TOWER— The city council here, on Monday, adopted a change in the method of staffing its ambulance service to help ensure that no emergency calls go without a response. The move, which is expected to sharply increase the service’s personnel costs, comes after the service had no EMTs available to respond to an emergency call from Scenic Rivers earlier this month.
The ambulance service has relied primarily on what’s known as an “all-call” system for years, under which all members of the department are subject to call at any time, but no members are specifically designated to respond at any particular time.
“The all-call method is unreliable,” said Clerk-Treasurer Victoria Ranua, while outlining the proposed change to a written on-call schedule. “That’s why the state has required a written on-call schedule for years,” she said. In order to maintain an ambulance service in Minnesota, a service is required to have at least two staff on-call at all times, 24 hours a day.
Other ambulance services in the area rely on a written on-call schedule to ensure they have adequate staffing available to meet that state requirement. But the Tower service has been largely resistant to the change, although the service has covered about half of the required hours since 2018 through a partial paid on-call schedule.
But after the Tower ambulance missed the April 21 call, the council was convinced that it was time to adopt a written on-call schedule, at least on a pilot basis while the city waits for the completion of a business plan and a rural ambulance analysis by the Emergency Medical Services Review Board, or EMSRB.
The change could pose a challenge for the ambulance service, given that it is currently reliant on a small handful of EMTs to respond to calls. The service is training several new Emergency Medical Responders, or EMRs, but each call requires at least one EMT, and the service currently has fewer than half a dozen. Ranua noted that two of Tower’s former EMTs have since left for Ely, which now pays EMTs $18 an hour, compared to the $11.50 currently paid by Tower. “That may have been the reason we didn’t have an EMT available,” said Ranua. In the end, it was the Ely ambulance that responded to the April 21 call.
The change in staffing method will increase personnel costs for the Tower ambulance, since it would require the service to pay for two on-call staff members 24 hours a day. City officials had explored adopting a pay structure similar to Cook and Orr, where on-call personnel are paid $3-$4 an hour, depending on their classification, in order to control costs. But that proposal met resistance from current staff, who have become accustomed to the higher pay ($10.50 for EMRs, $11.50 for EMTs) adopted by the former ambulance director back in 2018 when the partial paid on-call system went into effect.
Implementing a full on-call schedule at the current pay rate is expected to cost $200,000 a year, said Ranua, which is almost certain to push the service’s total payroll to over $250,000 a year. By contrast, the service spent a total of $240,000 for all of its expenses in 2017, the year before the paid on-call system took effect. Total payroll costs for ambulance personnel that year were a comparatively modest $93,000. In 2020, the ambulance service spent $127,960 for on-call staff.
Adding to the personnel costs is a change in the pay structure for staff. While the staff will continue to receive the current rate of pay for all on-call hours they sign up for, they will now begin to receive additional “activation pay” when they are actually responding to a call. That higher pay rate is one way the city is hoping to protect itself from overtime liability. The ambulance service has been limiting staff to 40 hours per week, to avoid having to pay overtime, but the shift to a full on-call schedule may not be possible without allowing some EMTs to incur overtime hours, at least at present. City officials are hoping the higher activation pay will provide them a stronger argument that the on-call personnel aren’t subject to overtime pay requirements, although that is one of only several factors at issue in such claims.
One other factor that could work to the city’s advantage is the extremely low utilization rate for its on-call ambulance staff. Ranua noted that in the last pay period, out of 220 hours of paid on-call time, on-call staff responded to zero calls. While that was unusual, the utilization rate has consistently run under ten percent, which means a staff member who is paid for 40 hours a week, typically works, and generates revenue for the service, no more than four hours per week. Overtime claims in court are typically bolstered when on-call times are frequently interrupted by call-backs to work, so the low utilization rate in Tower would tend to work against overtime claims.
The higher personnel costs are likely to strain the city’s budget, at least in the longer term. While Ranua said the city can cover some of the additional costs for a while, she said ambulance service revenues are unlikely to cover the increased expense.
Council member Dave Setterberg seemed more optimistic and pushed to adopt the new on-call schedule, and suggested the new structure be adopted on a pilot basis, rather than interim. “That way, if it’s working, we just go with it,” he said.
While the proposal will raise the pay of on-call ambulance staff, it may also eventually come with a requirement that all staff sign up for a minimum number of hours on the schedule. City staff had proposed requiring at least 24 hours per month to maintain active status. At the current utilization rate for on-call hours, a member of the ambulance staff who signed up for 24 hours in a month would be paid about $250-$300, depending on their classification, and could expect to be dispatched on one or two calls per month. Currently, the service maintains a requirement for members to respond to 18 runs per year to maintain active status.
But Setterberg said he was concerned requiring ambulance staff to sign up for at least 24 hours per month could cause some members to quit and argued for a lesser requirement. In the end, the council set no minimum for now, but will wait to see how staff responds.
While the council approved the switch to a written on-call schedule, they also approved the creation of an ad hoc committee to research options for covering the anticipated deficits in the ambulance budget. Council members Joe Morin, Kevin Norby, and ambulance director Dena Suihkonen will serve on the committee.
In other action, the council
• Approved a $3,950 agreement with Becher Hoppe Associates to conduct an independent estimate of anticipated fees for an airport master plan. The independent analysis is required by the Federal Aviation Administration for funding master plans, and the cost of the estimate is covered by the FAA. The city is planning to develop a master plan for the airport, taking advantage of the current 100 percent reimbursement by the FAA as part of COVID relief.
• Approved a bid of $123,212 from Parson Electric for the installation of Precision Path Approach Indicator, or PAPI, lights at the airport, with the cost to be reimbursed at 100 percent by the FAA. The city will also rely on an entitlement transfer of up to $100,000 from the Longville airport, to pay for the cost. The city will repay that entitlement using its own allotment of FAA dollars in 2022.
• Approved allocating up to $500 this year to support the “Tidy Up Tower” initiative of Mayor Orlyn Kringstad. The tidy up period is set to be held this year on Monday, May 10 and Wednesday, May 12. The council declined a request by Kringstad to establish the clean-up effort as an annual event, opting to make the decision annually.
• Approved a motion to spend up to $3,000 in support of the 4th of July celebration this year, excluding the security costs, which have yet to be determined. The city won’t be spending money on out-of-town advertising, such as was done in the past. Kringstad said he will advise the Tower-Soudan Lake Vermilion Events Board of the city’s participation.
• Heard a clarification on the anticipated revenues for the drinking water treatment plant and new water main, which included better news from the previous update. At the council’s April 12 meeting, Ranua had indicated the city and the wastewater board faced a $2.3 million funding gap. But that calculation did not include a bonding bill request for $1.75 million submitted to the Legislature by SEH on the city’s behalf. At the same time, the city has been informed that it will likely still qualify for about $187,000 in IRRR funding that had appeared to be in question. Any remaining funding gap could be made up through a loan from the state’s Public Facilities Authority.
• Approved a motion to seek quotes for an appraisal of unsold lots in the city’s Northstar Addition. Several lots on Birch Street remain unsold but the city has not actively marketed the lots for years. An adjacent property owner has requested to purchase one of the lots, but not for the construction of a new home there, which prompted the discussion.
• Heard an update on concerns expressed by some council members about online advertising claims made by Dave Rose regarding his Tower RV Resort, currently under construction. Rose has been advertising the park as including sheltered boat harboring, but he currently lacks permission for installing boat access or docking along the river. But city zoning consultant Tony Jeffries told the council that the concerns are outside the city’s jurisdiction.