Iowa ambulance services work to reverse decline in certified emergency rooms

Working in an ambulance is not an easy job. Working hours are irregular, the work can be overwhelming and it doesn’t always pay well. In some rural areas where ambulances are staffed by volunteers, no payment is made.

Ambulance services in Iowa and across the country are struggling to attract and retain staff. Data from the Iowa Department of Health and Human Services shows the number of certified emergency room personnel in the state has decreased every year since 2018. But ambulance service experts are working to reverse this trend, and changes to state laws in 2021 may have eliminated it. The first step in the right direction.

Data shows recruitment and retention strategies can work

within the state latest emergency medical services annual reportThe Department of Health and Human Services noted that although the number of emergency rooms continued to drop, the change between Jan. 1, 2023, and Jan. 1, 2024 (6,191 to 6,131) was the smallest decline the state has seen since 2019.

The decrease in the total number of emergency medical clinicians (meaning all EMTs, paramedics, and other emergency medical responders) was also small; Only 33 people fell from 10,743 in 2023 to 10,710 in 2024.

There are four levels of emergency medical clinicians: EMR, or emergency medical responder; EMT or emergency medical technician; AEMT or advanced emergency medical technician; and paramedics. One reason for the decline in the number of people with EMT certification was the advancement of some EMTs to AEMT, or paramedic, status, according to the report.

The report also notes that the number of EMS clinicians between the ages of 17 and 40 will increase between 2023 and 2024, meaning more young people are joining the profession.

“The above data suggests that the EMS industry may be improving its recruitment and retention strategies,” the report states.

Higher-paying medical fields attract some medics

Although the decline in certifications has slowed, this does not mean that there are more personnel available for ambulances. Many who achieve paramedic-level certification continue their education to pursue careers in higher-paying medical fields, such as nursing.

North Benton Ambulance service manager Anna Demuth said she has seen many paramedics go out into the field to do nursing. The North Benton service recently raised wages to compete both with hospitals hiring nurses and with larger ambulance services that could shift clinicians away from the service.

The struggle to remain fully staffed in ambulances staffed by volunteers becomes even more difficult.

“EMS providers across the country are definitely running low or not filling the space as much as we need them to,” said Andy Ney, president of the Iowa Emergency Medical Services Association and director of operations for Paramount Ambulance in Dubuque. “I think we feel it a little bit more in Iowa because we are so reliant on volunteers in each of these communities that they don’t get paid to do the work.”

According to the annual EMS report, 63 percent of ambulance services are staffed entirely by volunteers, while the other 10 percent are staffed partially by volunteers. Volunteer ambulance services across the state are finding it increasingly difficult to remain fully staffed as fewer people take the time to volunteer, Ney said. In the coming years, rural ambulance services may need to find funds to become a paid or hybrid service.

“What we really need is to make the career more rewarding for a newcomer,” Ney said. “This is one of the riskiest careers in the country, so I think we can make the compensation package look better.”

However, it will not be easy to find these funds with the current repayment system. Many ambulance services, both voluntary and paid, have struggled to keep up with inflation over the past few years, Ney said. He said reimbursement rates (the amount of money an ambulance service pays Medicare or private insurance companies for each ride) have not kept pace with rising equipment prices and other costs, making it difficult to offer competitive wages that protect workers.

“We really need to figure out how we can work with these commercial insurers to make sure we don’t get left behind in reimbursement,” Ney said. “I think this is something we’re really working on in the state, and if we don’t get a return from these private insurances, we may go as far as to provide some legal protections for EMS so we can increase our rates, which we really need.”

Essential service designation provides new revenue stream

New legislation in Iowa in recent years has been aimed at helping ambulances with financial difficulties. State lawmakers in 2021 passed a law This allowed counties to declare emergency medical services as an essential service; That means the county could levy taxes to support it if voters allow it.

Since then, 20 counties have adopted public measures to collect taxes for EMS programs. Seven of those counties (Appanoose, Butler, Cass, Hamilton, Jefferson, Sac and Tama) passed public measures on the Nov. 5 ballot this year. Five other counties — Buchanan, Floyd, Guthrie, Page and Taylor — had similar measures on this year’s ballots, but they were not passed.

Jones County Passed EMS tax in 2022and 2024 marks the first full year the county’s ambulance services have been able to utilize the funds. They can’t use the money to fund salaries, but tax dollars can be used to pay for equipment and buildings.

“If that money can be used for equipment, buildings and some non-disposable supplies, then we hope to alleviate some of the current funds being used for those types of things, and they can use other sources of funding for salaries and wages.” Jones County Auditor Whitney Hein said.

Funds can also be used for education; Brenda Leonard, Jones County emergency management coordinator, said the ambulance is helpful in recruiting for both volunteer and paid positions because it can offer payment for certification classes for recruits.

“They won’t have to take time out of their personal lives to attend fundraisers or pay to pay for the course out of their own pocket,” Leonard said. “We have a new class coming up and we have a lot of interest knowing that this class is not coming out of their own pocket.”

The 2021 legislation also changed state law to allow ambulance services to host their own certification training classes. Previously, these programs could only be organized by hospitals and colleges. This has helped increase recruitment opportunities with ambulance services.

Demuth, in conjunction with the North Benton Ambulance service, is currently teaching an EMT certification course as a way to recruit more emergency medical technicians. It partnered with Mercy College of Health Sciences in Des Moines to host the class held virtually with some students in Des Moines and some students in Vinton. Students meet once a week at both locations for in-person reviews and classroom skills training.

Three of Demuth’s students were already working as drivers for the ambulance service and had expressed a desire to become EMTs, which was one of the reasons Demuth decided to take the class.

“We have to look at different options to get education to those who want it, and that is always a challenge. “There’s the time commitment and the work on top of that, the family life and all that,” Demuth said.

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