With Lack of Volunteers, Altura Ambulance Service is in Danger of Closing

The seventh licensed ambulance service in Minnesota — dating back to the late 1960s — is in danger of losing that license.

The problem facing Altura Ambulance Service is a problem faced by rural ambulance services across Minnesota. The potential closing of the Altura Ambulance Service would mean calls in its region would be handled by its neighbors — Lewiston Ambulance and Winona Area Ambulance — which are already spread thin as well.

"That means that you're waiting on the next closest unit, everybody, the other ambulances around us would come in and cover our service area," said Altura Ambulance Director Jessica Romine. "They're already burnt out, because they're having the same problems everywhere. ... So, we wouldn't be adding the burden on surrounding services."

Monday night, the ambulance service held a community meeting at Altura City Hall to discuss the staffing problems faced by the ambulance service and look at options going forward and solutions.

Altura Ambulance is facing a loss of its BLS — basic life service — license because it has been unable to staff on-call shifts for more than 12 consecutive hours on several occasions in recent months.

Holly Jacobs, an EMS specialist with the Minnesota Emergency Medical Services Regulatory Board, which oversees ambulance service licensing in Minnesota, said the state statute calls for an ambulance service to face regulatory penalties, including loss of license, if it is unable to staff shifts for more than 12 consecutive hours just once. However, because of the shortage of emergency medical technicians and emergency medical responders in Minnesota, her agency is trying to be "reasonable regulators" when dealing with infractions.

Generally, an ambulance service has mutual aid agreements with its neighbors to provide coverage when short-staffed, but going more than 12 consecutive hours is a violation of state statutes.

Jacobs said in just the past year, she's attended similar town hall meetings in Spring Grove and St. Charles, which currently has its license taken over by Lewiston Ambulance while St. Charles — which was down to four volunteers on its roster — rebuilds its ambulance service.

She added the problem facing Altura Ambulance is a problem facing rural EMS agencies across Minnesota and the country.

Matt Essig, director of Lewiston Ambulance Service, said the stress his team feels covering for St. Charles would only be made worse if Lewiston also had to cover for Altura.

Altura Ambulance covers an area of Winona County from south of the city of Altura up to near Rollingstone, which also includes the cities of Elba and Minneiska.

When mutual aid is required or if Altura Ambulance lost its license, the response times to parts of Altura's coverage region would go to 30 minutes or more, several EMTs in attendance warned.

"There has to be an Altura (Ambulance Service)," said Essig.

Several members of the ambulance service stood up at the meeting to talk about their experience with the volunteer service.

Michelle Van Loon, who previously served as director of the service, said a big part of the director's job is juggling the schedule to make sure shifts are covered according to statute, but also make sure people are getting breaks and not getting burnt out.

Van Loon said her husband is a firefighter, so when a call comes in requesting fire and EMS, the couple has to decide who goes on the call, and who stays at home with the kids.

Today, due to family commitments, she said she serves more as a fill-in member of the ambulance service than as a person taking regular shifts. Because of the lack of volunteers on the roster — about a dozen, with four of five taking the brunt of the hours — she feels she cannot just quit.

"None of us are ready to give up, but we do need help," Van Loon said.

Romine said Altura is facing three options. One is to get more volunteers, fill out the roster, and continue providing ambulance services for the area as it has done for 54 years.

To do that, Romine said she wants to recruit more EMRs. While EMRs do not have some of the same abilities as EMTs — mainly, they cannot be alone in the back of the ambulance while transporting a patient — EMRs require about a third of the training to be licensed.

Every ambulance call requires at least one EMT and one EMR. Since almost all the volunteers of Altura Ambulance are EMTs, having more EMRs would mean Romine could pair EMTs with EMRs instead of pairing two EMTs all the time.

Romine also talked about paying volunteers while they are on call. The pay she suggested would be $2 an hour on weekdays while on call and $5 an hour on weekends. Currently, volunteers are only paid $20 an hour while answering a call for service or $10 an hour for training, she said.

Money, she said, isn't a problem as the townships served by Altura Ambulance have always paid for whatever has been requested from the service.

A second option would be to downgrade from a BLS to a first responder service. The big difference there would be a first responder service cannot transport patients, so they would still need a neighboring service to provide transportation to a hospital or another transportation option such as a helicopter.

Finally, the service could dissolve, leaving Altura's coverage area to other neighboring ambulance services, something that could prove costly financially and in terms of life-saving ability due to slower response times.

Jason Passow, a volunteer EMT, said he joined because he wanted to help his neighbors, and if the service goes away, that's akin to telling people in the community they need to wait for lifesaving medical response care.

Because the service area only generates about 80-90 calls a year, Passow said it would not be financially feasible to hire a full-time EMT to cover shifts.

Romine said she'd rather take the money it would cost to hire a full-time EMT and spread it among the group as an incentive to stay on the roster and cover on-call shifts.

The current shortage, she said, started in February when one volunteer moved out of the service area and two more retired. That left her scrambling to cover shifts.

"For our crews right now, our motto has been 'Something is better than nothing,'" Romine said.

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