applicants from rural EMS agencies are encouraged to submit applications before March 18, 2021
EMS organizations planning on applying for a Rural EMS Training Grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment must submit applications by March 18. SAMHSA plans on awarding up to $5.5 million in awards to help eligible agencies recruit and train personnel. More information is available on SAMHSA’s website.
In recognition of the great need for emergency services in rural areas and the critical role EMS personnel serve across the country, SAMHSA plans on funding up to 27 projects, with a maximum of $200,000 per grant awardee. Eligible applicants include rural EMS agencies operated by a local or tribal government (fire-based and non-fire based) and non-profit EMS agencies.
Developed by the Rural Health Information Hub: This toolkit provides rural communities with the information, resources, and materials they need to develop a community health program in a rural community.
Each of the toolkit’s six modules contains information that communities can apply to develop a rural health program, regardless of the specific health topic the program addresses. The toolkit also links to issue-specific toolkits for more in-depth information.
Happy National Rural Health Day! Thank you to all of the ambulance service providers who work hard providing life-saving treatment in rural areas every day.
In part of our ongoing advocacy efforts, the AAA sent a letter today to the Rural Caucuses in the United States Senate and House of Representatives. Addressed to leadership of the caucuses, Sen. Pat Roberts (R-KS), Sen. Heidi Heitkamp (D-ND), Rep. Adrian Smith (R-NE), and Rep. Tim Walz (D-MN), this in-depth letter highlights the critical work that our members do every day around the country and raises important issues affecting the industry. Issues covered in the letter include:
Stabilizing the Ambulance Fee Schedule
Make the add-ons permanent and build them into the base rate
Use new data from the ambulance cost collection program to ensure reimbursement is adequate going forward
New data should be used to assess the problems with the current ZIP-code methodology for determining rural and super-rural services
Ambulance Fee Schedule Reform
Proposed alternative models for rural ambulance services
Encouraging Congress to look at alternative destination options for ambulance service providers
Recognizing Ambulance Services as Providers of Health Care
Moving non-fire-based ambulance services from suppliers to providers under Medicare
The letter also highlights some of the burdensome regulations facing ambulance service providers that the AAA has recommended Congress address through its Red Tape initiative. These include:
Removing Unnecessary Regulatory Burdens:
Reduce the burdens created by the Physician Certificate Statement
Simplify the 855B Ambulance Enrollment Form
Address burdensome requirements of the patient signature on claims and the strict application of the revocation of billing authority
This letter from the AAA to Congressional leaders is just one part of the AAA’s ongoing effort to educate Congress on the crucial role ambulance service providers play in America’s healthcare system. The AAA wants Congress to know that in many rural areas of the country, ambulances are the medical safety net, yet face extreme challenges to staying in business thanks to below cost reimbursement and burdensome regulations. The AAA will continue to pursue this list of priorities with our members next year and going forward.
Again, Happy Rural Health Day to our members – thanks for all that you do!
If you have any questions about our letter or rural advocacy, please contact us:
Questions?: Contact Us
If you have questions about the legislation or regulatory initiatives being undertaken by the AAA, please do not hesitate to contact a member of the AAA Government Affairs Team.
Tristan North – Senior Vice President of Government Affairs tnorth@ambulance.org | (202) 802-9025
Ruth Hazdovac – AAA Senior Manager of Federal Government Affairs rhazdovac@ambulance.org | (202) 802-9027
Aidan Camas – Manager of State & Federal Government Affairs acamas@ambulance.org | (202) 802-9026
Thank you for your continued membership and support.
The transcript below was lightly edited for clarity.
Amanda Riordan: Thank you for joining us today. My name is Amanda Riordan, and I am the vice president of member services for the American Ambulance Association. I’m also the administrator for the Professional Ambulance Association of Wisconsin. I’m so happy to have the opportunity to interview John Eich, the director of the Wisconsin Office of Rural Health. John is an exceptional contributor to rural health in Wisconsin. He’s also a sterling advocate for the power of EMS to assist with public health in the least accessible areas of Wisconsin. I’ll ask John a couple of questions today about the recent Rural EMS Listening Sessions that he conducted in a number of areas across the state. John, thanks again for joining us. Would you mind telling me a little bit about your background and how you became the director of the Wisconsin Office of Rural Health?
John Eich: I appreciate your inviting me to talk about some of our programs, so thank you. I took a bit of a wandering path: I’ve done everything from carpentry and marketing to social work with homeless teens. I found my way to community [service] down in southern New Mexico. I caught the bug there working on behalf of the community and society at large. When I moved back home up to Wisconsin—I grew up in a rural area here in southern Wisconsin—I saw an opening and at the Office of Rural Health. I’ve been on board ever since, and it’s a lot of fun.
Amanda Riordan: Thanks so much. And we’re so glad you took the position. Would you mind sharing a little bit about why EMS is so important to rural health?
John Eich: If you’re not familiar with an office of rural health, we receive mostly federal funding to work on the state level. There’s an office in every state in the nation. Here in Wisconsin, we are funded mostly, I would say, to work with rural hospitals and EMS, and we find that EMS is one of the areas of greatest need. Every piece of the healthcare delivery system has its challenges and its strengths. EMS, I think by the nature of having formed itself—at least rural EMS formed itself—around the model of volunteer services. In my estimation, it has sort of painted itself into a corner. It started when medicine was not as complicated, and when populations, were not expecting as much. You were helping out your neighbors by getting somebody to a hospital. It has since evolved in a good way.
[EMS has] evolved into a healthcare profession. And so there are a lot more demands. There’s a lot more education; continuing education, learning new techniques that are lifesaving. Society depends on it. But that means that these volunteer services that started off small are under increasing pressure. That’s why we are trying to dedicate as many of our resources as we can to helping out that system within Wisconsin, and it’s paying great dividends. We’ve always really enjoyed our interactions with EMS. I think it takes a particular kind of person to do it. We just really enjoy our time with those who do the work. That led us to doing what we’re calling a “Rural EMS Listening Session.” So we did five of these sessions around the state in rural areas, and we intend to do a few more.
Part of the idea was that so often policy in general happens in urban centers. In EMS policy, because the state capital is down in the very southern part of the state and Milwaukee, the largest city is also down in the southern part of the state, the rural areas of the state (which most of the rest of it) tend to feel ignored or unheard. It’s much harder for them to participate. So if somebody has to drive five hours to go to a meeting that would take [a city resident] 15 minutes to drive to, that’s a disparity in access and it’s a disparity in having your voice heard. So we decided that it was important to go listening where rural EMS is practicing. So we did that, and are continuing to do so.
It’s been very eye opening. Obviously there was a lot that we expected to hear that we did hear. I mean, there’s, there’s not a lot new here. People in EMS know what the issue is as someone said these are the same ideas we’ve been talking about for the last 20 years or more. And that’s very true. We like to believe that it’s time for things to change. We’ve been talking about this long enough. Maybe we should do our best to push the issues forward. And that’s phase two of these listening sessions: take what we heard and get it into the hands of advocates, like the EMS associations, fire associations, et cetera, and other advocates like the Office of Rural Health that try to speak on behalf of the needs of EMS. I do think I’m optimistic that legislators want to help. When they’ve been presented with bills, they’re interested. Money is always an issue, but I would say that they definitely want to be part of a solution. So, it’s all of our jobs to make sure that they have the right solutions and presented to them.
Amanda Riordan: I think that’s a great segue to one of your other very popular innovative programs in Wisconsin. The Office of Rural Health actually helped put together the EMS at the Capital Day event in 2017. Would you mind telling us a little bit more about what that entailed and the groups that participated?
John Eich: Absolutely. So again, as we work with all parts of the healthcare delivery system, we work with hospitals and clinics and providers; physicians, PAs/physician assistants, nurse practitioners, the nurses that staff the hospitals and clinics and home health services. When we look at EMS, it always strikes me how it has a level of splintering that I don’t see in other professions. In other professions, they’ve managed to sort of circle the wagons and get on the same page and present a united face to push forward their vision and their legislative goals. EMS, for whatever reason. I’m not sure why it seems to have done the work but also, identified a number of differences. You can be a paid or career staffer versus a volunteer. You can work in a rural service versus an urban. You can be in fire versus EMS. You could be a Paramedic or you could be a Basic EMT or an Emergency Medical Responder. Each of those areas, each of those groups, sort of huddle and identify amongst themselves. I would like to see them working more cohesively together and I’m sure they would as well.
The effort that that led to an EMS Day at the Capital was to try and get all of the disparate groups together and on the same page. All of them had been working very diligently on the issues that were important to them, and I think there is a lot of overlap. As one of the participants said, “We can agree on a 80 percent of the issues, we may disagree about the 20 percent, but let’s work on the 80 percent and when we get that done, then we can disagree about the rest of them.”
So that was the goal that brought the groups together. So we were lucky to be able to get the two EMS associations in the state, the state fire chiefs, and the professional firefighters. The state EMS board joined in with us as well as they could, in more of a listening capacity. We created a wish list of legislative issues and a lot of it was centered around education: who we are and what we do. And we took that to the state capital. We had tremendous turnout and we had uniforms marching through the, through the offices of the legislature both in the Assembly and the Senate. I like to think we got their attention and we plan to, as I said, take what we’re learning from this rural EMS tour, connect with our urban allies as well, and get EMS advocacy on the same page so that they can do tremendous work together.
Amanda Riordan: It was truly exciting and a privilege to witness everything that happened in November 2017 when the Professional Ambulance Association of Wisconsin, Wisconsin State Fire Chiefs Association, the Professional Firefighters of Wisconsin, and the Wisconsin EMS Association, all came together with the help of your office, the Office of Rural Health, to speak with one voice when meeting with state legislators. I think that by working together they were able to present such an incredibly compelling message to legislators and to key staff that worked with legislators. I think a lot of times people are somewhat unaware that winning over the hearts and minds of critical legislative staff is almost as important as running to over the hearts and minds of legislators themselves.
With that in mind, and with all of the successes you’ve had helping execute your vision of moving EMS and rural health forward in Wisconsin, would you mind telling us a little bit about where you see the future of rural health going in your state, Wisconsin, as well as the country in general?
John Eich: I take it you mean in EMS terms. Because there’s a lot going on in healthcare, as you know! As far as EMS goes, I think the future of EMS care is not a wholly volunteer model. I think it is at least a hybrid model, and I think the industry needs to figure out how to make that transition. I think that’s going to be a difficult and painful transition. I think it’s going to take a lot of education to the local politicians who are used to having their services and frankly to be getting a pretty good deal.
We talked recently to a small community. It was a countywide meeting, but it was held in a small community that had been [served by] a volunteer service. They said they had a core group of about five people. The chief of the service had had volunteered 4,280 hours last year. The rest of his staff [had volunteered] around the 3000-hour level. They were proud of that, understandably. They were also somewhat reluctant to consider another model in their mind. They felt that they were just fine. When I look at that from the outside, I think, “What if one of you tears an ACL as you’re getting off the ambulance rig, what if two of you get the flu really bad? Which happens!” [What happens if] then there are two calls for EMS, at the same time, while two of your staff are bedridden. That’s three people to make all those calls. I struggle with the vision of that is as sustainable.
But when the local community looked at the numbers, they said, well, it looks like as far as the taxes go, that’s about $12 per capita. I was a little horrified, and asked “is that per year?” And they said, “Oh yeah, yeah, that’s per year.” I was struck by the fact that I pay more for Netflix per month than these folks pay per year to have two highly trained individuals show up with the latest technology to save the lives of their loved ones. I’m not criticizing that, but I do think there’s an opportunity there to really examine that in the daylight. And certainly when the board realized that and looked at it, there was a lot of sort of a flurry of questions back and forth. And is this true? On and on.
I think the nature [of the matter is that] if you can possibly put the question to a citizen in a grocery store as they’re walking out with their groceries, “How much would you pay per year in your taxes to have this kind of lifesaving service?” I don’t think the answer would be $12 a year. I think it would be more, but I don’t think most citizens or politicians have been given the opportunity to really look at. I think they assume it’s already paid for. It’s part of their taxes. I think they assume that Paramedics just show up at their door. They don’t necessarily know the difference between a Paramedic and a Basic EMT or EMR. They have a great deal of faith and trust in these people, as they should. I think they’re just not aware—they’re not aware of the challenges and the lack of funding and the way the system is sort of precariously balanced on top of volunteer hours to an incredible amount. I think the future in my mind, if you look at the data and volunteerism trending down, it’s trending down across all sectors, but that is hitting EMS very hard.
If you look at staffing, we’re seeing with low unemployment that means that it’s harder and harder to fill positions. That especially happens in rural areas. People are moving to urban areas for jobs. There’s not as many people there. If they do still live in the rural area, they tend to work in a neighboring larger town or other towns, so it’s harder for them to volunteer. So I just think the data is pretty clear where we’re headed. We just culturally have to try and do some heavy lifting and change the perceptions of what a society should pay for. As Dana Sechler from the Professional Ambulance Association of Wisconsin often says, we pay for garbage collection at $138, the median per capita cost per year. Like I said, some [areas are paying just] $12 per year for EMS. Garbage is very important. I don’t mean to dismiss it, but I think we can do better for lifesavers. I see that as the primary issue.
Garbage is very important. I don’t mean to dismiss it, but I think we can do better for lifesavers. I see that as kind of the primary issue. I think another issue is certainly something we’re hearing that is in rural areas, you have a lot of Emergency Medical Responders (EMRs). They’re taking a class that is 80 hours [in duration] because they want to help their neighbors. They’re not transporting— they are showing up to be of help. But they’re taking the National Registry tests in Wisconsin, and the National Registry tests, for a lot of good reasons, is lifting the industry into a level of professionalism and knowledge that is important and necessary. But I think that certainly what we heard is that an EMR is sort of an entry level to this.
So how can we figure out a way to lower the barriers to participation, without lowering the standards of care? That’s something we need to look at. And I think frankly, as a nation, we need to look at that and have that conversation with the National Registry. I think they’re doing the work that they do, and, and in a lot of ways it’s good work, but I think they need to have feedback from their customers and all of us states are their customers. All of us need to maintain a dialogue with them and say, this is what we need. We may need critical thinking in our clinicians, but do we need it in our technicians? Do we need it in our EMRs? [For EMRs] do we need sort of tricky questions that two of them are correct and you have to sort of guess which correct answer you wanted to give? I think it’s that sort of stuff that demoralizes local people who may not be eager to take a test in the first place and are a little put off by a computerized test in the second place. Then if they don’t pass, they go right back home to their church, their gas station, and their bar and tell everybody how this impossible test is not worth their time. I’m not against the National Registry tests, but I do think that we need to have more conversation about it and we need to find ways to lower the barriers and maybe that’s preparing EMRs in a different way.
I’ve got a daughter who is preparing for the ACT [college entrance test], and she’s learning the tips and tricks. She’s in a class just to help her take that test, and a lot of it’s not even about the content. Maybe since the National Registry is modeled on these other types of tests we need to train more on not necessarily the skill levels of how to save someone’s life, but how to take a test, which seems a little weird. But if that is our standard, then we need to make sure that our people are prepared when they walk into that room.
Amanda Riordan: That makes a lot of sense. Certainly we hear feedback in both directions from a variety of different stakeholders regarding the increasing professionalization of EMS. On one end, of course, we want to honor and maintain the contributions of those mission critical volunteer providers, particularly in rural areas, and on the other hand we have the push-pull of a Paramedic, in particular, looking for additional certifications and additional recognition of mobile health care as a profession. All of that mixed together with a flat or diminishing reimbursement makes sustaining a mobile healthcare/EMS in all areas really challenging. But of course as you so aptly pointed out, it especially impactful areas of our country and in a state like Wisconsin where you have so much land mass that is in rural areas. [These issues] particularly impact states of that nature is as they look forward to an aging population and the movement of younger people into urban areas. So truly appreciate those insights and those suggestions. And it’s certainly something that I’m sure there will be continued dialogue about for years to come.
John Eich: And I would like to say that I see a real difference between a Paramedic—or in Wisconsin, we also have the Advanced EMT classification—where we are expecting them to have a body of knowledge and to be healthcare clinicians, to be making life or death decisions in the field. Absolutely. Everyone in society wants those people to be the best-trained, the most knowledgeable, at the top of their game. And the tests should reflect that. I do think that if we have someone who is a firefighter who’s driving out to a site to assist, that’s not the same as a Paramedic and I’m not saying that they shouldn’t be trained and there shouldn’t be a gates for them to go through. We need to be sure that they are trained to the best of their scope and to the best of their ability. But I think it’s a different level of care is a different kind of professionalism. So I think we just need to really make sure that we’re doing a service to the rural areas where they are scraping together five people to cover a very large area and they just don’t have time for the level of nuance that you will often see in an urban, metro area where you’ve got, um, you’ve got enough staff to cover these sort of things,
Amanda Riordan: Makes complete sense and certainly something that we know so many communities are wrestling with right now. I thank you for bringing it to everyone’s attention. I think that we will get some lively dialogue in the comments when we get this posted about, as you pointed out, the diminishing volunteerism as well as the other pressures facing most mobile healthcare these days. Before we wrap up here, would you mind giving us some tips or thoughts about how EMS providers, mobile healthcare providers, in Wisconsin can work best with your office? Or if you have any generalized tips about how ambulance services and fire departments across the country can best work with the Offices of Rural Health in their state, we would be very grateful. Clearly you are moving and shaking in Wisconsin and we’d love to see that ripple out to other states.
John Eich: Absolutely. So, I have counterparts in every state and they’re all doing great work when it comes to rural health and rural EMS. If someone in any state simply goes to Google and, enters their state name and “office of rural health,” they’ll get right to them. I think there is a difference between Offices of Rural Health. Many of us are in state government, and so what you experienced there is common of state government—It’s a more bureaucratic system. The websites tend to be a little bit trickier to find the information because there’s obviously a lot going on there and some political considerations. We [here in Wisconsin] are university-based. There’s about 12 of those around the nation, and three that are nonprofit, so, even leaner and more flexible. So every [office] will look differently.
I do think that EMS should reach out to their Offices of Rural Health to let them know about their needs, because when we look at metrics for healthcare and for population health, we see the metrics getting worse. It’s almost like a horseshoe in that they get worse the more rural and remote you are. Suburban areas have the lowest need, and then the inner city tends to be equally challenging. We share a lot of population health issues with inner cities. The difference I think is really transportation. We’re farther away. And if you don’t have a car, you’re really isolated and stuck, so EMS is mission critical.
If you think about that first hour of care being so important to outcomes, [if sick or injured in a rural area] your first half hour could be without care as people are getting to you and you’re trying to find a cell signal to actually call 911. Once they arrive, your rural EMS providers are the people that are giving you that care. So it is vitally important that those people have the resources to do their job the best that they can.
Please reach out to express your needs. One of the things we’ve been talking about based on this Rural Listening Tour and talking with our state EMS office and the associations just yesterday is the idea of some kind of helpline; Somebody to answer the call when a service is identifying that they are really struggling, because [rural services] are a little nervous about calling the state and saying, “Hey, guess what? Things are really rough here. You might want to shut us down.” Nobody wants that. The state EMS office is very clear that it’s not in anybody’s best interest to remove care and burden neighboring services. So getting a helpline with a number of resources and even someone that can drive out and sit across the table and talk through some issues and get some advice would be very helpful for some of these services that are really struggling. Those are some ways that I think folks can get involved, and I’m always interested in hearing more.
Amanda Riordan: John, thank you so very much for your time and insights today. It has been an absolute pleasure talking to you and I’m sure that we’ll be hearing a lot more from the Office of Rural Health, you, and your staff in the years to come. So again, we truly appreciate it and wish you a very happy National Rural Health Day tomorrow, November 15th.
John Eich: Thank you very much, and I look forward to celebrations around the nation.
The AAA continues to push on policy issues important to our members we are happy to provide an update on two pieces of legislation that we have been actively monitoring. Congress is proceeding with consideration of several legislative vehicles as they address key topics prior to the November elections.
First Responder Opioid Grant Program
The AAA is pleased to report that language we supported on grant funding for opioid protection training for first responders has passed the Senate. Based on an analysis by counsel, we believe all ambulance service agencies would be eligible to apply for the grants.
In 2017, the Administration officially labeled the Opioid Crisis as a public health emergency, and in response Congress has finally taken action. On Monday, the Senate overwhelmingly passed the Opioid Crisis Response Act with a bipartisan vote of 99-1. The impact of this legislation on the ambulance industry includes providing resources and training so that first responders and other key community sectors, including emergency medical services agencies, can appropriately protect themselves from exposure to drugs such as fentanyl, carfentanil and other dangerous licit and illicit drugs. $36,000,000 will be given annually for each fiscal year from 2019 through 2023. The bill also gives $10,000,000 in supplemental competitive grants to areas that have a record of high seizure of fentanyl to be used toward training of law enforcement and other first responders on how best to handle fentanyl as well as to purchase protective equipment, including overdose reversal drugs.
Lastly, the legislation allows the Department of Labor to award grants to states that have been heavily impacted by the opioid crisis in order to assist local workforce boards and local partnerships in closing the gaps in the workforce for mental health care and substance use disorder. Counsel has provided us with an analysis that all types of ambulance service organizations would be eligible for the described grants. While this legislation is not a solution to every aspect of the opioid crisis our country is currently experiencing, it is an important first step in providing resources to the ambulance industry and others to help combat this public health emergency.
Rural EMS Grant Program
The AAA is diligently working on amending the SIREN Act (S. 2830, H.R. 5429) which would reauthorize the Rural EMS Grant program. In an effort to ensure the funding would go to the most needy, small, and rural EMS providers, the language of the SIREN Act would change the eligibility to just governmental and non-profit EMS agencies. Therefore, small rural for-profit ambulance service providers would no longer be eligible to apply for grants. The AAA will continue to work to ensure that all provider types will be able to apply for these grants.
Language similar to the SIREN Act has been included in the Farm Bill (S. 3042/ H.R. 2) that passed both the House and Senate. The Farm Bill is now in Conference Committee between the House and Senate to reconcile differences before final passage. Over the past weeks, the AAA has been pressing Senator Durbin as well as other co-sponsors and Farm Bill conferees to revise the language to ensure small rural for-profit providers would still be able to apply for grants. Our team has met with all co-sponsors of the House and Senate SIREN Act Bills as well as members of the Farm Bill Conference Committee to ensure that they are well informed of the impact this legislation will have on their local providers.
The AAA team has also been conducting targeted outreach to AAA members asking them to get involved by contacting their Members of Congress, especially those on the Conference Committee. It is important for Congress to hear that grants like this one, should be open to all provider types. We thank those members who have already sent letters to their representatives. With Congress trying to wrap up the Farm Bill by the end of September – although looking unlikley, the AAA is pushing hard to change the current language and make sure that all providers might have access to these grants once they are reauthorized.
The AAA will continue to keep you updated on any new developments.
I grew up in Jennings, Missouri, a small town in St. Louis County. I’m the baby of six kids—four brothers and a sister. I am very proud of my twin girls who just graduated from high school while simultaneously completing their associates degrees. They are now off to college to Rolla, Missouri, to finish their bachelors degrees. In addition to sharing time with my family and friends, I enjoy softball, camping, swimming, tennis, and walking.
How did you come to work in the industry? How long have you been involved?
David with some of his team at a recent AAA workshop.
Years ago I was involved in part of the law enforcement arena called “Police Explorers”, primarily because my brother was a police officer. From there, I progressed through many different facets of law enforcement. The one thing that sticks out in my mind is that every time I was involved in an incident including a sick person or trauma, I really felt as if I would filling my calling. I could calm people and make them feel better, even when at that point I had only first responder training.
I have been involved with EMS for more than 30 years now, from my early days as a dispatcher, then up the ranks to Training Officer, then Manager, and now CEO/Administrator here in St. Francois County.
What do you enjoy most about your job?
I enjoy working with the public, people in our community, and my staff. They are my second family.
What is your biggest professional challenge?
Dealing with the younger spirited individuals coming into the world of EMS. Understanding the different challenges in funding, retention of our employee’s, the right mix of people and balancing the good/bad at the same time.
Making sure the Emergency Medical Services is not the forgotten one in the mix of Fire and Police. We all have a very important roles and the same amount of responsibility.
What is your typical day like?
My day typically starts with putting out fires and finishing my to do list from the previous day. Having 24/7 responsibility for a large program has its ups and downs—including sometimes getting called into work in the middle of the night. By sunrise, I have usually been up and on the highway for several hours. During typical office hours, I attend meetings and handle projects, budgeting, scheduling, and other tasks that need to be completed to keep our service operating. I also address any concerns or needs of the board of directors.
How has participation in AAA membership and advocacy helped your organization?
The American Ambulance Association has bridged the gap for me in my role as a service Administrator/CEO. AAA has many valuable resources, and provides me access to a vast network of ambulance services across the United States. My fellow AAA members as well as staff are always available to answer questions.
AAA has been the leader in ambulance services resources for many years, and they continue to strive to be the best in everything they offer. I enjoy the daily updates, and feel that the work AAA does with benchmarking and standands forms the backbone of the industry. The American Ambulance Association is truly a leader for EMS.
In honor of today’s 
