The Pandemic raises the ‘Paramedic Paradox’ in Rural America

Even after her arrest, Sarah Lewin kept a Ford Explorer decorated with drugs parked outside her home. While he was one of four physicians covering five counties in central eastern Montana, he saw on a phone that someone had a heart attack, was in a serious car accident, or wanted to in life support and is 100-plus miles away from the nearest hospital. come every now and then.

“I got 100 hours of time in two weeks,” said Lewin, military chief for the city of Miles fire and rescue department. “Other people have it.”

Paramedics are the most skilled paramedics in emergency response workers, and their travels can make a difference in lives in rural areas where health services are scarce. Paramedics are trained to administer emergency care from the school, such as placing a breathing tube in a sealed airway or decompressing a falling lungs. Such procedures precede the development of critical care technologies.

But paramedics were hard to come by, and staff inadequacies were exacerbated by searching and leaving in connection with a terminal illness.

Major agencies are trying to attract paramedics by increasing pay and offering hefty sign -up bonuses. But small groups in undeveloped counties across the United States did not have the opportunity to compete. In particular, some rural forces are trying to train crisis responders for responsibilities, with mixed results.

Miles City is one of the few communities in rural eastern Montana to have paramedic-level services, but there aren’t enough paramedics to provide that care 24/7, which is why paramedics are calling. medicine like Lewin in their spare time. The company received a federal grant that allowed four employees to become physicians, but could complete two terms. Some students refused training because they could not balance the stressful program with their work days. Others don’t want the paramedic to come with a paramedic.

“If you’re just the paramedic, you end up making more calls,” Lewin said.

What is happening in Miles City is also happening all over the country. People who practice emergency medical care have a long name: the paramedic paradox.

“Patients who need paramedics are mostly in rural areas,” said Dia Gainor, executive director of the National Association of State EMS Officials. But there are more paramedics in large urban areas where response times are faster, transportation to hospitals is shorter, and health systems are more efficient.

“On the ground, throw a shot at the map, what can be difficult is rural areas with workers, with income, with access to education and training,” Gainor said. . “The list goes on.”

The Michigan Association of Ambulance Services called paramedic and EMT deficiency a “complete problem” and called on the state legislature this year to spend $ 20 million to cover the costs of training. and training 1,000 new paramedics and EMTs.

Earlier this year, Colorado reworked its dilemma of caring for short -lived health care workers seeing rising demands for ambulances at a time of rising emergencies. covid. The lack of a problem that combined a medical center and a high school in Denver to offer classes through paramedic school increased student interest.

In Montana, 691 licensees are licensed to treat patients in crisis areas, said Jon Ebelt, a spokesman for the Montana Department of Public Health and Human Services. More than half in the state’s five largest counties – Yellowstone, Gallatin, Missoula, Flathead, and Cascade – cover 11% of the state’s 147,000 square miles. Currently, 21 of Montana’s 56 counties do not have a single EMS paramedic license.

Andy Gienapp, vice president of the National Association of State EMS Officials, said money was a big problem. Medicaid and Medicare reimbursements for critical care often outweigh the cost of providing an ambulance service. Most local organizations rely on a patchwork of volunteers and staff, and the most isolated areas are always staffed only by volunteers, with no money to hire a paramedic. very clever.

If those rural teams have or train paramedics in -house, they are often eaten up by major centers. “Paramedics are laid off because once they have those skills, they can be traded,” Gienapp said.

Gienapp wanted to know other states where emergency care was considered an important service so he could be assured of his survival and tax money. So far, only about a dozen states have done so.

But working at the state level does not always guarantee the financial statements EMS workers need. Last year, Utah judges passed a law requiring counties and counties to ensure a “minimum” level of transportation services. But the laws did not allocate the money to go with the law, leaving the integration cost – estimated to be up to $ 41 per citizen per year – for governments. local to think.

Andy Smith, a paramedic and director of Grand County Emergency Medical Services in Moab, Utah, said at least one city served by his team did not provide the costs of the service. The company’s land has 6,000 miles of roads and trails, and Smith said it’s always difficult to find and maintain staff to cover that land.

Smith said his team was lucky – there were many paramedics, in part because of the restoration of a nearby public park and the ambulance service helped staff pay for paramedic certification. However, these benefits did not deter the candidates, and he knew some would be tempted. He soon found a paramedic job in nearby Colorado that started at $ 70,000, a salary he said he could not compare.

“People are hoping that if there’s something, we get a car ride, we’re within two minutes, and we have the most highly trained people,” Smith said. “The truth is that’s not the case when money is scarce and it’s hard to find and take care of people.”

Despite the nature of the workforce and financial services, state leaders often believe that crisis care groups can fill the gaps in basic health care in rural areas. Montana is one of the states that is trying to increase EMS work in nonemergency and preventive care, such as having medical technologies to meet with patients in their homes to provide care. four.

A private car service provider in Montana’s Powder River County has agreed to provide those community services in 2019. But the owner retired, and the company closed. The county took out emergency services last year, and County Commissioner Lee Randall said providing basic medical care was on the back burner. The most important thing is to hire a paramedic.

The success of care that EMTs can do without paramedics is impossible. Montana’s EMS chief of staff, Shari Graham, said the state has created certifications for regular EMTs to provide certain high levels of care, such as starting an IV line. The state has stepped up training in rural communities so that volunteers can avoid the trip. But those steps leave no room for successful life support.

“Of course, you don’t have paramedics in those counties that don’t have money,” Graham said.

After the town of Miles, Lewin said his office may have to increase the training of new paramedics next year. But she wasn’t sure she could fill in the blanks. He has a few new EMT hires, but they won’t be ready for paramedic certification at that time.

“I don’t have any enthusiasts,” Lewin said. Now, he kept that emergency safe in his driveway, ready to go.

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