Most of us are confident help will arrive soon if we ever have to dial 911.

That isn’t the case in rural Minnesota, where the dwindling number of volunteers has put emergency medical services in critical condition. Staffing shortages have been a concern for years, but the problem has become more acute as the baby boomer generation is retiring, creating the paradoxical trend of prompting more calls for help while having fewer volunteers to respond.

About 60 percent of emergency medical technicians and paramedics in Minnesota’s nearly 200 rural ambulance services are volunteers, industry analysts say. And it’s not just a staffing issue as more than 70 percent of payments come from Medicare and Medicaid, which reimburse below cost, according to the Minnesota Ambulance Association.

Rep. Shannon Savick, a DFLer from Wells, addressed the issue by sponsoring a bill that provides a $500 yearly stipend for volunteer firefighters, volunteer ambulance attendants and volunteer emergency medical responders in 14 Minnesota counties, including Faribault, Fillmore, Freeborn and Houston. The legislation funds a three-year pilot program aimed at recruiting and retaining volunteers for these emergency services.

Savick had hoped to make the tax credit available to all EMS volunteers in rural Minnesota, but she had to reduce the scope of the measure because of limited funding. The legislation will cost the state about $1.6 million per year. To be eligible, volunteers in the selected counties would need to serve an entire year. They would receive $500 per year for service provided in 2014, 2015 and 2016.

But Savick admits that even if the $500 tax credit proves to be successful, it will make a small dent in the problem. She said offering incentives for public employees, such as street department workers in small towns, to become trained first responders is one option. Another partial solution is establishing fire districts, where communities share firefighting resources.

“Fire districts work when you have towns that are five to six miles apart,” Savick said. “It wouldn’t work in the northern areas of the state where there are 50 to 60 miles between communities.”

Ultimately, Savick sees this as an economic development issue. “We have to get more population in the rural areas, and that means getting jobs,” she said. “If we bring more jobs, we can bring more of our young people (and more volunteers) into the rural areas.”

Mark Schoenbaum, who directs the state health department’s Office of Rural Health and Primary Care, agrees that narrowing the gap in rural EMS staffing will take multiple strategies.

“The landscape is really changing with the aging and the thinning of the population in rural Minnesota,” Schoenbaum said. “There are some growth areas, but it’s mainly older retirees who are moving to those areas, but that’s compounded by the changing nature of work. More family members are working (outside the home). They may live in one town and work in another. It’s not as routine for employers to automatically allow release time when the beeper goes off.”

Offering EMT courses in high schools has been a promising trend in recruiting younger volunteers, Schoenbaum said, but he’s especially encouraged by the recent development of community paramedics, which was authorized by legislation passed in 2011. The concept is that rural EMS have a lot of down time, and with additional training, an experienced paramedic can meet some of the primary care shortages in rural areas.

“They can respond to calls where you don’t necessarily need an ambulance,” Schoenbaum said. “They can call on folks and go to the home and take lab samples. They can have some basic mental health training. If you call 911 for help, they can defuse the situation to keep the person out of the ambulance and out of the hospital.”

Schoenbaum attended a rural health conference last month in Duluth, where he was impressed by a community paramedic presentation by officials from Wadena in Otter Tail County.

“It not only just fills a health-care need in a community, you can bill for these services, so it builds a revenue opportunity it helps fill the revenue gap that these rural ambulance services struggle with,” he said.

Funding emergency services always will be a barrier in rural areas. Savick, who served on the Wells City Council and as the town’s mayor before being elected to the Legislature, said small municipalities can’t afford to have paid EMS and firefighting professionals on staff.

“This is a topic we have to keep in the public eye,” Savick said, adding there are hidden costs to not having adequately staffed EMS and fire departments in rural areas. It’s becoming clear that tangible progress isn’t made until legislation is passed, such as the $500 tax credit and the creation of the community paramedic. This issue isn’t going away, so the Legislature should continue to address the rural EMS shortage in the next session.

We have come to expect emergency services as an essential part of living in a community. Getting a prompt response when you dial 911 shouldn’t be a matter of where you live.

— Rochester Post Bulletin, July 7