Story of the Year 2022: Iowa’s rural ambulances hemorrhage volunteers, staff
Telegraph note and story update
This story – first published on Friday, January 14, 2022 – is the North Tama Telegraph’s ‘Story of the Year’ for 2022. The online version of this article was shared widely across the Midwest via Facebook and our website, and even landed in the newsletters of several members of the Iowa General Assembly.
This was a story that resonated with those both working for a rural ambulance service and those living in small towns where more often than not, the local ambulance service is the closest, most accessible form of healthcare.
Traer Ambulance Manager Shaun Kennedy, featured in the story, provided an update recently on the status of his rural ambulance almost one year later. Kennedy told the Telegraph, “volunteer levels are about the same” with three paid employees and 16 volunteers.
Recently, Traer Ambulance lost its medical director and struggled to find a replacement as the county does not have a hospital and doctors are few and far between, but the service does have a new medical director as of press time from outside the county.
Tama County District 1 Supervisor-elect Curt Hilmer — who will be sworn into office in the next week — was contacted in regard to the possibility of Tama County declaring emergency medical services ‘essential’ like fire and law enforcement – something the county has not yet done. In order to do so, a tax referendum would need to be put to the voters, requiring a supermajority of 60% in order to pass.
Hilmer told the Telegraph: “Rural EMS is something that has to be looked at. We need to make sure we do what we can to ensure a high level of service for the people of Tama County. I’m looking forward to starting work on this and many other Tama County issues!”
When asked to sum up in one sentence his viewpoint as it relates to the state of affairs that is a rural ambulance service in Iowa today, Kennedy responded succinctly, “EMS needs to be made an essential service.”
Original story published in its entirety
Iowa’s rural ambulances hemorrhage volunteers, staff: Traer Ambulance seeks to hire, again
Shaun Kennedy, Traer Ambulance Manager, believed he finally had a decent thing going in terms of staffing his rural ambulance service – in addition to himself, he had two full time paramedics and one part time EMT/driver.
“On December 24th I found out Matt [part time EMT/driver] was leaving and on the 26th I found out Steve [weekend paramedic] was leaving. Christmas was great this year,” Kennedy said, sarcasm in his voice, as he sat inside his small, square ambulance office on the second Saturday of the new year, various training devices laid out on tables around him.
Nearby, a coverage schedule full of holes marked in orange or red dangled at eye level just above the computer.
“Working a 70-hour workweek is nothing for me,” Kennedy told the Telegraph as he sat inside his office on that early day in January. “I’m thinking now, 100 [hours], maybe 120 [hours]. I can’t do 100 hours a week for very long.”
Welcome to life as a rural ambulance director.
Despite keeping a fairly healthy volunteer list of drivers and EMTs, relying so heavily on volunteers – many of whom are either retirement age or young folks working out of town – can only get an ambulance service like Kennedy’s – or any rural service for that matter – so far these days.
At a recent Traer City Council meeting, Kennedy – a jovial, easygoing native Iowan who inexplicably sounds like he hails from an ice fishing house in northern Wisconsin – detailed to the council in dire terms what their city-owned, volunteer-powered ambulance is up against.
“Out of my 17 volunteers, I can’t get 24/7 coverage. Nobody wants to step up. I keep calling the fire department guys for help all the time, eventually, I’m going to burn them out, too. … When that pager goes off, not everybody wants to do that.”
Kennedy has a supportive council, thankfully. In response to his comments, council members proceeded to discuss the ambulance’s plight by first addressing the fact that Traer is hardly alone in its difficulties – “it’s a nationwide problem,” one of the council members said – before bringing up nearby ambulance services that have had to disband.
The council then discussed the lengths their own service has gone to or might have to go to in order to attract interested applicants.
“I got hired five years ago,” Kennedy told the Telegraph as he swiveled back and forth in his chair, a cold wind blowing down Traer’s east-west main street just beyond the ambulance’s front door.
“I just had my 5 year anniversary on [January 1]. I got hired at the same pay that I’m trying to hire people at now. Staffing has been an issue the entire five years. It just seems to get progressively worse.”
When pressed as to why he thinks rural ambulance services are having such a hard time finding both staff and volunteers, Kennedy doesn’t miss a beat – he knows and it’s not something he has any idea how to overcome.
“The regular person’s life … young families that could possibly do this … between sports, dance, etc., they’re being pulled in so many different directions.”
Kennedy shared similar thoughts during the recent council meeting.
“It’s a generational gap now,” Kennedy, 50, told the five-member council which represents a city of just over 1,500 people. “The current generation, they want their pay, they want their time off … they’ve set boundaries that we’ve [the older generation] ran past for years, so kudos to them.”
Unfortunately, a rural ambulance service like Traer’s is hardly a luxury when the county – Tama – has exactly zero hospitals and the nearest medical center – Waterloo – is a more than 30 minute drive on a good weather day.
And that’s, of course, if you can find a driver. Traer Ambulance cannot leave the bay without, at minimum, one volunteer driver and one certified paramedic in the back.
Kennedy said his ambulance had 339 calls for service in 2021. When asked to describe a “typical call” he chuckled softly.
“Pick it out of a hat,” he said, “it could be anything. Sometimes we go out for chest pain and stroke, breathing problems, car accidents.”
Sometimes, Kennedy said, it’s nothing more than “a little old lady who needs someone to talk to.”
“I’ve spent hours sitting in somebody’s house [talking to them],” Kennedy said. “I tell them, ‘let me see if I can find somebody.’ [Older Iowans] don’t have the resources at their fingertips – won’t call their church anymore.”
Legislation that now makes it possible for emergency medical services like Traer Ambulance to be treated as “essential services” by Iowa’s county boards of supervisors was signed into law last year by Iowa Gov. Kim Reynolds after passing the Republican-controlled legislature.
The legislation has been touted by members of both political parties as a key solution to Iowa’s emergency medical service woes – finally making EMS an “essential service” in the state.
In Iowa, fire protection and law enforcement have long been deemed “essential” county services and funded as such while emergency services have never benefited from such a designation nor received the funding that goes with it.
But the new law merely gives counties the option to put it up for a vote – voters must then pass the measure by at least 60 percent before supervisors can, in turn, increase property taxes to pay for EMS.
Tama County supervisors have not approved a resolution designating EMS as an ‘essential service’ in the county as of publication.
But would making EMS an essential service be the magic elixir for Traer’s rural ambulance woes?
“I don’t know how it all works,” Kennedy said in answer to the question. “[In smaller communities] this can be another hell of a tax base on somebody, especially the farmers that are being taxed on property … the cost of land keeps going up.”
The core of the issue, Kennedy said, is not as simple as funding.
“You can throw all the money at this that you want – if you don’t have the people, it doesn’t do any good. … They gave us all participation trophies [with the new legislation]. None of us can win the race but it appears we got a trophy for it.”
For now, Kennedy is back on the hiring beat, posting an ad for a full time weekend paramedic and a part time EMT.
If the positions cannot be filled, now or in the future, Kennedy said the ambulance may have to resort to routing local calls for service on particular days to other nearby ambulance services – but, eventually, that might not work either as more rural ambulances shut down.
“If we don’t find the volunteers, the rural services will die,” Kennedy said. “If I’m walking circles in my office banging my head, you know why.”