As another Ohio EMS agency closes, chiefs grapple with staff and funding shortages
The Riverside Emergency Medical Service started its squad in the early 1980s to serve the village of DeGraff and Pleasant Township, about an hour north of Dayton.
At the time, roughly 30 people volunteered as first responders, remembers Chad Kean, an EMT and trustee for the service.
“It was something that they had self-pride on for getting it started,” he said. “But today's world has changed dramatically.”
Now, fewer and fewer people have the time and interest to volunteer for the squad.
“It’s not like we don’t care anymore. We care and we can't provide the service any longer. And we're running out of money to be able to do it.”Chad Kean
Before COVID, Riverside EMS operated with 16 active members, according to Kean.
Since then, that number has dropped even lower.
“We've got five or six people trying to make a hundred runs a year,” Kean said. “We can’t do it any longer.”
The service is discontinuing operations at the end of 2023, leaving locals with medical emergencies to rely on help from farther away.
“It’s not like we don’t care anymore,” Kean said. “These are friends and family, people we went to school with. We care and we can't provide the service any longer. And we're running out of money to be able to do it.”
A statewide rural EMS emergency
This situation was nearly unheard of years ago, said Eric Burns, president of Ohio’s EMS Chiefs Association.
“But it's becoming more and more common as the workforce isn’t there to maintain EMS services and the funding isn’t there,” he said.
EMS chiefs across Ohio, from Miami County in the southwest to Ashtabula in the northeast, are grappling with those same concerns.
They say staffing has been a problem for decades, but COVID only made the shortage worse.
“It was the exclamation point on the snowball rolling down the hill that's been going on for decades since we started,” said Kenan Mylander, chief of Mid-County EMS in Ottawa County.
He says the training required to become an EMT and paramedic is time-consuming, expensive and emotionally intense — all for very little pay.
“We can't pay a living wage,” he said. “Right now, I am literally comparing our local McDonald's to our EMT wages as far as competition for the workforce.”
But Mylander, like other rural Ohio EMS chiefs, says he can’t afford to raise wages because his organization is strapped for funding.
The funding problem
For the most part, emergency medical services in Ohio have two main sources of funding: tax levies and billing.
Eric Burns estimates most services employ what’s called “soft billing,” meaning they accept whatever an insurance company will pay without charging the patient any more.
But there’s a problem with this system.
“Some of the worst payers we have are Medicare and Medicaid,” he said. “And when you look at the numbers of people who are calling EMS, it's those types of payers that we're having to deal with the most.”
If a call costs $500, for example, Burns says Medicaid will generally only reimburse a fraction of that cost, leaving the EMS service to cover the difference using tax dollars.
“So, we can't use the tax funding to maintain our equipment, our buildings, or help educate people,” he said. “It's kind of a double-edged sword. We can't get people to come in. We can't pay them to come in and we can't entice them with free education because we can't afford to do that without losing something else in our organization that we desperately need.”
At the end of the day, community members are the ones who feel the brunt of this loss.
As EMS services close and lose staff, departments rely increasingly on help from neighboring communities, which lengthens emergency response times.
“If you're getting an ambulance from a different district, it may take anywhere from six to 22 minutes to get to that particular call, which is detrimental, especially with patients who are having strokes, cardiac arrest,” Burns said. “And if you're talking about a car accident, unfortunately, patients will die waiting on an ambulance.”
Is help on the way?
Last month, Ohio Governor Mike DeWine announced the recipients of a seventh round of funding for Ohio first responder agencies.
To date, 250 agencies across the state have received nearly $65 million through the Ohio First Responder Recruitment, Retention, and Resilience Program.
But Burns says it’s not enough.
“I know an awful lot of departments out there applied for that funding. I know that we did apply for that funding and I know that we haven't been picked,” he said. “So it seems that it's a fantastic program, but I don't think there's enough funding to go around.”
Burns says he’s looking for a more sustainable, long-term solution, starting with better billing reimbursement rates.
He also thinks the government could help fund an apprenticeship program to introduce more young people to the profession.
“We are getting older and older,” he said. “I'm 55. I can retire in a couple of years. And I sit back and wonder who's going to take my place and who's going to carry on the torch of performing emergency medicine.”