HC emergency medical services lobby for ?essential? designation

By Grace King, Mt. Pleasant News


Emergency responders in Henry County have a big job. From being first on the scene of car accidents to responding to calls from Henry County residents requesting assistance, having a career as a first responder is not for the faint of heart.

In small Iowa counties like Henry where there is only one ambulance service, networking with first responders is crucial to serving the community. As the health care industry shifts, leaders of Henry County Health Center?s Emergency Medical Service are determined to provide volunteers across the county and their own employees the resources they need to stay in business.

To do so, Jacob Dodds, HCHC EMS operations coordinator, and Dan Waldervach, director of EMS services, are ?reformalizing? the Henry County EMS Association while continuing to lobby for EMS services to be considered essential by the state of Iowa.

?People think (an) ambulance is essential,? Waldervach said. ?Someone calls 911, they expect an ambulance to show up. It?s public safety.?

The fact, however, is that while EMS has to have a contract with the county to provide 911 services, technically they don?t have to respond after that. ?But it?s just bad business,? Waldervach said with a laugh.



It was almost half a century ago when local funeral home directors provided ambulances in Henry County. Looking for a more efficient way to provide services, Henry County Board of Supervisors asked HCHC to step in to provide an ambulance service to county residents.

Since then, HCHC EMS has been working with first responders and fire departments across the county to provide the fastest emergency medical response possible while staffing two ambulances out of HCHC for countywide use. The majority of EMS funding comes through the HCHC budget process and in part through the county property tax levied by HCHC.

HCHC chief operating officer Michelle Roselle described EMS services as ?budget neutral.? As a critical access hospital, HCHC is reimbursed for the cost of providing Medicare services; however, the Center for Medicare and Medicaid Services (CMS) does not allow the costs to run ambulance services to be included in HCHC?s overall reimbursement calculation.

?As a result, the expense of running the ambulance services through HCHC actually has a negative impact on the health center?s total reimbursement from Medicare,? Rosell said in an email.

If EMS services were made essential, more funding would be available, possibly lessening the negative impact of EMS services on the hospital and providing more funding for volunteer first responders across the county. ?That helps us funding-wise,? Waldervach said.


Advocacy is key

For 15 years, Waldervach has been advocating at the state capital with the Iowa EMS Association for that essential service designation. After a long career as a paramedic, Waldervach wanted to do something more in his chosen profession.

Today, Waldervach is hopeful. There?s momentum moving forward, and people are listening, he said.

To change EMS Services to an essential service, a bill needs to be passed through the state. From there, each county would adopt the bill, levying tax funding for EMS services.

In Henry County, the essential service designation would be more beneficial for volunteer first responders than for HCHC EMS. Dodds said as funding for volunteers becomes scarcer, it?s necessary in sustaining the operations they have.

Some counties have even taken it upon themselves to declare their emergency services essential. Just last year, Wright County voted to approve a new property tax to support a countywide ambulance program.

While the Henry County EMS Association isn?t as involved in lobbying as the Iowa EMS Association, it is a leap forward in engaging, communicating and training volunteers across the county. Moving forward, the goal of the association will be having more defined funding, communicating and providing resources to each town. To do so, every first responding agency will have a representative on the board.

?These volunteers are often underappreciated for what they do,? Dodds said. ?I?m excited about (the Henry County EMS Association) and it is pretty necessary. We would not be able to do what we do without them.?

Waldervach, a big supporter of volunteers, is intentional about continuing education for first responders through monthly staff training. He also tries to make sure HCHC EMS is doing more of the administrative paperwork that goes into responding to calls. ?Our goal is to take that all over for them and then we?re just one organization,? he said.

Some of the paperwork includes non-transport agreements, routine state paperwork and field maintenance on vehicles.


Working Together

In the meantime, paramedics across southeast Iowa are working together to ensure the population?s medical needs are met.

Although all ambulances were busy in Henry County when a 911 call came in from a home health nurse on behalf of a patient needing additional assistance at their home in Mt. Pleasant on June 20.

A call to Jefferson County for an ambulance came up empty as well.

Third time?s the charm, and Washington County responded affirmative. They were available and were sending an ambulance.

In Henry County where only two ambulances are staffed 24/7, contingency plans for requesting services from other counties is crucial. While it doesn?t happen very often, occasionally both trucks will already be out on call unable to respond to a third request for an ambulance.

That?s why Henry County has agreements with surrounding counties of Van Buren, Jefferson, Washington, Louisa, Lee and Des Moines. In instances like that when an ambulance is needed or busy, another county can lend their services and vice versa. It?s just being a good neighbor.


A Rewarding Career

Overall, being a paramedic or first responder is a difficult profession. Waldervach said there?s a national shortage on paramedics and jobs everywhere are hard to fill.

When Waldervach hires a new staff member, it?s a tossup if they will make it in the long run. During interviews, he asks if they think they can do it. ?The first time they experience death, the first time they experience a bad car accident, I?ve had staff say, ?I?m done.??

Regardless, Waldervach?s long career has shown him it?s rewarding, and that outweighs the bad. Every day is something different and challenging, which makes paramedics think critically. That?s what drives Waldervach, the chances he gets to think outside the box on the spot.

As director, Waldervach now sits behind a desk, but when he was younger, he loved the heat, being outside every day and never sitting still. Now, Waldervach sees the beauty in the hospital-based aspect of HCHC?s EMS services.

?I have connections to families,? he said. ?You see them, you may have picked them up, you create this bond. It?s so crazy. I?ve been to funerals of patients because of becoming close to the family.

?That sense of it drives you to continue doing it,? Waldervach continued. ?It?s a very rewarding job.?