Declaring EMS an essential service: Critical care transports ‘absolutely vital’

SHELBY COUNTY —  Emergency Medical Service (EMS) staff and volunteers throughout Shelby County currently work together to respond to ambulance calls around the clock and transfer patients to facilities where they can be provided the care they need.  
 The Shelby County Board of Supervisors, along with the county’s EMS Advisory Council, consisting of community leaders and stakeholders, have reassessed the needs of the county’s emergency services and are in the process of passing a resolution declaring EMS an essential service in the county.  They are seeking public opinion at public hearings, scheduled for June 6 and June 13 at 10 a.m. at the Shelby County Courthouse.
 The Board unanimously passed the resolution for the first time at a public hearing held May 23. Two more subsequent approvals will be required during the next two public hearings.
 The public is encouraged to provide written or in person comments about the EMS resolution and the intentions of the Board of Supervisors. If the resolution passes, the issue will be on the ballot in the November 7, 2023 election.
 The Advisory Council’s recommendation is 75 cents per $1,000 of taxable valuation (not assessed valuation), and a 1% income tax would be collected by the state and apportioned to the Shelby County EMS Fund. The EMS Fund will financially support all Shelby County Ambulance and Emergency Response teams, as well as local volunteer emergency medical response agencies.
 “Our goal in Shelby County is to build a system that continues to support volunteer squads,” said  Myrtue Medical Center Emergency Room Manager Jennifer Lefeber, RN BSN, TCRN.
 “It is volunteers in this county that are the backbone of the EMS care provided throughout the county.   In order to support them, it is vital that we have a paid service to help respond county wide to 911 calls, and to assist and provide Advanced Life Support care when needed.”
 A private business currently assists the volunteer departments in providing ambulance service throughout the county. However, they will be discontinuing their business within a few years.
 Nationwide, volunteer departments have ongoing issues with staffing and funding.“When a volunteer unit has no or limited response the county relies on the response from the next closest squad as well as dispatching the paid service to assist,” Lefeber said.  “This tiered response approach ensures that there is help coming to those in our service area that need it.”
 Many times, the private ambulance service is relied upon to transport patients to another facility, and Myrtue Medical Center is renowned for getting patients to the appropriate place for treatment. In 2021 and 2022, the American Heart Association presented Myrtue with the Mission: Lifeline Gold Plus Achievement Award — a first for any Iowa critical access hospital, and one of only five bestowed nationally. This award recognizes critical access hospitals that have met or exceeded recommendations in treating patients with severe heart attacks.
 “When it comes to transfers out of Myrtue Medical Center – it is absolutely vital that the new Shelby County EMS Department include the ability to do critical care transports of patients who need specialty services not offered locally,” Lefeber said.
  “One of the most time critical times we transfer patients for is a STEMI (ST elevation myocardial infarction), or more commonly known as a heart attack.   Currently, if you come into the Myrtue Emergency Department and are diagnosed as having a STEMI, we are able to call Medivac and they present for transfer within five minutes. Our goal is to get you on the way to a cath lab within 30 minutes of arrival to our door. With the assistance of Medivac, these times are often much less.”
  Lefeber said the quicker the patient is diagnosed, transfer is arranged, and the patient is transported to another facility, the better the outcome is likely to be. “The quicker we get you get to a cath lab,  the quicker the specialist is able to return blood flow to the heart.   This lifesaving transition of care could not be done without the efforts of the paid service.”

    Methodist Jennie Edmundson Cardiology Team Member Carly Clare, ARNP, who provides cardiac care and sees patients in Myrtue’s Specialty Clinic, said, “The timeliness of treatment of a heart attack depends on you recognizing you’re in trouble, getting to a medical facility so they can recognize what’s going on, and getting you to the appropriate place.”
 Lefeber noted heart attacks are not the only type of emergencies requiring patients to be transferred. Severe injuries, strokes, pediatrics, and respiratory emergencies are also common reasons. She said she is often asked why patients are not just flown out when being transferred. “While we are long time partners with the helicopter services in the area , they are not always the fastest route of transfer,” she said.  “They are also not available 24/7 due to weather, downtime and unavailability.”