Despite Jasper County’s efforts to improve EMS services, state may need to pay more attention

Editor’s note: The following story is the final article in a multi-part series about Jasper County’s efforts to improve emergency care for rural residents and assist the volunteer teams struggling to keep crews full and find new members, many of which may not have the means or time to be certified for paramedic-level care.

Brandon Talsma wants Jasper County residents — especially those who are older and live in the more rural areas — to be assured that when they dial 911 for a medical emergency, there will be an ambulance and a paramedic on scene in a timely manner to administer care and even save a life.

No citizen should have to wait 45 minutes to receive care, and Talsma said thankfully that has not happened in Jasper County. But it did not stop the chair of the county board of supervisors nor the sheriff from worrying about those very scenarios when they know some volunteer agencies are struggling to keep up.

Low recruitment and an inability to ensure a paramedic can always respond to critical calls are having a big effect on small town EMS agencies in Iowa and across the country. Talsma, who has served Jasper County the past four years, can recall concerns brought up to him as early as his first year in office.

“I knew it was an issue and I’ve been having conversations with friends who work on different volunteer departments before I ever got elected,” Talsma said. “I never worried too much about it until I got elected. The first year I was elected I had townships from eastern Jasper County reaching out to me.”

Several of those townships contract with Grinnell in Poweshiek County, and Talsma said they were in danger of being refused service from the neighboring region if they did not provide more money; and the issue “kept spiraling from there.” Officials were constantly being contacted by several township trustees.

Which is partly why Talsma and his fellow supervisors had no problem supporting the pilot program, which has been funded exclusively by COVID-19 relief funds.

“COVID wasn’t a good thing, but it presented several unique opportunities if people were willing to capitalize on it — and Jasper County was,” Talsma said, referring to CARES Act and ARPA funds. “One of the things we capitalized on was that COVID payment and ramping the ALS program up.”

The advanced life support (ALS) program is barely one year old at this point. Other than some pushback from a few volunteer EMS providers, the program has been largely accepted by elected officials. Supervisors sing the praises of the program and see it as something worthwhile for their citizens.

Altogether, about $2.18 million has been allocated toward the program, which is run by part-time reserve deputy paramedics. It is a large sum of money to give to any new program. Talsma reasons it is one of the core services the county is supposed to provide to citizens.

“I don’t like big government, but that being said there are certain things a government should be involved in and needs to be involved in: infrastructure and public safety are two of those,” Talsma said. “I see this as an extension of the sheriff’s department’s and the county’s roles and responsibilities.”

ESSENTIAL SERVICE LEVY COULD BE ON A BALLOT IN COMING YEARS

Other counties in Iowa are already taking notice of the changes going on at the Jasper County Sheriff’s Office and its advanced life support pilot program. Talsma said he has been contacted by township trustees and supervisors of counties in Iowa; county supervisors from Ohio have reached out, too.

“They’re kind of seeing the same things (the sheriff) and I are, which is not necessarily this is the answer for the EMS shortages and struggling volunteer departments for all of the Midwest, but it is a solution,” Talsma said. “And it’s at least someone being proactive about it.”

Finding easy solutions to the EMS service gaps in rural areas and the dwindling volunteerism is a challenge, but from what Talsma can see few are willing to make a move. The “wait-and-see” approach does not cut it for him or Jasper County Sheriff John Halferty.

“It’s something we have to be proactive about,” Talsma said. “If nobody else is doing it and nobody else is proposing solutions, then, OK, maybe it’s time for the county to look at it and take a run at it and come up with a viable solution and enhancement to the system we have in place. That’s exactly what we did.”

Some volunteer agencies have questioned why another solution has not been explored: the essential service levy. Two years ago Iowa Gov. Kim Reynolds signed into law a bill that would allow counties to put a $0.75 tax levy on a public measure ballot. Citizens could vote whether it passes.

Moneys collected from the levy would go toward EMS providers in the county. Talsma claimed there have been some misperceptions about the levy, noting it is “very regulated.” If the levy collected $1 million, for example, it would not mean each small-town EMS agency would get an equal check from that total.

“The county is not going to turn around and write a $100,000 or $150,000 check to every volunteer department and say, ‘Here’s $150,000 now go and do what you want with it.’ That’s not the way it’s going to work,” Talsma said. “I know there are a couple volunteer departments that think that’s what’s going to happen.”

Others are concerned the levy would go toward the ALS program rather than the small-town agencies themselves. Talsma said that could be a possibility, but it is still uncertain. However, it is likely the county will put the essential service levy up to a vote in the next few years.

“It’s something we probably will be doing down the road, but we saw with the CARES Act and the ARPA funds a unique opportunity where we could essentially get a lot of the upfront costs covered and paid for before going that route,” Talsma said, noting the program’s efficacy will be assessed.

From there the county will have a better idea of whether to continue with the program and find a way to sustain it or find another solution and dissolve the program. Talsma reiterated the county is not trying to seize or encroach on anyone’s territory, but rather to ensure adequate is being provided.

“If a loved one of yours is having a stroke or heart attack or your kid gets in a car accident, don’t you like knowing that when you dial 911 an ambulance and a paramedic are coming? That’s exactly what we’re trying to provide,” Talsma said.

STATE COULD DO MORE TO INCENTIVIZE VOLUNTEERS

Dr. Pat Edwards of Newton Clinic briefly mentioned EMS struggles at the Jan. 21 legislative gathering held by the League of Women Voters of Jasper County. Edwards said the county’s population is aging, emphasizing the need for good EMS services. Edwards is mayor of Lambs Grove, a town of about 180 people.

“A lot of these people live in rural areas, and they’re not going to stay there unless we can help them with EMS. I understand the Legislature has allowed … local communities and counties to decide whether EMS is an essential service or not,” Edwards said, referring to the essential service levy.

However, Edwards argued it does not matter if the citizens of Lambs Grove deem it an essential service when the small town cannot raise enough taxes to do that. Lambs Grove can contract with Newton Fire Department to cover most of the community’s EMS needs, but other communities do not have such luxuries.

“For citizens of Mingo, even if you raise their taxes it’s not possible for them to have a consistent, comprehensive plan to take care of people out in the county,” Edwards said. “…I think Jasper County is doing a great job moving forward on this. But it might require one of the leaders in the state. This is statewide.”

Although the essential service levy does provide funding opportunities to small agencies, it has no effect on the recruitment challenges. Halferty said a county EMS study in 2014-2015 said recruiting and retaining volunteers was a priority. As a member of the volunteer Mingo Fire Department, Halferty sees the decline.

“The amount of hours and commitment and things associated with it can be very time consuming and expensive,” Halferty said. “People are busy now. It’s just been a challenge. It’s a different mindset as well. I don’t blame people at all now when we ask people to volunteer and they look at the potential time required.”

For as many years the United States has operated its EMS services with the help of volunteers, Halferty said it might be time to reflect.

“The state and the country really need to look back and see how well off they’ve been because of volunteer services across the country for many, many years,” Halferty said. “There have been very good, dedicated people that sacrificed time and money and lot of other things in order to provide services.”

The state may need to find ways to incentivize volunteers who want to earn their paramedic certifications or trainings.

“The state needs to look at incentivizing, not subsidizing it. Maybe it comes in the form of an income tax credit where you’re a qualified EMT or a qualified paramedic on a volunteer department and you’ve logged ‘X’ amount of hours and ‘X’ amount of calls. Maybe you get a $1,000 to $2,000 tax credit,” Talsma said.

But Talsma is not convinced that alone will solve the issue. The state needs to take a multi-faceted approach and collaborate with its counties and cities.

Rep. Jon Dunwell posted about the EMS struggles on his Facebook page on Jan. 30, noting one way to commit to improving EMS services throughout the state is to authorize cities, townships, counties or agencies to implement a length of service agreement awards. Dunwell also mentioned grant opportunities.

“The Local Government Committee has reintroduced House Study Bill 19 to create a grant program to allow municipalities to provide an award to volunteer firefighters, emergency medical care providers, and reserve peace officers,” he said. “The grant would provide up to $1 for $1 match in funding for municipalities that have established the award.”

Still, Talsma said the best way to incentivize volunteers is to give them a full-time job with pay and benefits.

“That’s how you incentivize somebody,” he said. “You pay them for their time that they are rending and providing this service. Because that’s what it’s going to take to incentivize somebody. It takes a lot of time … Between the trainings, the certifications and being available to go on call. You’re talking a significant sacrifice in time and money.”