Editor’s note: The following story is the second in a multi-part series about Jasper County’s efforts to improve emergency care for rural residents and assist the volunteer teams struggling to keep crews full and find new members, many of which may not have the means or time to be certified for paramedic-level care.
Justine Wyma cares for her community in every way possible. When she is not tending to children’s health needs in the classrooms or teaching nursing courses at DMACC, she is responding to ambulance calls in her own community of Sully, a small town populated by less than 900 people.
Prior to working in the schools, Wyma worked in critical care units and intensive care units. And for the past 23 years she has volunteered her time and expertise to the Sully Rural Fire Department and Ambulance. Wyma has been the ambulance director in Sully for about 20 years.
Out of the 20 or so volunteers in Sully Rural Fire Department and Ambulance, Wyma is one of the few certified to provide paramedic-level care. She has a Master of Science in Nursing and is a registered nurse and certified legal nurse consultant, which more than qualifies her to provide medical assistance.
However, being one of the only paramedics in town to respond to calls has proven difficult for Wyma. If she is able to be on scene during a critical emergency, the Sully EMS crews can function as a semi-advanced life support service, Wyma said. But transportation services are limited.
Patients can be transported to a local hospital in Newton, Grinnell or Pella, but if someone needs to go to Des Moines it can be challenging as it would likely put Sully out of service for up to three hours. Which is partly why Wyma has embraced the ALS program from the Jasper County Sheriff’s Office.
In fall 2022, crews had to report to a big fire south of Lynnville and required the help of six other departments. Wyma and another staff member were the only two people left in town to cover an ambulance call near Kellogg at the same time as the fire. But Kellogg’s fire crew was already helping as mutual aid.
“Luckily (Jasper County) had their fly car out and were able to help us,” Wyma said, noting one of the two reserve deputy paramedics was able to assist in that scenario, which she was grateful for.
Other departments are seeing the benefits of the county’s program, too, specifically when it comes to filling in service gaps and providing a higher level of care when needed.
Brock Hansen, the chief of Baxter Rural Fire Department, said the county’s program is a “very welcomed” resource for its rescue unit. Baxter and other communities have had issues in the past covering calls. There are times when the town of more than 970 people needs the reserve deputy paramedics.
“Other times we don’t need ‘em,” Hansen said. “I think it’s a good, flexible fit for both departments. We work well with each other and complement each other.”
Wyma, too, said the ALS program is an excellent resource, but it may end up costing the county a lot of money.
ESSENTIAL SERVICE LEVY IS AN UNEXPLORED OPTION
The sheriff of Jasper County has frequently called the county’s ALS program a solution, not the solution, noting he is open to other alternatives. Volunteer agencies in the county may yet have another option in the future thanks to a bill introduced in the legislature almost two years ago.
Iowa Gov. Kim Reynolds signed into law a bill that would allow county boards of supervisors to ask residents in a referendum to vote for or against an essential service levy. If approved, a $0.75 levy would be imposed on property owners, which would go towards EMS agencies in the county.
While it may seem like all agencies would be in support of the levy, Wyma is worried about the distribution of funds and does not want to see the small towns surrounding Newton to be short changed. Plus, Sully Rural Fire Department and Ambulance is not operated by the city; it is operated by a board of trustees.
“That’s going to be governed more by cities,” Wyma said. “Right now, fire is the only essential service. A city in Iowa does not have to provide EMS, but they do have to provide fire services. The city can technically govern the fire side. We keep fire and EMS separate regarding the financial side, but all our members are expected to perform in both roles.”
Jasper County has not put the public measure on a ballot. However, the Baxter Rural Fire Department is currently working to establish its own local essential service levy with the city. Hansen is also worried about the distribution of funds if the county passes its own levy, and that it might supersede the Baxter levy.
Ultimately, Hansen’s primary concern is providing adequate patient care to his fellow residents. By establishing the levy in Baxter, the chief knows the funds will stay local. Hansen could only speculate as to why the essential service levy has not been presented as an option. He figures it is up to the cities to decide.
“I have pushed our emergency management people and told them, ‘Why are we not doing this? Why haven’t we done this?’ This essential service bill has been passed for two years now,” Hansen said. “It’s up to the county or the townships or municipalities to move it further down the path, from my understanding.”
Gerald Malone, the EMS director of Monroe Fire and Rescue, was critical of the program in large part because the essential service levy is in place already to assist departments in Jasper County. The board of supervisors, he said, could have put it up to a vote in 2021 or 2022.
“But they failed to do so,” he said. “We have a lot of departments in this county that are established, obviously, with fire service and ambulance service. I think that would have gone a long way if they put that on the ballot to vote that in to have EMS as an essential service. These towns wouldn’t be struggling.”
RECRUITING VOLUNTEERS IS GETTING MORE DIFFICULT
EMS agencies also have been struggling to recruit new volunteers for years.
In order to volunteer for the fire and EMS department in Sully, a individual must be a certified EMT. Wyma said certification classes can cost up to $2,500 and take up hours of a person’s time. Although the department can reimburse applicants who pass their certification, it is still a huge commitment.
The state has made it challenging for volunteers to get accredited, Wyma said, and at times it feels like there are too many hoops to jump through. While she understands the importance of some of those requirements, it can also dissuade people from wanting to go through all the processing and paperwork.
“People have to come up with that money ahead of time, and that’s kind of a hinderance,” Wyma said of the certification courses. “People don’t necessarily want to go and take an EMT course. We would have 50 members, probably, if everybody could just drive or go fight fires.”
Some of the small town agencies in Jasper County split their crews into fire and EMS. Wyma said some agencies fear they will not have enough volunteers to cover one or the other. If there are so few medical volunteers, there won’t be enough people — or, by extension, enough care — to adequately respond.
“I fear, at some point, if our community is not covered with necessary services and resources, members will not want to volunteer causing a downward spiral,” Wyma said. “The dedication is strong with community support and our excellent department. We are committed to continuing this relationship because we have an awesome community.”
Community support certainly goes a long way when it comes to fundraising, which is required of most agencies. Still, the lack of volunteers is prevalent throughout the state and most of the country. Hansen said it gets tougher and tougher every day to get people to volunteer.
“It’s becoming ever tougher to just volunteer your time,” he said. “You can’t just say, ‘I want to come help you.’ Well, are you certified in this? Have you done this? Can you do this class? Can you do this? You can’t just volunteer your time anymore. Finding volunteers is just tough.”
Historically, many volunteer departments look to their own family members to don the firefighter’s helmet or drive the ambulance. Malone said it may be easier for cousins, sons and daughters or any other relatives to join because of the environment they’re brought up in. Monroe is no different.
“We have quite a few family members,” he said. “I think the Jenkins family has one, two, three, four on the department right now. A father and three kids.”
SOME WORRY THE ALS PROGRAM IS NOT THE ANSWER
More than 30 people volunteer for Monroe Fire and Rescue, and six of them — including Malone — can provide advanced level care. For the most part, Malone said the Monroe squads rarely ever require a reserve deputy paramedic on scene to assist or provide primary care.
“Some departments do have a problem with their EMS responses, but I don’t think that was the answer to it,” Malone said. “A lot of us feel that way.”
In Malone’s opinion, the sheriff’s office should be a policing force rather than an EMS service. Any business or organization can try to provide multiple services, but Malone said “you can’t be a cook and fix tires” or “you can’t run the bank and fix hair.” There is a follow-up phrase to the old saying “jack-of-all-trades.”
Malone said, “One person cannot provide every service. You’re overburdening that system. No disrespect to the people they have working for them because they are experienced. They work for Newton Fire Department. But they could have done things a lot differently, I believe.”
Jasper County has set aside $2 million to expand the county’s ALS pilot program, which was launched thanks in part to CARES Act money. Malone said a lot of money was given to the sheriff’s office to create an EMS service “out of one that was not there” and when there are actual EMS agencies in the county.
By having a law enforcement agency respond to EMS calls, Malone said it may get confusing for patients who see a uniformed reserve deputy as opposed to a paramedic or EMT, even though they are providing the same service. Personally, Malone does not think Jasper County needs a county-based EMS service.
In 2022, the county’s reserve deputy paramedics assisted in 158 EMS calls. Most of the rural volunteer agencies respond to 100 to 140 EMS calls a year. Malone said a majority of Monroe’s 911 calls are not necessarily calls that need to be handled by advanced life support services, but rather by an EMT.
Malone said a volunteer with paramedic-level experience is able to respond to 90 percent of Monroe’s calls and be on scene. He estimates 20 to 25 percent of the calls in Monroe — a population of about 2,000 — require that type of service. To say the least, Malone is apprehensive about the county’s program.
“To get to a call that ends up being a non-ALS call is not worth the risk to the public when you’re driving across the county at an excessive rate of speed to get there,” Malone said. “I think (county residents) would have been better served to staff the departments that are already in the county.”
Jasper County Sheriff John Halferty has heard these concerns in the past, and he has credited those agencies for all the work they have done meeting the needs of their community. But he sees medical calls rising at the same time volunteerism is declining. Something needs to be done.
“We have to come up with ways to respond quicker with adequate care, and support — I can’t say that enough — support our volunteer services,” he said.