LANSING, Mich. (Michigan News Source) – A shocking report from the Center for Healthcare Quality and Payment Reform reveals there are more than 200 rural hospitals at immediate risk of closure and 12 of them are in the state of Michigan. But if you can’t even make it to the hospital, what difference does it make?

Hospitals are not the only ones in crisis. Ambulance services are on the brink of collapse as well. And you might not even realize it’s happening until it happens in YOUR city. But a simple Google search will open your eyes to the ambulance service crisis in Michigan and throughout the country.

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Lansing-Mason Ambulance closed in October of 2022 after operating in southern Ingham county for 50 years. They decided not to get their license renewed after several challenging years. They have been replaced by Mobile Medical Response who operates in 17 counties in Michigan. The Lansing State Journal reported that priority calls should be answered within nine minutes but non-priority calls will take more time. Deborah Stuart, city manager of Mason says about the response time, “We are a rural area and we will have rural response times.” There are no performance measures in the contract but there will be quarterly evaluations.

Pickford EMS also closed last year after 60 years of service. Their community is now receiving service through Kinross, about 15 miles away. According to 9 and 10 News, Pickford was no longer able to provide an ambulance 24/7 for 365 days of the year as required by the state.

In December, Michigan Radio highlighted problems with EMS services in Detroit and obstacles in finding emergency medical service personnel. Current employees were reportedly working overtime and doing hundreds of runs every day while the city worked on integrating their EMS employees into the fire department.

Tom Gehart, president of the Detroit Firefighters’ Association Local 344, said, “What’s happening a lot is we’re having no units available. So the fire engines are responding to give that care, and they’re doing CPR for 10, 15 minutes before an ambulance arrives.”

Rumors of Portage’s Pride Care Ambulance Service closing are also currently circulating online although according to WWMT, they are still in operation after their Director of Operations, Becki Russon, took a step back from the company after about 40 years of service. Because of the management change, wage issues and short staffing, some workers in the company have been leaving and others are fearful about changes in the future.

These are just a few examples of ambulance service issues in Michigan. There are many more that are easy to find if you are looking for them.

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So what’s going on? It’s a lack of both money and personnel and it’s reached a crisis level. It’s literally life and death. The industry was already struggling but the pandemic made it even worse. And little by little – and sometimes quickly – ambulance services are disappearing.

In May of last year, the Michigan Association of Ambulance Services (MAAS), a trade association, said that agencies were short about 1,000 full-time paramedics and EMTs across the state and they said it’s getting worse daily. About 50 of those openings were reportedly in the Upper Peninsula.

Brian Scribner, Executive Director of Southwestern Michigan Community Ambulance Service, told WSBT 22, “EMS in general across the nation is in crisis. You open the paper, and you’ll see communities that are struggling with long response times.”

Alan Morgan, CEO of the National Rural Health Association, told ABC 57 that about 1/3 of all rural EMS are in danger of closing. He said, “The pandemic has further stretched the resources of our nation’s rural EMS.”

Dia Gainor, Executive Director of the National Association of State EMS Officials, told Michigan News Source, “The implication for the community in which an ambulance service closure happens is how far away the next due ambulance service is located. For victims of time sensitive medical emergencies or severe injury, this can seriously affect their chances for an optimal outcome. The local community or county in which the closure occurs is unlikely to be able to fund or establish a replacement agency quickly.”

Whether the ambulance service is from a municipality, run by a non-profit or a pro-profit company, the issues are still the same – money and staffing.

Michigan News Source reached out to Rodney Palmer, founder and owner of Mercy Ambulance, a company based in Lansing who has about five ambulances that cover Barry and Clinton County. Mr. Palmer was highly involved in the evolution of emergency medical services for the State of Michigan and contributed largely giving input to the state of Michigan on the first EMS legislation establishing the basic emergency standards we still see in EMS today.

Palmer also agreed that ambulance services are in a crisis because of both staffing and money issues. He said the problem is not hyper-sensationalized. He said, “EMS really is at critical mass just like the hospitals. This is a REAL problem. And it’s not unique to just Mercy Ambulance or just private ambulance services…” He said municipal services and non-profits are also dealing with the same issues.

And due to short staffing, Palmer has even had to pull a few shifts of his own recently to meet the demands of his community. As busy as he is, short staffing creates even more headaches for an already overloaded workload. In addition to complying with regulations from the State of Michigan and other medical controls that oversee ambulance services, running an ambulance service involves the difficult task of juggling the staffing and monetary issues which have only gotten worse since the pandemic. And when the money is tight, who or what gets shortchanged? Does he fix something on the ambulance or replace older equipment? Those choices are not easy ones to make.

Palmer says that in terms of healthcare, the ambulance industry is not seen as a priority. Even though they are literally on the front lines of service, they make up less than 5% of the billables to Medicare, Medicaid and the insurance companies. The ambulance service industry just doesn’t seem to be able receive the funding that is needed for the work that they do or get the attention of the politicians who could help them.

Palmer explains the financial issues that many are having. He said, “In the last five years, ambulance services have had a net 12% increase in Medicare and Medicaid reimbursements.” But those increases haven’t covered the costs of the ambulance service companies. He said, “The cost of equipment, vehicles and ambulances, AEDs, heart monitors, defibrillators…all that kind of stuff that we have in the back of ambulances have gone up 68%. And our labor has gone up 45%. And so people go ‘how do you stay open’? Services were able to stay open based on volume. We can’t get our volume up when we don’t have enough licensed people to put in the ambulances.” He predicts that there are going to be a lot more services who fold in the future and he hopes that Mercy Ambulance isn’t one of them.

Even when the ambulances are able to be staffed, the turnover rate has always been pretty high in the ambulance industry for employees. Palmer said that EMS is basically a stepping stone job and it’s an average of three years and out. It’s hard work and there is burnout with little to no advancement.

Angela Madden, executive director of the Michigan Association of Ambulance Services told Michigan News Source, “The EMS staffing shortage is hurting communities in every corner of our state. While the need for EMS is as critical as ever, ambulance services are in crisis facing rising costs and not nearly enough first responders entering the field. Rural areas of the state, who have fewer EMS training opportunities available, are having an especially hard time recruiting and retaining first responders. We are optimistic about reversing these trends with the help of a state recruiting and training grant program that is currently underway.”

Palmer, however, described the process of applying for the state grants as generally being too time consuming and confusing of an undertaking and said that because of that, many have opted out of even trying.

It is also clear to see that Michigan is not alone in this crisis. The closing of ambulance services is a nationwide problems that you aren’t going to see unless you actually look for it. But if you do a Google search on ambulance services closing, you will see results coming back from every corner of the United States – New York State, Kentucky, Hawaii, Washington State, South Dakota, Vermont, Virginia, Wisconsin, Florida, and many other states.

Some ambulance services are closing entirely and communities are left with no local services, having to share ambulance services with companies who are farther away which impacts the response times. Still others are relying on alternative sources in the community. That includes driving oneself to the hospital if the victim has a vehicle and a person to drive them. Others might be relying on the fire department or the police.

Palmer says that the first responders have been real heroes to the system, often showing up before an ambulance gets to the scene. The firefighters and other first responders will jump in and do what’s needed with the ABCs – airway, breathing and circulation. But that is not a permanent solution to the crisis we are in.