Ambulance service proves challenging for rural areas


— Emergency service crews face significant challenges in trying to provide life-saving services in rural areas such as Dinosaur and Maybell.

"We have many problems," said Karen Burley, Moffat County EMS coordinator. "It's more than just equipment problems."

The first is a state mandate that patients be transferred to a hospital equipped to deal with their specific injuries, something that is not always feasible in a rural county where the choices are few because of the distance to any hospital.

"It's our job as EMTs to make sure you get those patients to the right facility," Burley said.

The Maybell Ambulance Service in west Moffat County covers 3,400 square miles, much of it rough terrain and difficult to access.

The Maybell Ambulance Service was created decades ago, following an automobile accident in which five youths waited more than an hour for an ambulance. Three of them died.

After that, 12 Maybell residents became certified EMTs and raised the money to purchase an ambulance. But the time it takes to get to victims is still an issue in rural areas.

According to Burley, the average call for the Maybell crew is three hours. In many of these emergencies, much of that time is spent just getting to the victim.

"We call the BLM, the Forest Service or the wildlife department for help in determining access and other conditions," Burley said. "You try to get anyone on scene to determine whether you need to fly them out. We're making decisions even before we even see the patient."

In a rural community, sometimes an ambulance just isn't enough.

The problem is compounded by communication problems. In rough country, there are several zones where there is no cellular or radio signal.

"We may travel 20 to 30 miles before we get a signal," Burley said.

A call from a cellular phone, which cannot be pinpointed, once had the Maybell Ambulance crew responding to an accident "somewhere between Craig and Dinosaur."

"When you know there's an accident and there's an injured person waiting for you, it's very stressful," Burley said.

In many places, the ambulance crew can't get a radio signal either, she said, which means the crew has no contact with emergency rooms, doctors or support services just when they need it most.

"We lose contact with the ER, so we're making decisions on our own," Burley said.

Recruiting and retaining EMTs has been identified as a statewide issue, but Burley said rural areas suffer the most.

There are nine EMTs in Maybell, eight of whom have full-time jobs in Craig, which leaves only one person to respond to emergency calls during the day. Another works shifts, so that EMT might be available, but many times the crew is searching for someone to drive the ambulance.

"It's very challenging to man that ambulance with one person," Burley said.

Luckily, they've always had the resources when they've needed them.

"In the 18 years I've done this, the Lord has been very good to us," she said.

One problem is that EMTs don't get paid for making runs.

"The state has made grants available for retention and recruitment but grant money can't move people into your town," Burley said.

Maybell's population is 84, with more than 60 percent of the population being older than 65. Dinosaur has similar issues with a growing senior population making it difficult to recruit EMTs.

It's difficult to recruit for a volunteer position when it demands so much time and energy outside a person's regular job and family. Maybell EMTs put their own time into the six months of classes required to become certified, continuing education, fund-raisers and emergency runs that can last from three to five hours.

It is estimated an ambulance service could make 150 runs a month and charge Medicare rates and still only meet 60 percent of its operating costs.

"We're looking at the feasibility of putting EMTs on the payroll," Burley said. "In Dinosaur and Maybell, who do 30 to 40 runs a year, how do you do it?"

Rural communities have enough financial problems in establishing an ambulance service, purchasing the equipment and paying to operate and maintain it. In Craig, the ambulance crew is a department of The Memorial Hospital and funded as such. In Maybell, a portion of the tax collected for fire services helps fund the ambulance service. The biggest problem is a state that recognizes there are problems with emergency services, but is working to solve them in a way that benefits metro areas, not rural ones, Burley said.

"The rules and regulations tend to support policy and issues for the metro area," she said. "They don't understand rural issues and how we have to do things differently."


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