Challenges continue with ambulance service
November 14, 2020
By TOM LAVENTURE
Four years after helping prevent the loss of quality ambulance services in Gogebic County, a special committee continues to explore ways to address increasing costs, cross-border regulations and rural response times.
The county had considered running its own ambulance service but it makes more sense to contract, financially speaking, said Jim Lorenson, chair of the county ambulance committee.
The committee formed to find immediate and long-term solutions when Beacon Ambulance could not keep up with operating costs. Along with providing taxpayer revenue to support Beacon, the Gogebic County Commission approved a recent agreement to negotiate the purchase of the ambulance service should it cease operations.
“We’re pleased with the way the contractors are doing it now and would prefer to stay that route,” Lorenson said. “The preference is to have someone else do it but if things were to change dramatically we have an option.”
Beacon Ambulance Service has operated in the county for several years but the costs to maintain staff and equipment increased while insurance reimbursement levels dropped to the point the company was on the verge of closing from 2016 to 2018, Lorenson said. This is a national issue and not limited to the Upper Peninsula, he said.
Beacon was also challenged with hiring and retaining emergency medical service (EMS) staff who are certified as emergency medical technicians (EMT) or paramedics, he said. The cost to educate and certify an EMT is approximate to nursing and people tend to pursue the higher paying career of nursing, he said.
“At the same time, providers were being squeezed financially and with a shortage of staff, the cost to retain staff was going up,” Lorenson said. “It was kind of a perfect storm.”
Voters approved a three-year 1-mill levy for ambulance services in 2018 as the ambulance committee’s long-term solution. The county has since extended into a two-year contract with Beacon that paid $338,500 in 2020 and will pay $407,925 through 2021.
Separate community agreements with Beacon are preferable to forming a county ambulance authority to pay for the service, Lorenson said. The separate municipal contracts address specific needs and are more cost-effective than an authority, he said.
“Wherever Beacon is providing service there is an agreement with that municipality,” Lorenson said. “The county provides matching dollars raised by the cities and townships.”
Jodi Kennedy, manager of Beacon Ambulance Service, said the county millage helps to purchase new ambulance rigs costing $120,000 to start as well as staff costs and updated equipment and supplies
“We provide the best care that we can with what we have,” Kennedy said. “The millage is essential and the community is repaid through excellent service.”
This year Beacon replaced older cardiac monitors with more advanced LIFEPAK automated external defibrillators, she said. Beacon also purchased intravenous infusion pumps that more precisely administer fluids and medications.
“This is all because of the millage we are receiving,” Kennedy said.
The up-to-date ambulances also make interfacility transports of patients between hospitals and other medical care much more safe and valuable to the community, she said. The life-span of a rig is approximately 300,000 miles.
Kennedy has been with Beacon for 14 months and took over as manager two months ago from Randy Forstrom, who is now the operations manager. She manages approximately 25 employees who answer around 3,000 calls annually from rigs that are strategically placed throughout the Gogebic County, portions of Ontonagon County and Iron County, Wisconsin.
“We are a very busy service,” Kennedy said.
Rural ambulance service is a statewide issue and the ambulance committee looks at what other communities are doing to find solutions to similar challenges, Lorenson said. Gogebic County contracts with Beacon to cover the western half and Aspirus Med-Evacs service has a two-year $63,825 contract to cover the eastern half.
Beacon coordinates with Aspirus, SONCO Ambulance, based in Ewen, and other smaller community ambulance services to ensure the closest rig responds to a call. Aspirus serves as a higher level care intercept for patients in route with lower level care transportation on the east side.
The county needs to maintain small, local ambulance services so that higher level care can respond when needed at the scene or with an intercept, Kennedy said. The small town responders are often on-call volunteers who are trained to stabilize patients and make the determination if higher level care is necessary such as cardiac or respiratory failure, accidents and pain management, she said.
“Service changes dramatically when going from urban to rural service,” Lorenson said. “The volunteers just aren’t there and it’s expensive to run.”
In August, the Gogebic County Board of Commissioners approved a three-year contract for county dispatching services to Negaunee Regional Dispatch. The contract change effective in January is supported by the Michigan State Police Wakefield Post.
Negaunee dispatch provides communications along with an advanced tracking and mapping system, Kennedy said. Returning to Negaunee will improve service, she said.
“Going back opens us up with more communication to include the state police and county services,” Kennedy said.
Service by Beacon in the west is going well, Lorenson said. Service by Aspirus and others in the east is also high quality, but there are challenges with distance.
Aspirus Med-Evacs is located in Iron River, which is a half-hour response time to the intersection of U.S. 2 and U.S. 45 in Watersmeet, a community that has approximately 180 calls annually.
“That response will be significantly longer to go anywhere else in the township,” Lorenson said. “You risk losing what they call that ‘golden hour.’”
The Watersmeet Fire Department has a rescue squad with medical first responders and EMTs, he said. The department does not transport patients but the county contracts with them as first responders before advanced care can arrive.
The ambulance committee looked at other alternatives to include a $10,000 ambulance service agreement for basic life support services with the town of Land O’ Lakes, Wisconsin, in September. The town is just a few minutes across the border from Watersmeet while Aspirus is around 45 minutes away.
The agreement would have Land O’ Lakes serving the southern tier of Watersmeet Township. But there are inter-state licensure issues that prevent Land O’ Lakes EMTs from responding in Michigan at present.
There are not enough paramedics in the Watersmeet area to provide a volunteer service, he said. There may be enough emergency medical responders to place a rig in Watersmeet to provide initial transport to an intercept with advanced life support.
“We need to find a better way,” Lorenson said.