EMS services should be considered essential

COUNTY – Shelby County Emergency Medical Service (EMS) staff and volunteers throughout Shelby County work together to respond to ambulance calls around the clock and transfer patients to facilities that can provide the care they need.  The field of emergency medicine is facing a great challenge across the state and in Shelby County: how to continue to provide timely ambulance service in the communities and rural corners of Iowa with fewer volunteers, a handful of staff and no sustainable source of funding.
An EMS Advisory Council of local leaders and stakeholders comprised of the Shelby County Board of Supervisors, Harlan city officials, Myrtue Medical Center officials, emergency management, law enforcement, fire department, government officials and volunteers have started the process of reassessing the way emergency services are provided in Shelby County. Rising costs, staffing challenges, and the retirement planning of Medivac owners, Bob and Nella Seivert, bring the issue to the forefront of local discussion. The Advisory Council’s mission is to provide for a high-quality EMS system that assures a comprehensive approach to best serve the citizens of Shelby County.
The advisory group wants to not only ensure a sustainable ambulance service for many years to come, but also assure there is a smooth transition from a Medivac-operated ambulance to a new model. The group has made significant progress over the past few months and has considered several different options such as where the service could be housed and which entity should operate the service long-term. These options include the County, Hospital, City/Fire Department, and private contractors.
New Iowa legislation signed into law by Iowa Gov. Kim Reynolds in June, 2021, provides the framework for Iowa counties, including Shelby County, to deem EMS (Emergency Medical Services) as essential, allowing for possible funding opportunities that would be critical to saving lives.
“We need reinforcement of this system,” said Steve Kenkel, Board of Supervisors.  “Currently, we are at a crossroads for EMS / Ambulance Services moving forward in Shelby County. Now is the time to build on what is working and improve or change what is not. Doing nothing is not an option.”
Calling 911
Currently, when Shelby County residents call 911 for a medical emergency, an ambulance staffed with volunteers or Medivac is dispatched to render aid and transport to a hospital. When calling 911 for emergency services, it is expected that the ambulance will arrive quickly.  
However, in many rural Iowa communities, a certified emergency medical technician (EMT) or paramedic may not be readily available or not available at all.  The calls to 911 don’t stop, no matter where you are in the state. The number of workers to respond to those calls, however, either paid or volunteer, is dwindling.
“In Iowa, there is no state requirement for EMS to be provided and it is not considered an essential service. When someone calls 911, there is no guarantee an ambulance will respond in a timely manner and it is not legally required to dispatch,” said Alex Londo, Shelby County Emergency Management Service Coordinator.  
Right now, law enforcement and fire departments are classified as essential services so they receive funding from the state. When calling for a fire or police, those services arrive because Iowa law mandates it. EMS services are different.
With EMS not considered an essential service, providing emergency medical services in rural Iowa has become increasingly more difficult, officials say.
Senate File 615, signed by the governor, allows counties to deem EMS essential, and introduce a tax referendum that would help fund the services in a county. Making EMS essential in Shelby County is under consideration.  
The Hospital Board of Trustees approved a resolution to partner with community stakeholders to develop a county-based ambulance service. This was just prior to the City Council also approving a resolution. The County Board of Supervisors will be considering a similar resolution.
Funding, staffing challenges
Funding, staffing and volunteers remain obstacles in a rural area, and Shelby County is not immune.
The EMS Advisory Council is discussing EMS reorganization.  A tax levy would allow Shelby County to deem EMS as an essential service and would require a vote and a potential increase in property taxes to fund EMS.  No final decisions have been made.
Ambulance service in Shelby County logs about 1,300 calls per year between 911 and emergent transfers. In the past 10 years, there has been a dramatic decline in the number of EMT volunteers.
“No one wants their EMS provider to have interruptions or delays in response time, but with the severe shortage of EMS professionals right now, this is a real issue,” said Barry Jacobsen, CEO of Myrtue Medical Center.  “We have been fortunate to have Medivac Ambulance/Rescue coupled with a robust volunteer system provide high-quality care in Shelby County. Our goal is to build upon and enhance this system to ensure quality care to our county moving forward.”
 “We have been experiencing a similar shift to many other rural areas across Iowa and the nation – the availability of trained EMS responders, no matter if they are career or volunteer personnel,” said Gene Gettys, City of Harlan Administrator. “We need to consider our options and determine the best alternative. We are collaborating to determine the best method for a high-quality EMS system that is reliable, fiscally responsible and sustainable into the future for Shelby County.”
Everyone in this stakeholder group understands that the most important aspect of a successful transition and service long term is the EMS professionals, who are in the trenches responding to our family members, friends, and neighbors in their time of need. While an exact date on when the transition will occur from Medivac to a new model, all efforts of this stakeholder group are directed toward a County-based ambulance service.



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Harlan, IA 51537-0721

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