May 13, 2024 • Jeremy Olson, Star Tribune
(TNS) — Lawmakers are considering spending $6 million to test the use of “sprint” paramedics in three northern Minnesota counties and confront the state’s worsening rural emergency response.
The hope is that paramedics, roving the Iron Range and northwest lakes region in cars and trucks, could shave minutes off response times, and sort out calls that don’t need fully loaded ambulances in the first place.
“Could mean the difference in surviving and not surviving,” said Jim Rieber, who has led efforts to use sprint paramedics in Otter Tail and Grant counties.
When rural EMS agencies are notified about medical emergencies, they often page paid or volunteer first-responders to hustle to the station and drive ambulances to the scenes. This long-standing approach is breaking down in some small towns, because the pool of first-responders is shrinking and taking longer to assemble.
Sprint paramedics by comparison would drive directly to the scenes in standard vehicles and begin treatment, even with ambulances on the way.
The solution gained House approval Tuesday and is awaiting Senate action after it was proposed by a legislative task force to address problems in Minnesota’s system of emergency medical services, or EMS. Lawmakers also proposed replacing the existing licensing agency, and its industry-selected leadership, with an agency that features more state oversight and a commissioner appointed by the governor. A 2022 audit found the state was lax in its existing oversight of its EMS providers.
Newly released response time data highlights the concerns, especially when looking at the 10% of emergency ambulance runs in Minnesota that took the longest in 2023. Ambulances in Hennepin County took 13 minutes on average to respond to these longest calls once they were notified by 911 dispatchers. The average was 17 minutes in St. Louis County and 22 in Otter Tail. In Lake of the Woods County, the average was 44 minutes.
Rieber said response times are acceptable when local crews are available, but when they aren’t, EMS agencies are relying on neighboring communities to send ambulances from miles away. That often happens when agencies send ambulances and don’t have enough medics to provide backup for other calls.
Some disparity in urban and rural response times is inevitable, especially in a county such as Otter Tail that spreads over 2,000 square miles and is dotted by 20 small towns and hundreds of cabin-country lakes.
Sprint paramedics could close the gap, said Becca Huebsch, the EMS director in Perham, Minn., by being placed strategically in vehicles with life-saving equipment. Their start positions would vary each day depending on which local EMS agencies in Otter Tail and Grant counties were the most understaffed. Problems are often greatest on weekdays for small EMS agencies, because their volunteer first-responders work full-time in other communities.
Paramedics have more training than emergency medical technicians, who make up the bulk of rural ambulance crews, and can do more complex life-saving techniques such as inserting breathing tubes and intravenous lines. Depending on the type of 911 call, a sprint paramedic might be sent first to assess a patient, or at the same time as a single EMT in the nearest ambulance. If a transport to a hospital is needed, the paramedic would leave the sprint vehicle behind and monitor the patient during the ambulance ride. In some cases, the paramedic could handle treatment on scene and keep ambulances with advanced-life support equipment from being dispatched unnecessarily.
“It opens up flexibility we’ve never had before,” Huebsch said.
Rieber said EMS agencies have been pressed since the COVID-19 pandemic, which burned out volunteer medics and thinned their ranks.
“Before, you paged (about an emergency call) and you had 20 people, and the first two people there went out,” he said. “Now, you have six people left on the ambulance service, and they have already done six or eight calls that week,” he said.
Rieber said EMS agencies have been pressed since the COVID-19 pandemic, which burned out volunteer medics and thinned their ranks.
“Before, you paged (about an emergency call) and you had 20 people, and the first two people there went out,” he said. “Now, you have six people left on the ambulance service, and they have already done six or eight calls that week,” he said.
Sprint paramedics have gone by many names, such as fly cars and intercepting paramedics, but the concept borrows from successes at larger urban ambulance services. Fire departments in the Twin Cities often have paramedics on board fire trucks or send them ahead in separate vehicles. The University of Minnesota deploys SUVs with mobile ECMO equipment, which can maintain blood-flow and circulation for patients in cardiac arrest.
Rieber said the state’s test project, including St. Louis County, would be among the first in the nation to use sprint paramedics to confront rural shortages and response challenges. When sprint paramedics aren’t on calls, they would visit frail residents in the region or check those who were recently discharged from hospitals. Methodist Hospital in St. Louis Park pioneered that approach a decade ago, sending local firefighters to check on discharged patients.
EMS leaders said they are underpaid by the federal Medicare program for ambulance runs, and the state legislation isn’t solving this problem. Rieber said agencies used to make up the difference through higher reimbursements by private insurers, but they have started paying at Medicare levels as well. EMS agencies also don’t get paid when medics stabilize patients on scenes and don’t transport patients.
Rural agencies as a result can’t afford sprint paramedics on their own, Huebsch said, so the goal of this test is to prove their worth and justify ways to pay in the future.
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