Rural Emergency Care Needs Transfusion

TULSA, Okla. — Rural ambulance services in Oklahoma are dying, leaving thousands of rural Oklahomans stranded without quick and dependable emergency medical care.

“It is a crisis,” said R. Shawn Rogers, Emergency Medical Services division director for the Oklahoma State Department of Health. “All across the state, we’ve got a very dicey situation.”

Since 2000, about 50 rural ambulance services in Oklahoma have closed, and 13 communities in the state have no dedicated ambulance service.

“Medicare has really knocked the pins out from them,” Rogers said.

Rising gas costs, a higher number of uninsured patients and Medicare reimbursement cuts have fueled the downward spiral for services that play such a critical role for rural Oklahoma.

Many Oklahomans depend on rural ambulance service as their sole health-care provider.

Each service has its own way of funding itself, from collecting fees to property taxes. All rely on Medicare reimbursements.

“Up until the late 1990s, Medicare was the primary payer. It used to be that costs per run were high. Now services lose money per run,” Rogers said.

Oklahoma requires nearby ambulance services to respond to any emergency where services have failed, Rogers said.

As a result, surviving services get spread thin, and financial pressures mount.

The latest victim of the statewide crisis is Rural Emergency Medical Organization in Big Cabin, which is between Vinita and Pryor on U.S. 69 in Craig County.

“We were fighting a losing battle,” said former director Janet Kimberlin. Parochial and political concerns, along with financial difficulties led to REMO’s closure in March.

Wait times for the county’s residents now are longer as Mercy Oklahoma takes on the additional load, she said.

“For traumatic accidents, every second counts,” said Kimberlin, who now works for Mercy.

The quality and promptness of emergency care also greatly depend on where one needs it.

“If you take I-44 (Interstate 44) from Tulsa, you will go through all kinds of situations,” Rogers said. “Tulsa’s ambulance service is excellent, then you go through Claremore where they are struggling. Mayes County is pretty good; Craig County is still forming, and Ottawa is chaotic.”

Services struggle: For Rick Langkamp, running a rural ambulance service is a daily struggle.

“I am a retired fireman, and people used to look up to me,” said Langkamp, director of Mayes Emergency Service Trust Authority. “EMS is a struggle. It’s not looked at the same as the Fire Department.”

Still, people expect an ambulance to be at their doorstep when they are called, he said.

It is costly to run an ambulance service. For every $1,000 billed to Medicare, MESTA collects $420, Langkamp said.

“I liken that to a regular business. Say, if you told everyone who went to AutoZone they would get a 58 percent discount, how long do you think AutoZone would stay open?” he said.

Fuel prices to operate three ambulances in Mayes County have climbed from $3,000 per month to $5,200 per month over the past 2-1/2 years, Langkamp said.

When the county trust authority took over the service in mid-2003, the ambulance service was up to $300,000 in debt, he said. MESTA cut its number of ambulances from five to three to survive.

“The key is the fact that we’re able to still exist in a lot of areas, but not with the type of manpower we would like to have,” Langkamp said.

Recruitment is difficult. Paramedics, who are trained to provide high levels of care, make $12 to $15 per hour. And emergency medical technicians, who perform basic life support procedures, make only $7 to $9 an hour.

“It’s virtually volunteer work even if you do it professionally,” said Rogers. “A paramedic’s training is comparable to the complexity of an registered nurse.”

Benefits are paltry, particularly when compared with other public servants such as police officers and firefighters, Rogers said.

“Medics across the state of Oklahoma are making life-and-death decisions,” said Langkamp.

Lawmakers’ action sought: It likely will take action by lawmakers to revive the state’s rural ambulance services.

Early last year, a governor’s task force produced a report that identifies the crisis and suggests numerous solutions.

As a result, some state lawmakers proposed several bills aimed at improving and preserving emergency medical service throughout the state.

Rep. Paul D. Roan, D-Tishomingo, proposed comprehensive legislation last year that would provide $5 million per year for four years to develop a self-sufficient rural ambulance service system.

New types of funding streams would be explored, along with the possibilities of shared dispatch and medical control.

“It needs to be reorganized so it has an economy of scale so it can survive,” Rogers said. However, HB 1615 is languishing in a Senate subcommittee as the end of this legislative session approaches.

“Our vision at the state Health Department is to develop a regional, collaborative system,” Rogers said. “Our goal is to ensure high quality EMS in every part of the state.”

Kim Archer 581-8315

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