REGIONAL— The future of an emergency medical response pilot project in the Tower area remains uncertain even as the project is slated to begin sometime early next year in Cook, Orr, and Nett Lake.
The so-called “sprint medic” program is a three-year pilot project funded by a $6 million allotment approved last session by the Minnesota Legislature. Lawmakers earmarked half of those funds for St. Louis County, which is directing the money to the Virginia Fire Department. The department also operates the Virginia area ambulance service, providing advanced life support service, or ALS, to its coverage area as well as several surrounding services. Representatives of the various ambulance services have met several times in recent weeks to discuss their involvement in the program. “Verbally, all four have MOUs and bylaws waiting for approval,” said Erik Jonassen, Virginia’s deputy fire chief. “It’s been approved on Virginia’s end,” he said.
Ambulance services in Cook and Orr have also signed on as participants in the pilot program, which will employ roving paramedics who will operate within their designated coverage areas. Under the plan, one paramedic would serve the Cook, Orr, and Nett Lake area, while the other would serve the Tower area. Paramedics receive a higher level of training than emergency medical technicians, or EMTs, who are typically the most highly trained personnel at smaller ambulance services offering basic life support care.
“The plan is to put a paramedic in a chase vehicle,” said Jonassen, who noted that the medic would automatically respond to about a dozen different types of calls that tend to require a higher level of care. The smaller participating services could ask for assistance from the medics for other calls as well, at their discretion.
The concept has been shown to improve EMS response time in urban settings and the pilot program is designed to help determine its viability in rural parts of the state. If successful, the project could become a permanent fixture of EMS response in the region, although how it might be funded in the future remains uncertain.
While everyone involved seems to agree that the idea could improve patient care in more serious incidents, members of the Tower City Council are questioning the longer-term impact of the program on their local ambulance service. They’re also questioning why the Virginia ambulance is proposing to charge the local services each time their roving paramedic responds to a call.
Virginia initially proposed charging $400 for each call that involves their paramedic, but after protests from Tower, Virginia dropped the charge to $200.
That still isn’t sitting well with Tower officials. “I would love to do this, but I’m concerned about the charge,” said Tower City Council member Kevin Norby, who has been heavily involved in ambulance issues. He questioned why the city should be expected to pay to conduct a pilot project that appears to have more than sufficient state funding. “Our profit margin is thin as it is,” he added.
Norby and others on the council note that the pilot program is funded by state dollars administered through the county. The current budget for the project appears to cover all of Virginia’s costs for vehicle and equipment acquisition and operational costs, including staffing costs, at $49 an hour plus benefits like PERA and deferred compensation. Under the current plan, the sprint medics would be available between the hours of 8 a.m. and 8 p.m., five days a week.
The current budget, reviewed by the Timberjay, anticipates expenditures of just over $2 million from a $2.4 million allocation, leaving approximately $387,000 unallocated.
Long-term factors
City officials in Tower say past experience suggests the sprint medic program could have a negative impact on department morale. When the city shifted to a paid on-call service in 2018, the service lost some volunteers who felt the use of paid EMTs left them less critical to the success of the ambulance service. “What if they go on too many calls and my members can’t keep their skills up?” asked Dena Suihkonen, Tower’s ambulance supervisor. “Will they feel they aren’t needed anymore?” Suihkonen worries that could leave her service increasingly dependent on Virginia for EMS response if too many existing EMTs opt to serve elsewhere.
Norby agrees. “We don’t want to just be drivers for paramedics from Virginia,” he said.
But Matt Tuchel, who formerly served as ambulance supervisor in Tower and remains an EMT on the service, said he doubts that the service’s EMTs will feel superfluous, at least at this point. “There are only three EMTs who respond as it is,” he said. Those three include Tuchel, Suihkonen, and the service’s most active EMT, Steve Freshour. If anything, said Tuchel, the service’s EMTs might benefit from working around paramedics, potentially enhancing their skills.
While Tuchel said he hasn’t formed a firm opinion on the merits of the program, he said he has a hard time discounting it. “I don’t think we’re in a strong position for sustainability,” he said. “If we have an opportunity to do something different, why not consider it? If there are concerns, let’s figure out how we can address them.”
While Suihkonen and other city officials agree that the ALS, service provided by the Virginia ambulance is important to patients in the area, they note that the city already calls in Virginia’s paramedics when needed, at a cost of $400 each time. Currently, Tower calls for ALS assistance about once a week on average. And, according to Suihkonen, many of those calls happen outside the hours that the Virginia sprint medic program currently plans to operate. And city officials worry that if ALS calls are too limited, the sprint medics could well opt to show up at more non-critical calls, which could push the city’s costs higher. They note that people who go into the EMS field are often motivated by a desire to help others and won’t want to stay away from scenes where they could provide assistance.
Given the limited population in many of the ambulance service territories in northern St. Louis County, the viability of providing a sprint medic program long-term would seem to be in doubt without a permanent source of outside funding. Service fees alone, even at $1,000 per response, wouldn’t come close to covering the basic operational expenses of maintaining a paramedic in any given service area. While a paramedic could potentially cover multiple service territories, a larger coverage area would inevitably slow average response times.
That’s been the challenge with ALS service for years in sparsely populated regions. Providing ALS service is costly and without a sufficient patient base, such service isn’t viable without support from taxes or another reliable revenue source.
City wants more information
Suihkonen contends that she lacks the authority to approve the city’s participation in the sprint medic program and, at least for now, members of the city council say they don’t have enough information to make a decision. While Virginia ambulance officials have held several meetings with ambulance personnel in Tower, Cook, Orr, and Nett Lake, the city council in Tower questioned why Virginia officials haven’t reached out to actual decision-makers for the city’s ambulance. “I think the rest of the council would like a presentation from Virginia,” Norby said. “I’ll try to set that up before the next council meeting.”
Further discussions could also include area townships to gauge interest in providing some funding to cover the cost of the sprint medics if Virginia insists on charging the local ambulance services. “If the greater community wants to support it, they should come to the table and tell us how,” Norby said.