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When people in West Alabama dial 9-1-1, will anyone answer?

Caleb Aguayo

Healthcare services in some rural West Alabama Communities are on the decline. A lack of financial support appears to be causing problems for those who have to travel almost an hour to a hospital. Others are worried whether they’ll make it there if they or a family member has a life-threatening emergency. APR student reporter Caleb Aguayo* explains how this situation is impacting rural ambulance services and peoples’ access to care. This feature is made possible by a grant by the Caring Foundation.

911 calls for medical needs typically prompt ambulance services to respond. Shortfalls in funding for those trained to help can lead to longer response times and possibly a life-threatening situation that no one can predict. Pickens County resident Kristen Sanders faced that reality in November 2023.

“My family found me passed out,” Sanders said.

Sanders is like others who are living in what’s called a rural ambulance desert. This refers to areas where it could take up to an hour for trained medical experts to reach you.

“My son had to administer CPR and wait 45 minutes for an ambulance to get to me on Highway 17, south of Reform. That alone was enough. We need a hospital around here,” she said.

Caleb Aguayo

Sanders is not alone. Almost 27,000 people in Greene and Pickens counties are all facing this reality, and it’s not a new problem. The State of Alabama has eight counties without hospitals. For people in Pickens County, they had a hospital, but it closed in 2020. This delivered a major blow to the community.

Vicky McCrory said, “We’ve always been able to support ourselves until the closure of the hospital.”

McCrory is the director of Pickens County's emergency medical services (EMS). She said local ambulance crews must travel a minimum of 30 minutes to get a patient to Tuscaloosa or Columbus, Mississippi. She also said the agency can’t keep up with the cost without consistent funding.

“Without that, we’re going to have to have some kind of financial support from the county in some form, whether it be a subsidy or a millage tax to keep the doors open,” McCrory said.

But the problem isn’t limited to rural areas. EMS agencies go underfunded because of maintenance and staffing costs, travel and low insurance payouts.

In Tuscaloosa, NorthStar EMS director Edgar Calloway said the problem affects agencies in larger cities, too.

Calloway said, “We, as a company, have gone out and found second jobs to generate revenue for us to be able to provide the core of our service.”

Calloway added that the main goal is getting you to the hospital.


“You care about that community, and you provide the best care for those people that you live and work with every day,” Calloway said.

And Alabama isn’t the only state facing the problem of rural EMS shortages and looking for solutions. In one of Delaware’s three counties, Aetna Hose, Hook and Ladder serves Newark, a city of about 30,000 people.

Aetna’s public information officer Lawrence Tan said the volunteer fire and EMS services in the state are facing staff shortages, leading them to also hire paid employees to meet call volumes.

Tan said, “We probably have 48 part-time employees, as well as 20 full-time employees, and then have a couple of other opportunities to help provide staffing.”

But there’s another idea out there, as well. Aetna is also partnering with the University of Delaware. Students in the school’s EMT programs can work in the university ambulance service. They can also apply for Aetna’s live-in firefighter program or volunteer with the company for work experience. In addition, there are part-time jobs.

Tan said these partnerships can help organizations across the country to find volunteers and staff.

“If you’re an organization that’s in the immediate vicinity of a university, then it’s not a bad idea to take a look and see if, potentially, you’ve got people that may be interested or may be able to assist. It’s a staffing pool,” Tan said.

Tan said the fire company offers EMS training in return for service with the organization. Aetna receives dedicated staff, and students in health care-related fields work with the company for job exposure, get direct contact with patients and earn experience in the medical community.

“If they move to another area, they’ve got a skillset where they could participate in their local area,” Tan said.

New York state is dealing with a shortage of rural EMS workers, too. The New York Association of Counties (NYSAC) is currently working to pass a series of bills in the state legislature. Those measures would address some of the concerns with providing EMS care.

NYSAC legislative director Ryan Gregoire said, “It’s a little different in every single county, but the counties are being faced with this.” He explained the state is losing volunteers because of a lack of money. The ‘Rescue EMS’ legislative bills might just fix that.

“Everyone across the country expects to receive fire service, police service and emergency medical services if they are faced with an emergency. If you dial 9-1-1, there’s an expectation in the United States that someone will come and help you,” Gregoire said.


He also said helping the agencies that provide EMS care is critical, and he noted that the Rescue EMS bills would increase insurance reimbursements and the incentives to become an emergency medical technician (EMT).

Gregoire said, “This whole package is designed to help the financial situation of our EMS services, help the volunteers and incentivize recruitment and retention of our volunteers. And set up a path forward so that, in the future, EMS services can be reimbursed and actually paid for the services they deliver.”

One of the bill’s propositions includes making EMS an essential service in the state. Another would mean reimbursements to EMS agencies for in-home care. They would also raise the Medicaid reimbursement rate to help with the cost of transport. A full list of the bills is available on NYSAC’s website.

Gregoire added that the Rescue EMS bills have supporters because they’re considered critical across the political spectrum.

“There’s not a single partisan bill in this package. And the reason they’re all bipartisan is because both sides of the aisle look at this and realize that these are solutions that the government can take to help fix this industry,” he said.

The Rescue EMS bill package is currently in the New York State Senate and will have an outcome in early June. In the meantime, Gregoire said NYSAC is spreading the word that emergency medical care is crucial for everyone.

He said, “When I dial 9-1-1, God forbid I’m having a heart attack or whatever, I want an ambulance to arrive, and I want them to be able to help me. And everyone deserves that across this country.”

Back in Alabama, the state Office of EMS also reported in 2022 that state residents made over 2,500 ambulance calls per day. On average, that’s almost 40 emergency transport calls every day to every Alabama county.

Caleb Aguayo

Cecelia Miller is a former staffer at the Pickens County Medical Center. She said a hospital is critical for emergency services, but so is an ambulance to get patients there in time.

Miller said, “Everybody has issues, but people that have heart problems, diabetes and all that stuff – by the time you get to Tuscaloosa you could be gone. I have severe asthma, but you have to make sure you’re ready to go at all times to Tuscaloosa or Columbus.”

Greene County EMS director Chris Jones said he’s hopeful about bringing more stable funding to the ambulance service.

“We need to make money. We can’t do things for free,” Jones said.

Jones and McCrory are working daily to bring awareness to their situations and pleading with their county commissioners for new ways to support local health care. They hope their pleas are heard before it’s too late for those who make that call and no one can come.

This feature was made possible by a grant from the Caring Foundation.

Caleb Aguayo is a master’s student intern at Alabama Public Radio. He is studying Community Journalism, a news communications degree with a focus on real people in local areas. In his free time, Caleb enjoys spending time with family, gardening, and hobby carpentry.
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