Akron council: No ambulance rig replacement

Posted September 7, 2017 at 5:00 am

By Julie Ann Madden

Akron EMS will not be receiving an ambulance vehicle any time soon.

That was the answer they received from Akron councilors at their Aug. 22 meeting.

First, Akron EMS Director Lynette Kiger reported City Administrator Dan Rolfes had informed her the Akron EMS’ Vehicle Replacement Fund has been depleted by nearly 50 percent to pay over-budget operating expenses the past three years.

It was originally thought that the fund had $80,000 in it but it’s actually only about $34,000, said Kiger.

One of the problems is that ambulance services are not considered “essential services” in Iowa, therefore, entities do not tax for this service. This leaves ambulance services at the mercy of city officials, private insurance company officials, Medicare/Medicaid officials and private donors for revenue sources.

With setting aside only about $12,000 a year, it’ll take more than 10 years to buy a Type 3 rig and the Type 1 rig that Akron EMS crew members want would be even longer than that, said Kiger. “There are only so many ways we can increase revenue.”

A new way is to charge for supplies used on each call, she said. However, City Clerk Melea Nielsen was doubtful they would see any actual reimbursement as insurance companies and Medicare/Medicaid will only pay so much per call — no matter what it actually costs.

“This is what they’re going to pay so you end up eating it,” said Nielsen, “and we all know that running an ambulance service isn’t something we’re trying to do for profit.”

Kiger agreed, noting an ambulance service has to have at least one Emergency Medical Technician (EMT) on duty 24 hours a day, seven days a week, and must purchase needed medical supplies — one needle costs $175.

New rig bids came in up to $248,000, said Kiger, “and it sounds like a lot of our Vehicle Replacement Fund will probably be eaten up this year by operational expenses plus some of these large maintenance items we’re going to have to do.”

Just to get Rig No. 2’s fuel pump injection system repaired, it’s going to cost at least $1,500, she said. It’s also nearing the mileage on Rig No. 1 when the fuel injectors need changed and “I have no idea how much that is.”

“Please keep in mind this $1,500 (for Rig No. 2) isn’t going to fix the air conditioning (in the patient compartment),” said Kiger. “It’s not going to fix the problem with the leaf springs (suspension system). It is simply going to try to fix the problem with the engine so we can be up to the capacity of having two rigs in service…to cover the largest area in the state of Iowa.”

“We have a lot of ground to cover and every time we take off to go down to the hospital in Sioux City, it’s kind of a scary experience now because we have nothing to cover,” she said, noting there is at least one EMT available but no rig for transport. “We need one but (with the last three years’ trend) there are probably insufficient funds in the Ambulance Vehicle Replacement Fund to insure we can cover the cost if we were to take out a loan.”

“We should move forward with figuring out how to get another ambulance,” said Councilor Kasey Mitchell. “We can’t have the risk of someone croaking because we don’t have a backup ambulance. The first time that happens, it’ll fall back on us. Maybe people will look at us like we just made the wrong decision.”

“The $1,500 doesn’t guarantee that’s going to run and not breakdown,” he added. “It’s just going to be a money pit.”

Rig No. 2 is 24 years old and no parts are available, said Kiger, explaining the fuel pump will have to be removed, taken to Le Mars where it will be rebuilt and then reinstalled here — about a two-week process — if there hasn’t been more damage to it as they continued to drive it when needed until last month.

Speaking on Rolfes’ behalf, City Clerk Melea Nielsen stated, “It’s not his intention to suggest that it’s a moot point — we are never going to do anything.”

“We all know that something needs to be done,” she said. “It’s just a six-week turn around from the first discussion probably isn’t feasible to pull a trigger to get it done.”

“I don’t have a solution,” said Kiger. “I haven’t been in the position long enough except to see the trends of the previous three years.”

Akron EMS personnel and Councilor Jenell Lanning pointed out there are other things happening that may effect Akron EMS, including the closure of Siouxland Paramedics Inc. the first of January 2018 and the state’s failure to make ambulance services “essential services” like fire and police departments.

Siouxland Paramedics Inc. has provided paramedic assistance to municipal ambulance services that don’t have paramedics on staff. Sioux City officials are considering absorbing the ambulance services into their fire departments which would confine paramedics to their city limits.

Another ambulance service, Midwest, is just a transfer service between hospitals and has a 20-minute response time before they actually leave their station. They don’t respond to 911 calls.

“If we are going to lose an Advanced Life Support tier (of paramedic), if any of us in this room has a heart attack and we don’t have equipment to support that, chances of survival are little to nothing,” said Akron EMS volunteer Luke Nixa.

“We don’t even have medications and things paramedics do,” said Kiger.

That’s the reason a second rig is so important, said Akron EMS volunteer Joe Hook.

“We have a little time (before Jan. 1),” said Nielsen. “That goes quickly but it is not that this (request) is absolutely shut down.”

A rig breaks down in an instant, said Nixa. “If Rig No. 1 goes out at this point, we’re done. What do we do?”

“We do what Westfield does, what Oyens does,” said Councilor Jenell Lanning. “If you look at all the factors playing into this, it’s not a time to make a rash decision. We need to sit back and look at this.”

She noted the West Akron Fire District hadn’t decided if they were going to pay what Akron has requested. If they don’t, Akron EMS’s coverage area could shrink.

With Siouxland Paramedics Inc. closing, “you would think somebody would step up and fill that void because there’s clearly a need for it,” said Lanning. “If you just spend the money, it’s not there. Where are we going to come up with it?”

“It has to come out of somebody else’s fund,” she said, “and I’m not saying this isn’t as important. It is very important but we’ve kind of got to take our time and look at all the options, look at all the factors.”

Getting a rig from EMS services that are closing may be an option, said Mayor Sharon Frerichs. But others said there was no guarantee rigs would actually be for sale.

Councilor Gerry Stowers asked what it would cost to fix all of Rig No. 2’s problems but Kiger said Rolfes only wanted to focus on the fuel pump/injector problem.

It was noted that Rig No. 2 hasn’t been needed since it was deemed inoperable. However, shortly before that decision Hawarden Ambulance Service was called to take a second call for Akron and another time, a patient was transported without air conditioning on a hot day.

“Last year at this point, we’d had 106 calls,” said Kiger. “As of today, we’ve had 151 calls this year.”

“Thank you for being there when we need you,” said Frerichs.

“We’re glad to do it but there’s just about 10 of us,” said Kiger. “We work a lot of hours but we are trying to do things to improve the service every day.”

Frerichs suggested Akron EMS do a year-end donation appeal letter like the firefighters did as it netted a few thousand dollars.

Akron EMS volunteer James Kiger asked if city officials could appeal to the outlying areas, and Nielsen responded townships would have been able to tax for this if it had been made an essential service. Then he suggested appealing to churches.

Lanning asked if there was a way to combine with the Hawarden service but others said Hawarden was struggling, too.

“If only we had a fairy wand to wave over the people and say, ‘We need help — will you come help us?’” said Frerichs.

“We’re a very conservative community but you know, we’re doing okay,” she added. “We just don’t want that one tragedy to hit anybody because it will definitely be someone we know.”

“I hear you saying this isn’t a dead issue,” said Kiger.

“This will never be a dead issue,” said Councilor Alex Pick. “We’ve got to figure it out.”

“Rig No. 1 is going to be in the same mileage shape as Rig No. 2 is now within another year or year-and-one-half,” said Nixa. “Then we’ll be stuck with two rigs that potentially need replaced.”

“I agree they need to be replaced,” said Lanning. “I’m not going to say they will be new…but I think you have a whole storm of factors going on…for us to throw down the money to buy brand new, it could really backfire on us, especially when we don’t have a long-term plan. You’re going to come to the 10 years of paying off your ambulance and you still haven’t replaced your second one and that’s if we can maintain giving you guys that same amount of money every year.”

“What if something goes down infrastructure-wise in town?” she asked. “You’ve got to have water and electricity. If something happens there, the money has to move where it’s needed. I’m not saying this isn’t an urgent need.”

“We ask you to keep us in mind as something that does need funding,” said Kiger. “We are an essential service that is not recognized as an essential service.”

“We’re here for individuals who need help,” she said, “and you may not ever be that individual but there is a chance you could be and we need to make sure we’ve got coverage to take care of the people in our area.”

“Please understand we, a small group of volunteers, are doing the best we can with the people, the supplies and equipment we have,” she continued. “We’d like to get out of the 24-year-old rig as soon as we could.”

“We’d like to get on a path moving forward instead of continuing to go backwards,” said Nixa. “That’s what we’re doing right now and we’ve been doing it for three years and we’ll continue to do it until you do something.”

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