Rural EMS needs emergency policy solutions

Sen. Grant Hauschild (DFL-Hermantown) speaks at an EMS Task Force meeting in St. Paul on Dec. 8, 2023.

Small towns and rural counties across the state face an emergency services crisis. Failure to solve the problem could leave rural people without timely access to advanced life support after accidents or medical incidents.

On Nov. 25, I wrote about challenges facing the Nashwauk ambulance service in eastern Itasca County. In subsequent weeks, communities across the Mesabi Range met to discuss solutions to keep vital EMS service available to the region. Nashwauk is still exploring its options, hoping to find a solution by Feb. 1 of the new year.

The funding mechanisms that support ambulance service routinely shortchange providers whether they are public or private. Jim Ducharme owns Meds-1, a private ambulance provider in Grand Rapids. He says unfunded costs make it hard to operate.

Medicare and Medical Assistance severely cap reimbursement rates, meaning that most emergency calls do not earn enough for ambulance services to pay skilled staff and other costs. Meantime, private payers must pay more than most people can afford out of pocket.

“This is a systemic problem,” said Ducharme. “It’s statewide. There are ambulance services closing down all over the state because of this.”

Ducharme said that his business can make enough money on hospital transports to cover the losses, but that services like Nashwauk’s — where there is no hospital — can’t. That’s one of the reasons he said he won’t be bidding for Nashwauk’s ambulance service. Essentia Health Services passed on a bid earlier this fall.

Ducharme highlights another problem: the incredible collapse in volunteerism for local fire departments and ambulance services, and the difficulty in hiring new workers due to low wages.

Nationwide, more than a third of all EMTs quit the industry in 2021, according to a CBS News report, mostly because of low pay. In Minnesota, the crisis is acute. A state legislative report shows fewer people entering the EMS field than there are job openings.

How did such a big crisis seemingly sneak up on us?

“We are very, very busy and we don’t have time or energy to get our story out,” said Ducharme. “And that’s unfortunately over the years come to hurt us.”

On Dec. 8, a new state EMS Task Force met for the first time at the State Capitol in St. Paul. The group met again Wednesday in Mountain Iron.

“Rural Minnesota is facing an EMS crisis that we need to address quickly to make sure Minnesotans have reliable service. We have small communities on the Range going bankrupt trying to provide the critical services that people need,” said Senator Grant Hauschild. “If we don’t do something soon, we are not going to have ambulance services on the Range. So I am determined to make sure that something happens for my region and for the other communities that are in dire straits.”

The 2024 legislative session might be the last opportunity state lawmakers get to address the issue before many rural services fail. Meantime, a divided Congress appears unable to perform basic functions, much less address Medicare reimbursement rates, a thorny budget issue.

On the western Mesabi, local governments explore ideas to help fund the service. One popular suggestion would create a special taxing district. Affected towns and townships would form a board to oversee local taxes that would fund ambulances.

Ducharme prefers the idea of creating a county ambulance district administered by the county board of commissioners.

“That way it’s fair and you get it split up among all the ambulance services in the county because they all have the same problems,” he said.

Regardless, leaders have precious months before inaction starts affecting people’s lives.

We live in a society of made-up controversies and arguments. It’s time to dedicate our public energy toward solving a real problem, a solvable problem, to save the emergency services we will all need someday.

Aaron J. Brown

Aaron J. Brown is an author and college instructor from northern Minnesota’s Iron Range. He writes the blog and co-hosts the podcast “Power in the Wilderness” on Northern Community Radio. This piece first appeared in the Saturday, Dec. 16, 2023 edition of the Mesabi Tribune.


  1. The notion that EMS should be a profit making business is at the root of this problem.

    Medical services in general have difficulty operating in rural areas with low populations. The need to keep services at a high level of care conflicts with the costs involved in dealing with needs scattered over miles of highway and in demand much less frequently than in larger cities.

    Clearly it is in the interest of the residents of any area that those services continue to operate effectively in spite of the costs. The obvious way to do that is to recognize that health care is and should be a public responsibility, like schools, roads, water and sewer, and so on. Public financing is the only effective way to deal with this. Taxes will increase, but these services affect everyone.

    The day will come when even the most fierce opponent of taxes will be dependent on these services. Structuring public financial arrangements for hospitals, ambulance and EMS services, and nursing homes in rural areas is the only solution to the problem. The alternative is a future where getting sick or injured means being loaded into the back seat of a private car and being driven to Duluth by friends or relatives.

    Take your choice.

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