Emergency medical services in Iowa are operating without a net

I still can hear the phone ringing. It was a continuous shrill ring, clearly distinct from an ordinary  call. No matter the time of day, my heart would begin to race. When I picked up the receiver, I’d hear worried — and sometimes frantic — voices asking for help.

It wasn’t a wrong number — my husband was a member of the Pilot Mound volunteer fire department, and emergency calls rang in the homes of firefighters and First Responders, as well as the county dispatcher.

This communication system has been modernized since those years, and Pilot Mound no longer has a First Responders unit. But a recent front-page headline of the Dayton Leader newspaper reminded me that one acute rural problem persists: “Volunteers Wanted: Dayton Rescue Squad seeks out next generation of EMTs, drivers.”

Volunteers are the backbone of rural Iowa. Since the prairie was settled, they have played an integral part. They’re still the ones who keep the small-town churches, school boards, fire departments, Extension Councils, township trustees, and other civic groups going. But are their best efforts good enough when it comes to life and death situations?

“With having only three EMTs, it’s hard to answer every call,” says Sara Pieper, an Emergency Medical Technician (EMT) and ambulance driver.

Pieper, who also is the Dayton city clerk and a firefighter, was featured in the story. She joined the Rescue Squad three years ago to help fill the need for volunteers who are available during the daytime hours of the work week. With few local businesses, many residents work out of town and their employers may not allow them to leave for a call. The average age of EMTs in Webster County is 43-47 years.

The Dayton Rescue Squad currently has two ambulances and five active drivers. Driver requirements include a monthly evening meeting, driver training, and CPR certification. EMTs need to complete 120-150 hours of training and fulfill a minimum of 20 hours of continuing education every two years to keep their licenses current.

Dayton Rescue pays for these CPR and EMT courses, provided there’s two-year pledge of active service. Its budget is based on service calls, insurance reimbursements, and fundraisers.

Unlike fire and law enforcement, EMS is not a required essential county service in Iowa. In 1981, the federal government shifted its responsibility for EMS to the states. Only 11 states fund EMS as an essential service.

“It’s hard to not be able to pay our volunteers much, since we currently don’t receive any tax money,” Pieper says. “It makes it hard to retain volunteers and find ways to buy supplies and maintain equipment.”

This disparity is receiving more recognition today, and EMS in Iowa may be at the crossroads of significant change. In 2021, the Iowa Legislature passed a law allowing counties to ask their voters to increase income and/or property taxes to support EMS as an essential service. Eight counties placed this referendum on their Nov. 8 ballots this year, and five counties reached the required 60% threshold for passage: Jones, Kossuth, Osceola, Pocahontas, and Winnebago. In Jones County, residents will pay an additional $35 in property tax for a home valued at $100,000. The revenue would be divided among nine ambulance regions in the county, as well as a portion of two other neighboring counties.

Calhoun, Floyd, and Worth counties voted it down.

Iowa at EMS crossroads

Too often, gaping holes in EMS are patched up with the Band-aid of charitable contributions. In 2021, our 4-H club worked with the Pilot Mound Fire department to obtain a Pioneer Community Seed Grant to purchase a permanent, wall-mounted Automated External Defibrillator (AED) for the community center. An older AED is kept in the fire truck. The fire department supplements its funds by holding a huge annual Biscuits & Gravy Breakfast organized by MIRZA Lodge #609 in Boone.

“Emergency medical response for communities like Pilot Mound is an ongoing concern,” says Pilot Mound Fire Chief Sean Whalen. “We no longer have a local First Responders, so having an AED available in town might be the difference between life and death. We try to keep members current on CPR and AED, but it’s been difficult with Covid.”

Staying alive and well

Serving as an EMT in your home community is rewarding, but often stressful because you often know the individuals requiring rescue. My sister-in-law served as a Pilot Mound First Responder for 12 years. She was trained in AED, basic first aid, and CPR. She recalls being at the scene of these fatalities:

A man backed over by a county truckA girl thrown from her horse at a local rodeoA woman who fell off a hayride onto a hard surface roadA girl who went over the handlebars of her bicycle at Don Williams Park A man who ingested his fentanyl patch

“We had no training to process our emotional trauma,” she recalls. “Two volunteers quit.”

Farming always has been one of the top two most hazardous U.S. occupations. I wrote many articles for Successful Farming focusing on first aid and emergency measures to help farmers and their families survive until trained help arrived.

In 1981, I wrote about the successful reattachment of a severed finger, using a new technique called microsurgery. Not long afterward, I received a letter from an Iowa farm reader who had cut off his thumb working on his farm. He recalled this article, and followed the directions to rinse his thumb, put it in a sealed plastic bag, and surround the bag with ice. A Des Moines surgeon successfully reattached it.

In 1990, I wrote a 12-page article, titled “Staying Alive: the Struggle To Save Farm Accident Victims.” Farm injuries are a specialized challenge for EMTs. Few, if any, have much training in farm rescue, including grain bin entrapment, anhydrous ammonia exposure, and tractor rollovers.

The Pilot Mound Fire Department has a grain bin rescue tube system, but lacks the required training to use it. “Our role would be rapid delivery and staging support,” Whalen says. Dayton has a grain bin rescue tube, and attends an annual training conducted by the Stratford Fire & Rescue Department.

Rural patchwork of services

Rural Americans tend to be older, sicker, and poorer than other Americans. Adequate emergency medical service is a matter of equity. But Iowa also should make it an economic development and quality-of-life priority. How do you attract people to live and raise their families in rural Iowa, if they can’t count on EMTs to arrive sooner than 20 minutes? Why wouldn’t our senior citizens move to larger communities to be closer to emergency medical services?

I’m not sure how many rural Iowa counties fall into the category of an EMS desert. But many suffer from fragmented and disorganized EMS services. If more than one EMS responds to a call, only the transporting service is reimbursed.

On Oct. 4, Rep. Cindy Axne introduced the bipartisan Supporting Our First Responders Act (HR 8994) to help EMS agencies with hiring and retention, training reimbursements, facility upgrades and more. It would establish a five-year grant program under the U.S. Department of Health and Human Services. Twenty percent of the funds would be earmarked for rural EMS agencies. Axne’s successor, Rep.-elect Zach Nunn, should be urged to cosponsor this bill. The American Rescue Plan Act of 2021 also may offer a one-time shot in the arm to EMS agencies.

However, all the funding in the world won’t solve the problem of depopulation. The farm crisis, a depleted manufacturing base, and a low-wage economy have frayed the fabric of rural Iowa, creating chronic shortages of volunteers. COVID-19 exacerbated the situation. “If the current trend of volunteers remains on the same path, the rescue squad may not be sustainable,” Pieper says.

Since 2020, 16 EMS departments in Iowa have closed. Fourteen closures were caused by a lack of personnel. According to the Iowa Department of Health and Human Services, 40 EMS departments have two or fewer EMS workers. Escalating equipment and fuel costs also are factors. As more EMS agencies shut down, the remaining ones are required to cover larger areas, leaving rural families without immediate assistance in their greatest moment of need. “A few minutes may make all the difference between life and death in some emergencies,” Pieper says

She is encouraged by the new law allowing counties to put EMS on the ballot. “I think it would be greatly beneficial and I’d hope that someday we move in this direction,” she says. She’s also hopeful that a few younger individuals will respond to her outreach, and join Dayton’s EMS team.

Until then, when the next 911 call comes in, Pieper will do her best to have all three of her hats  — ambulance driver, EMT and firefighter — at hand to answer the call.

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