Rural EMTs Alarmed by Ambulance Rules

CENTER, N.D. – When there's a car crash or a heart attack near this rural town, the emergency medical technicians who rush to help are familiar faces from the high school, the county clerk's office and the coal mine.

The 17 members of the Center ambulance squad who serve nearly all of Oliver County are volunteers, much like most EMTs (search) in the state.

And like many of their counterparts around the country, members of the Center squad are worried that proposed national standards could more than double the amount of training they must have and thin their ranks.

"A lot of people can't comprehend what it's like to drive 345 miles and not see a house, not see anything, and to have to cover that," said Mickie Eide, the squad's leader. "If you keep requiring us to do more, there's going to be less of us to do it."

The revamped certification rules are being developed for federal regulators by doctors, EMTs and state emergency medical directors (search).

Supporters say more training requirements would ensure a better qualified national corps of emergency medical providers. But in rural areas where volunteer crews are the rule, many fear the change will limit the pool of new recruits and force experienced EMTs to drop out.

"This is one of the most difficult decisions that I have been involved in in EMS (emergency medical service) in the last 20 years at the national level," said Bob Brown, director of the National Registry of Emergency Medical Technicians (search).

The goal is a national standard that would guarantee highly trained workers in ambulances across the nation, Brown said.

"When those ambulance people come up to your side following your incident, you want them to be the best. Capitalize it — The Best," he said. "And those EMS workers want to be the best as well. But it's a bridge too far."

The proposed changes were designed to give EMTs the skills to treat conditions they commonly encounter, said Bob Bass, the Maryland state emergency medical director who sits on a national committee overseeing the reclassification efforts.

"They decided that an EMT could handle more than we currently handle," he said.

For example, the new level of training would allow EMTs to administer such emergency medications as epinephrine, a form of adrenaline given to people suffering severe allergic reactions.

In North Dakota, basic-level EMTs need 110 hours of training to get their initial certification. To meet the new standards as currently proposed, the state Emergency Medical Service Association estimates that basic EMTs would at least have to double that.

In places like Center, a town of about 680 people, crew leaders think a change that steep could push about half their volunteers out of the service.

"It could even affect more," said Eide, a teacher's aide who leads Center's ambulance crew. "We have squad members that are between 10 and 15 years anyway, and are kind of wanting to cut back."

Bass said the minimum requirements might increase, but he said regulators may be able to eliminate some outdated sections to make room for the new lessons.

"I think that the first draft was the flag up the pole," Bass said. "I think there's still a lot of work to be done."

North Dakota officials estimate that 90 percent of North Dakota's 140 ground ambulance services are staffed by volunteers.

Many EMTs likely will find the new requirements too difficult to meet, said Dean Lampe, director of the North Dakota EMS Association.

"These guys have jobs. They work at the Cenex store, they work at the butcher shop. They're farmers trying to get their crops in," he said.

Emergency medical services in other states have found similar problems. In Texas, officials estimate that about a third of the state's emergency medical providers are volunteers.

"I think that there would be a lot of services that would have to make some major adjustments," said Pete Wolf, chief of the volunteer fire department in the north Texas town of Windthorst.

Public comments on the plan are being accepted through January, and the group drafting the rules is set for a new meeting in March.

Wolf sees benefits in national standards, but says a major increase in training requirements could hurt services that already have trouble holding on to members for more than a few years.

"It's fun and great and exciting," Wolf said. "But after a couple of years, you start to look back and reflect, and you have to feed your family as well."