Federal funds on horizon for Nome Volunteer Ambulance Service
The Nome Volunteer Ambulance Department is facing a problem. While volunteers to staff the City’s two ambulances are getting harder to find, the number of call-outs is increasing. There are currently 16 volunteers and they each sign up for eight 12-hour on-call shifts per month. There is one full time paid responder. According to Nome Volunteer Ambulance Chief Jim West Jr. Nome’s ambulances are responding to about 500 calls a year. With resources stretched thin, the response time is getting longer.
According to West Jr. the response time is currently around six to eight minutes. “And that’s to get to the ambulance,” he said. A run requires two responders. According to Interim City Manager John Handeland, who is also a long-time ambulance volunteer, the response time used to be around three minutes.
“We’re always looking to recruit new people,” said Handeland. According to Handeland, there are two Emergency Medical Technician 1 training classes going on. Tom Vaden is teaching one and Amy McNulty is teaching the other. There are a total of six students enrolled in the two classes, but Handeland cautions that it doesn’t mean all six will become NAVD volunteers. “We’re hoping that we’ll get at least one or two people who, after taking this training, will consider being members of the ambulance services as well,” he said. “These classes go on regularly and we end up getting some volunteers but they’ve been short lived.” The courses are time-consuming and intense. They require a commitment of four hours a night, three days a week, for eight weeks. And study time for the course material is on top of that.
“It’s not just Nome that’s having trouble with volunteers, it’s everywhere in the United States,” said Jim West Jr. He’d just returned from the World EMS Symposium in the Lower 48. “There’s no real answer. Being a first class city, we’ve got to provide for public safety.”
The large number of call outs has produced a sort of response fatigue in the volunteers. “As a volunteer I do think twice when I hear a buzzer go off at three in the morning,” said Handeland. “Or even in the afternoon. ‘Is it important for me to leave this meeting that I’m in right now or can that call wait?’ It’s unfortunate that we’re in a situation where the evaluation does happen.” In his last city manager’s report Handeland wrote that the problem of getting a response is aggravated by the number of times they go downtown for the same people.
Norton Sound Health Corporation did a report on what could be called the “power users.” Those are the individuals who are often the subject of a response. The top power user utilized the ambulance 34 times in one month last summer. “Those type of things are unfortunate,” said Handeland. This response fatigue reached a critical point in August when the ambulance took over an hour to respond to a call on Front Street. This incident motivated Kawerak CEO Melanie Bahnke to write to the City Council telling them to get their act together and suggesting it was time for a paid staff. With new developments in funding at the federal and state level, paid staff might be in Nome’s near future.
Ground Emergency Medical Transport, GEMT, is a supplemental reimbursement program that falls under Title XIX of the Social Security Act. It draws funds from Medicaid and allows public EMS providers to collect 50 percent of their uncompensated costs for providing care to Medicaid patients. A large percentage of those calls that the ambulance volunteers respond to involve Medicaid patients. The Alaska Legislature recently passed HB 176, which enables local EMS providers to access those federal funds.
“The hospital is doing a really good job of getting people signed up for Medicaid,” said West Jr. “But not all the people around have Medicaid. But there’s an active approach on the side of the hospital to make sure they have. It also helps them get some money back.”
There is no cost to the State of Alaska for the GEMT program. Compensation for each ambulance run is now at $480. GEMT should increase that to between $1,200 and $1,600. “We cover our costs from what we bill out,” said West Jr. “We have to write off some, but not very much. The GEMT is going to help cover more costs.” He says the City is going to have to decide whether to keep going with nearly all volunteers or move to a department with a paid staff. With GEMT that will become a possibility. West Jr. says a full staff would include from four to six full time people with two administrators. He says we don’t need more equipment, that what we currently have is state of the art. The city has two four-wheel drive ambulances and a Tahoe that is equipped to go out of town. Volunteers would still be needed to augment the paid staff.
On Oct. 7 Norton Sound Health Corporation CEO Angie Gorn sent a letter to the Nome City Council proposing that NSHC become the sole provider of EMS services for Nome starting on Feb. 1, 2020. Gorn cited the rising call volume and delayed response time as being cause for concern, mentioning Melanie Bahnke’s letter to the council. NSHC would pay rent for the use of the city’s ambulance garage until their new warehouse building is completed, at which time they would move into that. NHSC would purchase the City of Nome’s ambulance fleet and continue to solicit for volunteers. They would train those volunteers and compensate them with a stipend. According to Gorn’s letter, this would increase the resources available for EMS and also cut the city’s losses on providing services. However, the proposal has not found any traction. “We’re committed to providing the care and the transport of people,” said West Jr. “We always have been and always will be. The new GEMT program is going to help.”
NSHC created the Nome Volunteer Ambulance Service in 1980. This became an independent non-profit agency in the mid-1980s and was absorbed by the City of Nome in 1996. A volunteer who wishes to serve with the NAVD needs the minimum requirement of an Emergency Trauma Technician certification. NAVD meetings are the first and third Tuesdays of every month at 7 p.m. at the Public Safety Building.