Labor shortage triggers long wait times for ambulances in rural America

Budget increase is being sought to help recruit, retain rural EMS providers

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A labor shortage is putting people’s lives at risk in rural areas. In fact, the National Association of Emergency Medical Technicians warns that its teams are in crisis.   

Ambulance services are having a hard time finding qualified staffers, and it’s also tough for those relying on volunteers.  

In Mountain Lake, Minnesota, the volunteer EMS service gets anywhere from a few calls a day to a few a week. The closest hospital is 11 miles away, so having an ambulance ready to go can mean the difference between life and death. 

Mountain Lake, Minnesota, is a town of about 2,000 people and residents describe the atmosphere as similar to the fictional Mayberry from "The Andy Griffith Show."

Mountain Lake, Minnesota, is a town of about 2,000 people and residents describe the atmosphere as similar to the fictional Mayberry from "The Andy Griffith Show."

Mountain Lake is home to just over 2,000 people.

"It’s just a nice, quiet little town," Emily Kunkell, the local ambulance director, said. "My real job is accounting."  

Kunkell said she'll make the 20-minute drive to St. James for her day job, where she also volunteers for its EMS service. "It’s hard to get people to want to give up their own free time to volunteer to do something."

Allen O’Bannon has been volunteering for Mountain Lake EMS for over 40 years. He was injured in an industrial accident that left him with chemical burns over 20% of his body. It felt like a long drive from the small town to Rochester, Minnesota, where he received care – and that’s when he decided he wanted to give back. But, he saw the volunteer shortage getting worse. 

"Back then, there was a lot more people that lived in town that could break away," O’Bannon said. "Not as many people work in town, there aren’t as many jobs in town."

The state of Minnesota requires each EMS to have two medically trained personnel on call 24/7, and that’s gotten tough.

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"It’s sometimes hard to fill the schedule because a lot of people don’t work in town," Kunkell said – and many rural towns have had to deal with the flight of jobs related to health care. 

The National Association of Emergency Medical Technicians warned that the towns could see a domino effect.  

The EMT association warns rural America will struggle as a result of the labor shortage in bigger cities. 

The EMT association warns rural America will struggle as a result of the labor shortage in bigger cities. 

"If the rural areas start to collapse in health care, which it is in certain areas, that has an effect on everywhere else in health care," David Edgar of the National Association of Emergency Medical Technicians board of directors Region III said. 

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Edgar is also serving as the assistant EMS chief in West Des Moines, Iowa, which has used employees, not volunteers. The city of nearly 66,000 people can’t find enough workers for its seven ambulances.    

Mountain Lake EMS receives some money from the city, but its EMTs volunteer their hours. 

Mountain Lake EMS receives some money from the city, but its EMTs volunteer their hours. 

"Now we have five ambulances, which means those rural hospitals where we would go out and help transfer those patients in, we have less ability to do that," Edgar said. "It’s a recipe that's setting up to really be a collapse of the system when you can't have ambulance response for an area, or it takes, you know, 30 or 40 minutes to get an ambulance there."

The EMT association is asking Congress to extend Medicare and Medicaid funding for ambulances.   

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In 2022, rural nonprofit and public EMS agencies received some $7.5 million for recruitment, retention, education and equipment – and the association is asking for $20 million next year.   

The association also warned that many paramedic or EMT job listings found online are for hospitals trying to address the nursing shortage. This has been a real issue for paramedics, since many prefer to work a more normal schedule in the hospital instead of the unpredictable schedule on an ambulance.