Ambulance service rolls along
Progress continues as Heart of America Medical Center works on revamping their ambulance service for the community, according to administrators charged with care and fundraising efforts.
Cathy Jelsing, who serves as coordinator of fundraising efforts for the Good Samaritan Health Services Foundation told the Tribune the foundation recently received $500 from the Pierce County Endowment Fund, a charity that raises funds for healthcare projects.
The money will be used to fund a new four-wheel drive ambulance for the hospital’s emergency medical service.
“We’re getting ready to launch our Twice Blessed campaign with St. Joseph Community Health Foundation,” Jelsing said.
The campaign will match donations up to $15,000 toward the ambulance purchase.
Jelsing said the foundation is also applying for a USDA grant to fund the new vehicle.
“We’re inching away and hoping for the best,” Jelsing said of the ambulance project.
Susan Price, who serves as chief nursing officer for HAMC, heads the ambulance service.
“We’re not planning on purchasing (a new vehicle) immediately,” Price said.
“We’re planning on doing some fundraising and getting some grants and seeing where we fall. However, the reality is we’re going to need another ambulance soon,” Price added.
“It only makes sense to get the best safety-rated standard ambulance you can get because I want to protect my staff and protect my community, and we live in North Dakota so to me, not having a four-wheel drive ambulance is kind of strange,” Price noted.
Price recounted difficult experiences in HAMC’s ambulance last winter.
“I went on a few calls last year where we couldn’t even get through (because of winter road conditions). We probably could have gotten through if we had a bigger vehicle but we were worried about getting stuck so we had to turn around and go a totally different way to get to a house out in the country.”
HAMC made its own contribution to the ambulance service with a purchase of the former Premier Lube building earlier this year.
“I didn’t make the decision to purchase the Premier building, that was the decision of our former CFO, Lee Holter, and our CEO Pat Branco,” Price said.
Price explained the reasons behind the purchase: “Our maintenance department is running out of space. The second thing is we do all of our training on the third floor of the (ambulance) building, and it’s just not conducive to having (the activities needed for training, etc). And it’s not big enough.”
To accommodate a larger rig, the present facility would need major and costly renovations, Price noted.
Price added, “We brought the nursing program back so we utilize that training room for the nursing program now.”
“We will utilize (the new location) for training and there will be sleeping quarters there plus it’s more accessible to the highway, more accessible to the fire department. It’s just as easy to get from there to here as it is to go around (to the ER). There’s no throughway for the ambulance to get here,” Price continued.
Price and HAMC administrator Dustin Hager also addressed public perceptions concerning the ambulance service’s life support capabilities.
The service recently took a basic life support (BLS) designation, which some members of the public saw as a downgrade from the advanced life support (ALS) designation the service had before.
Price said she had learned last year the service had not operated in a way that complied with the ALS designation.
“The difference (between ALS and BLS) is with advance life support, you have to have a paramedic and an emergency medical technician (EMT) on every trip,” Price said.
“Any 911 call, that’s a licensure thing. You have to have a paramedic and an EMT. For transports, if you have a basic life support from the hospital to Minot, you can have two EMTs but you can’t have an EMT and a driver that’s not certified. Because you have a license for advanced life support so there has to be two licensed staff on board,” Price noted.
“You can never, ever use a driver as your second person with advanced life support,” Price added. “With basic life support, you can.”
Price said on some transports, “what (paramedics) would do is go on every 911 call but all the transports to Minot, they would send an EMT and a driver. So, that was illegal.”
“So,” she added, “We could have lost our Medicare status completely for the entire organization if they came in and audited us. We were operating outside the scope of a) our license for the state and b) we were billing insurance companies for these trips that we weren’t even licensed to do.”
“Because of the flexibility afforded by BLS, it’s not necessary to have a paramedic on each ambulance call nor is it desirable because 80 per cent of our calls are BLS calls,” Price continued. “So, we’re staffing an ALS level ambulance for 20 per cent of our calls. It just really doesn’t make sense.”
Price and Hager said they presented information on compliance and the different levels of service to voting members of the HAMC board of directors in January. The board voted 6-2 in February to give the ambulance service the BLS designation.
Hager said, “One thing I told (the board) was, as a BLS -licensed service, you can operate up. But you can’t operate down. So, if you’re a BLS service, that’s the minimum standard you can provide. At the ALS level that’s the minimum standard you can provide. There’s no ability to provide BLS service when you’re licensed at an ALS level for emergency response.”
Price said, “There is nothing in statute or rule that prohibits a BLS ambulance from offering ALS-level care as long as the ambulance is staffed with a paramedic or equivalent and the ambulance service’s medical director permits it.”
Price noted she and nurses on HAMC’s emergency room staff are qualified to act as paramedics on ambulance calls. Some EMTs on staff have advanced training and qualifications to do more medical procedures than basic EMTs as well.
“Most ambulance services in North Dakota are licensed as BLS but often provide ALS when paramedic staffing is available. This flexibility is not offered to ALS licensed ambulance services. Staffing an ALS ambulance with a BLS crew is not permitted for emergency responses. This lack of flexibility at the ALS level was the reason HAMC elected to pursue a BLS license.”
Price said some North Dakota communities Rugby’s size operate ALS ambulance services, however, most are located in the Bakken and respond to as many as 1,500 calls per year.
“We have between 400 and 500 calls a year,” Price said.
Both Price and Hager described Bottineau’s ambulance service as similar to the one Rugby now operates – a BLS service with ALS capabilities.
Like many rural communities, however, Rugby feels the squeeze of increased staffing shortages. Other neighboring communities such as Towner and Rolette have to rely on Rugby’s ambulance service for help in their own emergencies.
Price said, “Chris Price is the state EMS director and virtually every day he’s getting some communication from somebody about an ambulance service that will possibly close.”
North Dakota legislators changed their formula to fund local ambulance services to place a larger burden on local communities to come up with funds through taxes. Many community ambulance services receive 15 mills, but Price said Rugby’s service receives eight. The money raised through local property taxes “doesn’t even cover the staff salaries for the year,” Price said.
Furthermore, only eight state governments view emergency services as essential for their communities, according to a recent story by NBC news. North Dakota was not included among those states.
“It’s a national crisis,” Hager said. “It’s not just our area or our state.”
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