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…Primary Service Areas across the Range…need to be redrawn into consolidated, professionally administered…sustainable ambulance services
Editor: I sent this letter to the MN Legislative Emergency Medical Services Task Force today, March 25.
Dear EMS Task Force members.
I live in Greenwood Township, one of seven entities within the Tower Area Ambulance Service PSA, a BLS ambulance service that is facing the familiar administrative, financial and staffing problems that are chronic in rural areas. Learning as much as I can about the TAAS and the other ambulance services here on the Iron Range has taken up a lot of my time in the last five years. I’ve also read and reread the very valuable 2022 OLA Report on the failed EMSRB. I took in the March 19 House Health Finance and Policy Committee hearing on HF 3992, a good bill introduced by Dave Lislegard. The hearing was marred a little bit by some unneeded posturing. The time has passed for that. The ambulance issues, at least here on the Range, have been brewing for years and it isn’t actually rocket science to see what the problems are and what the Legislature has to do to guide our area ambulance services into well administered, modern, sustainable services that put the patients and the ambulance staff first.
One thing that I’d like to emphasize is that although many of the rural ambulance services need a short term bailout, it shouldn’t be so generous that it perpetuates the failed status quo. It’s critical that the Legislature needs to go beyond HF3992 and SF3886 and correct things for the long term: 1. The EMSRB, as reported in the 2022 OLA Report, is a cumbersome, prone to regulatory capture agency that is not designed for accountability. For the sake of the future, the EMSRB needs to be shut down and replaced with a Cabinet level “Department of Emergency Medical Services” the head of which will be appointed by the Governor, pending review and approval by the Legislature. The so called “ping pong” argument against this due to changes in administrations is a red herring, simply floated out there to preserve the undeniably failed status quo. If the voters want change, they’re entitled to get change. The public shouldn’t be stuck with an unaccountable non functioning EMSRB tragedy that it took the OLA to uncover. Pass legislation this year to create the Department of EMS.
2. “Innovation Zones” need to be worked on by the Legislature immediately. The Iron Range is the perfect place that is in need of real, common sense change. Primary Service Areas across the Range obviously need to be redrawn into consolidated, professionally administered, modern, higher level, sustainable ambulance services. The case for this is plainly laid out in the OLA’s Report. Those of us who live in rural areas, and I can certainly speak for the Range, are aware that our local hospitals are doing fewer and fewer of the procedures they used to be counted on to do. The doctors, specialists, the professional staffing and the machines they use to make life better for sick and injured people have been consolidated into fewer, but better hospital centers. For the Iron Range, that full service hospital center is Duluth. And to put it vividly and honestly, we on the Range often need, when sickness or injury requires it, Advanced Life Support ambulances with paramedic staff to get us to the life saving and function preserving hospitals in Duluth. Reliable service and timing is critical. Rarely do any of us drive Hwy. 53 between the Range and Duluth and not see at least one Range based ambulance transporting a patient to Duluth for advanced care. The Legislature will probably have to go into a Special Session this year to choose and to implement the changes that need to be made. Bills 3992 and 3886 are meant to be one year bailouts, we sure don’t want that to become a habit forming annual effort at the Legislature. This year is the time to fix the problems.
3. Newly drawn, consolidated PSAs are long overdue on the Range. They will first need to reflect the population increases and declines and changes in roads since 1980. The new PSAs will have to be large enough to be able to take part in the economics of scale. As the OLA states, professional administrative capability obviously is a key need in order to run a modern ambulance service effectively and economically. Instead of nostalgia, logic will have to be used to decide where in the newly drawn PSAs the ambulances are stationed.
4. I don’t believe that the Legislature will be willing to permanently take on the cost of funding rural ambulance services, at least not at a very significant level. And I hope that the Legislature isn’t counting on Medicare, Medicaid, etc. raising their ambulance reimbursement rates to a level that would sustain rural ambulance services. Where would the votes in Congress come from? I kind of doubt that the County will step in either. That being the reality, I believe it is inevitable and desirable that the new, logically drawn PSAs will have to take part in the MN Fire Protection and EMS Special Taxing Districts, MN Statute 144F.01. Modern, sustainable ambulance service needs to be paid for, and 144F.01 is fair and is very workable. The funding for modern ambulance services will need to be high enough to pay for full time EMTs, Paramedics and professional administrators so we can get past the recruitment problems. These folks deserve a good living. Modern, Advanced Life Support ambulance services can no longer rely on volunteers or low paid part time staff. There will need to be enough reliable funding to provide for training and scholarship aid, particularly for paramedics. Possibly the Fed., State and County can be tapped to provide some one time funding for buildings, vehicles and equipment that will be needed to get the new PSAs on their feet. A lot of equipment already exists, but at least some new buildings will be needed.
Where I live, it is my perception that an EMS tax district will be looked upon favorably as a necessity.
5. From what I’ve observed, it’s my opinion that there are many important advantages and reasons for newly drawn ambulance PSAs to be based where there is a hospital. From what I see across the Range there could be five viable PSAs: 1. Ely, 2. Aurora-Hoyt Lakes, 3. Virginia-Cook, 4. Hibbing, 5. Grand Rapids. Each of these locations generate a significant number of profitable patient transfers, primarily to the hospitals in Duluth. Each of these PSAs is large enough to have a sustainable EMS tax district and all are large enough to require professional administration. Hospitals are a natural resource for an ambulance service staff. There will also need to be some satellite stations, taking population, response time, etc. into consideration.
6. A little bit about parochialism and status quo. Being a life-long Iron Ranger and having graduated from the Eveleth High School, I know plenty about parochialism, to put it mildly. But it’s not like it used to be when I graduated in ‘67, and we can’t let it trip us up. Also, the perceived comfort of the status quo can really be the enemy to the changes needed to make our ambulance services modern and sustainable.
With that, please take my comments and suggestions into consideration, and if you have any comments or suggestions for me, I’d sure like to get them by email or phone.
Lee Peterson Tower, MN Greenwood Township
