911 CRISIS: Shortage of EMS workers affecting rural response times

by: Calyn Thompson

Posted: Nov 23, 2022 / 10:15 AM CST

Updated: Nov 23, 2022 / 10:15 AM CST

WHO 13 NEWS – When you dial 911, you expect help to come in a timely manner. One Des Moines man learned that where he was, had an impact on the emergency medical services he received all due to a shortage that's being felt across our state and nationwide.

They weren't the Friday night lights Mollie and Brian Carnine were expecting when they went to Huxley to watch their sons play football this past fall. But they were the ones they had to wait for to save Brian's life back on Sept. 30.

"From that point, it was lack of vision and it slowly started to decline," Brian Carnine recalled.

"I really wasn't aware until he tried calling me and was unable to speak at that point in time," Mollie Carnine said.

Brian was suffering a stroke. Mollie's sister called 911 right away.

The Huxley fire chief lays out what happened next. Two minutes after the 911 call was received at 6:48 p.m., no ambulances from Story County were available. Five minutes later, Huxley first responders arrived on the scene. Before they got there, Mollie says a sports trainer and a nearby nurse practitioner were helping Brian.

"At that point is when I knew when EMTs were evaluating him and I heard his blood pressure and the bottom number being as high as it was, that's the time where I started panicking because I knew he was in the stroke territory," Mollie said.

Brian needed an ambulance to take him to the hospital.

Mollie said, "I was on repeat of where are they where are they? Where are they? How much longer? Where are they?"

An ambulance finally arrived from Mary Greeley.

"I guess looking back I assumed that it would be Huxley and it would take minutes to respond," Mollie said.

It came at 7:17 p.m., almost a half hour after the 911 call was made.

"When you’re in that scenario, time seems to stand still or nothing's fast enough for you," Mollie said. "I knew minutes were everything and so that's when I had the panic of where is the ambulance because we’ve been there for what felt like a long time already."

The wait added to the trip Brian would need to take from Huxley to Methodist Hospital in Des Moines. It all left him thinking.

"I definitely had that belief that if you dial 911 and you need an ambulance, you know, I really never thought geographically where I was at that I would not have the same resources that I would potentially in the city or somewhere else," Brian said.

A spokesperson with the Iowa Department of Health and Human Services said Iowa communities have no legal obligation to provide emergency medical services. The Iowa EMS System Standards say the response time for an ambulance should not exceed eight minutes in urban areas and 20 minutes in rural areas.

"There are cases, there are areas where people wait too long for an ambulance," Mark McCulloch, the immediate past president and current legislative chair of the Iowa EMS Association, said. "And they’re saying, ‘Hey wait, what's the problem here?’ And they’re surprised to learn that EMS is not essential."

McCulloch says because EMS is still fairly young compared to police and fire services, not every community has the resources needed to respond in a timely manner.

"There's not a square inch of Iowa currently that's unserved by an EMS agency," McCulloch said. "The question becomes how long do they have to wait?"

McCulloch says the longer wait times are because of increased demand and a smaller workforce. Right now there are more calls for help with fewer people responding to them.

"So going from an era of relying on volunteers who are now overburdened by this vast expanse of technology and medical science requirements to maintain your certification, that's one of our most difficult challenges because we overburdened our volunteer base," McCulloch explained.

The American Ambulance Association conducted a survey and found the turnover among paramedics and emergency medical technicians ranges from 20 to 30 percent leaving annually. That results in a 100-percent turnover every four years.

Retention is a challenge, but so is recruitment. McCulloch says EMS is competing with the rest of the job market.

"Our national average wage is somewhere around 17 bucks," McCulloch said. "Well, I can go to retail and make that and not have to be in a ditch in the middle of the night on my kid's birthday."

That's where Senate File 615 comes in. It allows counties to declare EMS as an essential service and pursue funding for it, but citizens have to vote on it.

This past election, voters in eight Iowa counties had referendums on their ballots. It was rejected in Calhoun, Floyd, and Worth counties. It passed in Jones, Kossuth, Osceola, Pocahontas, and Winnebago counties.

"The message I think this will send is that Iowa, the population especially in rural Iowa, is on board," McCulloch said. "They’re willing and ready and they want EMS services, even if they have to pay tax to provide it."

As McCulloch continues to educate and advocate about the service that many Iowans already assume is essential, Brian Carnine is thankful to be alive to share his experience but is also hopeful for change.

"If there is truly a shortage of medical professionals and ambulance drivers then I would definitely like to bring light to that," Brian said.

Brian has been undergoing tests to see what caused the stroke.

The Iowa EMS Association is hoping to someday make the job more accessible, especially for first-generation Americans, through scholarships and free training programs.

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