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Rural EMS Faces Challenges in Illinois


Even if lawmakers may not always realize the consequences for rural areas if Emergency Medical Services troubles aren’t addressed, operations fold, and rural residents have to rely on help from bigger cities, State Rep. Don Moffitt appreciates how everyday people get it.

Moffitt, a Galesburg Republican, said, “One elderly gentleman from the Arthur, Ill., area pointed out problems with distance and delays if people in the country have to rely on towns – in his case on Charleston or Mattoon. He said that’d mean waiting 30 minutes or so for an ambulance, and ‘Two Amish boys in a buckboard would get there faster’.”

The lifesaving Emergency Medical Services (EMS) are as important to communities as police and fire, and when people call 911, they think someone will answer and send help. However, Illinois’ rural EMS system is straining amid ongoing demand, rising costs, falling support and a declining pool of volunteers.

Today’s rural situation is reminiscent of the 1930s, when the distance between fewer customers discouraged power companies from expanding there, leading to the establishment of electric cooperatives to meet the need. Greater distance also means higher mileage and fuel costs, longer response times, and fewer calls from lower populations. State insurer payments and reimbursements from Medicaid (cut 2.7% last summer) are delayed six months to a year; the state owes about $20 million to EMS providers, and there are 400+ in Illinois.

So, some EMS outfits – municipal or county, hospital or fire department, volunteer organizations, or for-profit and nonprofit enterprises – are hundreds of thousands of dollars behind their budgets and forced to borrow to meet costs. Also, the money crunch, staff shortages and so on can result in delayed arrivals or missed calls; old equipment or vehicles can’t be replaced or updated; and it’s increasingly difficult to get and keep qualified personnel – especially unpaid volunteers.

Moffitt, who co-chaired the Illinois House’s bipartisan Emergency Medical Services Task Force, said, “Small towns’ employment base has dwindled so populations have dropped, and the volunteers aren’t there like they used to be. The state required two [paramedics] and some places just don’t have two available.”

Now, after thousands of miles, 17 hearings and a year’s work, that task force and the Governor’s Rural Affairs Council are pushing for reforms in the General Assembly’s spring legislative session.

Besides explicitly making EMS a priority, the groups’ recommendations include relaxing requirements to recognize skills (making Registered Nurses, veterans with medical training, and so on eligible to become volunteers or staff); allowing local referenda to create ambulance tax districts; offering 0% bridge loans to local EMS; increasing Medicaid rates and making faster payments; dedicating a better, $40 million funding source from gaming revenues (in addition to the $46 million now earmarked for several agriculture programs); setting up tax credits for rural EMS volunteers; starting to gauge staff competency instead of requiring 30 hours of training a year; and setting annual meetings of EMS stakeholders to plan future lobbying efforts.

Already, the Illinois Department of Public Health (IDPH) is reforming rules to accommodate alternate staffing and meet-at-the-scene policies so one paramedic could meet a first-responder such as a police officer at emergencies.

Moffitt and Task Force co-chair Lisa Dugan, the Democratic state Representative from Kankakee, led 22 House members, including Quincy Republican Jil Tracy and Aurora Democrat Linda Chapa LaVia. The task force held public hearings throughout the state, including stops in Canton, Galesburg, Macomb and Quincy.

Elsewhere, dealing with Emergency Medical Services became one of three goals of the Governor’s Rural Affairs Council, which last year – with Lt. Gov. Sheila Simon’s Strategic Planning Working Group – did its fact-finding, including surveys and several “listening post” hearings throughout the state about rural EMS and also existing state programs that can help rural residents, and initiatives to improve services to rural areas.

Illinoisans spoke up; legislators listened; now it’s up to the General Assembly and Governor to act.

Hopefully, the legislature can move fast. Maybe they can outpace a kid in a buckboard.

Bill Knight’s newspaper columns are archived at

The opinions expressed are not necessarily those of Tri States Public Radio or Western Illinois University.