The Nebraska Public Service Commission continues to investigate two, separate 911 outages that occurred around Sept. 1. Operators, in some cases, had to use personal cell phones to call those seeking help. (Getty Images)
LINCOLN — Rural Nebraskans who wait longer than their urban peers for ambulances to arrive and then deliver a patient to a hospital told state lawmakers Wednesday that many of their local emergency medical service providers need state help to stay afloat.
The interim study hearing sought by State Sen. Myron Dorn of Adams on Legislative Resolution 206 drew testimony from first responders and hospital groups. Many shared steps Nebraska could take to help smaller communities recruit, train and retain more emergency medical responders.
Most Nebraska communities use volunteer fire and rescue squads, but many are struggling to replace older helpers. Additionally, as the rural population ages, calls for service are up, adding pressure to the volunteers who remain.
Dorn said this means farmers and rural employees leave their jobs more often, making it harder to persuade a generation of young people to help. It’s also harder to recruit volunteers from among younger adults who have children at home, busy with activities.
“The issues are systemwide,” Michael Dwyer, a longtime Arlington, Neb., firefighter/EMT testified. “The trends are historic, and the current system of EMS is not sustainable.”
Long drives to hospitals
Nebraska is one of three states with the highest rates of rural residents living more than a 25-minute drive from where an ambulance is stationed, according to a national study by the Maine Rural Health Research Center in May. More than 76% of the state’s counties had some residents living at least that far from a station.
Dwyer told State Sen. Ben Hansen of Blair that no state has all the answers for providing rural EMS service. However, he said, many states spend more on addressing the issues than Nebraska.
For instance, South Dakota in 2022 earmarked up to $20 million for emergency medical services. This money appears poised to boost rural EMS service, from EMT training to helping smaller communities replace old equipment and access telemedicine.
In an exchange of candor with the Legislature’s Health and Human Services Committee, Dwyer said, “At the risk of pulling the scab off, it just takes money.” However, he said, “This isn’t just math. This is advanced calculus.”
Rural first responders on Wednesday called on the state to pay upfront for training new potential emergency medical responders and medical technicians instead of making them or their volunteer departments seek reimbursement.
Even volunteer EMTs must obtain 160 hours of training over six months, Dorn said. And they need continuing education to be able to maintain licensing. State Sen. Merv Riepe of Ralston wondered whether there might be simple ways to tweak requirements.
Told that national training requirements make it harder to reduce state training requirementst, Riepe, a former hospital administrator, said, “I was hoping you’d say there was some cure-all to all of this.” People in the audience laughed.
Angela Ling of the Nebraska Hospital Association stressed the importance of the state seriously discussing the impact on rural rescue squads of inadequate Medicare and Medicaid reimbursements that leave EMS agencies fighting to make up the differences.
“The problem in all locations usually revolves around funding,” Ling said. “Developing or increasing future funding sources will help fix the volunteer/no-pay format that is killing our EMS system.”
The committee heard suggestions about having the state pay to bring emergency medical response trainers closer to the communities where people volunteer instead of requiring distant travel, including using community colleges.
One testifier, Wahoo EMS director Grant Anderson, called on the state to address in state law which levels of government should shoulder what costs of emergency medical services. Wahoo and Ashland provide EMS services beyond the city limits, but only city taxpayers pay the costs beyond what fees cover.
Anderson said he fears that rural residents near communities providing service today at city cost might one day be forced by their local property taxpayers to limit ambulance runs to the city limits, leaving more rural residents at risk.
Nebraska state law requires EMS service as an essential service, but it does not specify which level of government should fund the service.
More info needed
State Sen. Brian Hardin of Gering asked the first responders to research how many volunteers the state is short. Several described the challenge of counting when not every local volunteer on rescue squad rosters remains active.
At last count, one testifier said, Nebraska had 13,000 volunteer firefighters and about 15,000 volunteer EMS providers.
John Bomar of Battle Creek, Neb., Fire and Rescue, said the state has lost 60 EMRs and 60 EMTs over the past five years.
He and others who testified said the state could increase the flexibility of the kinds of care each level of trained emergency medical responder can provide. EMRs, for instance, can’t legally administer an inhaler or check a person’s blood pressure.
Ling, echoing other testifiers, said: “I do not have the solution but hope this is the beginning of a conversation.”
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